0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Article |

School-Based Overweight Preventive Intervention Lowers Incidence of Disordered Weight-Control Behaviors in Early Adolescent Girls FREE

S. Bryn Austin, ScD; Juhee Kim, ScD; Jean Wiecha, PhD; Philip J. Troped, PhD, MS; Henry A. Feldman, PhD; Karen E. Peterson, ScD
[+] Author Affiliations

Author Affiliations: Division of Adolescent and Young Adult Medicine (Dr Austin) and Clinical Research Program (Dr Feldman), Children's Hospital Boston; Harvard Prevention Research Center (Drs Austin and Wiecha), Department of Society, Human Development, and Health (Drs Austin and Peterson), and Program in Public Health Nutrition, Department of Nutrition (Drs Kim and Peterson), Harvard School of Public Health, Boston, Massachusetts; Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign (Dr Kim); and Department of Health and Kinesiology, Purdue University, West Lafayette, Indiana (Dr Troped).


Arch Pediatr Adolesc Med. 2007;161(9):865-869. doi:10.1001/archpedi.161.9.865.
Text Size: A A A
Published online

Objective  To determine the effect of a school-based intervention to promote healthful nutrition and physical activity on disordered weight-control behaviors (self-induced vomiting or use of laxatives or diet pills to control weight) in early adolescent girls and boys.

Design  Using a group-randomized, controlled-trial design, we randomly assigned middle schools to an intervention or control condition. Multivariate logistic regression analyses were used to assess the effect of the intervention on the odds of reporting a new case of disordered weight-control behaviors at follow-up, adjusting for sex, school-level prevalence of disordered weight-control behaviors at baseline, and school clusters. Students reporting these behaviors at baseline were excluded from the analyses.

Setting  Thirteen middle schools.

Participants  At baseline, 749 girls and 702 boys in grades 6 and 7.

Intervention  The 5-2-1 Go! intervention (Planet Health obesity prevention curriculum plus School Health Index for Physical Activity and Healthy Eating: A Self-Assessment and Planning Guide, Middle/High School Version) was implemented during 2 school years, from November 2002 through May 2004.

Main Outcome Measure  Self-reported disordered weight-control behaviors in last 30 days at follow-up.

Results  At follow-up in girls, 3.6% (15 of 422) in control schools compared with 1.2% (4 of 327) in intervention schools reported engaging in disordered weight-control behaviors (P = .04). Multivariate analyses indicated that the odds of these behaviors in girls in intervention schools were reduced by two thirds compared with girls in control schools (odds ratio, 0.33; 95% confidence interval, 0.11-0.97). No intervention effect was observed in boys.

Conclusions  Results add compelling support for the effectiveness of an interdisciplinary, school-based obesity prevention intervention to prevent disordered weight-control behaviors in early adolescent girls.

Figures in this Article

Eating disorders have substantial negative consequences on the health of affected adolescents, including fluid and electrolyte imbalances, menstrual and gastrointestinal dysfunction, cardiomyopathy, and premature death.13 Disordered weight-control behaviors, including self-induced vomiting or use of laxatives or diet pills to control weight, often precursors to eating disorders, also have been positively associated with overweight in adolescents as antecedents, correlates, and sequealae.410 The rising obesity epidemic in children and adolescents11,12 and its associated health consequences1316 and economic costs to individuals and society1719 add urgency to the need to identify effective strategies for the prevention of maladaptive methods of weight control in youth. Interventions that can prevent both overweight and disordered weight-control behaviors may have the potential to be most efficient and safe.5,2022

A recent analysis of the efficacy of the Planet Health obesity preventive intervention23 in a randomized controlled trial conducted in middle school students found that the interdisciplinary curriculum had an unanticipated but beneficial effect, halving girls' risk of reporting disordered weight-control behaviors after 2 school years in intervention schools compared with control schools (odds ratio [OR], 0.41; 95% confidence interval [CI], 0.22-0.75).24 Planet Health had previously been found effective in reducing obesity prevalence in girls.23 To our knowledge, the Planet Health protective effect on the onset of disordered weight-control behaviors has been evaluated in only a single trial conducted a decade ago, and potential effects for boys are unknown. We undertook the present study to determine the effect of Planet Health implemented in a randomized effectiveness trial25 on incidence of disordered weight-control behaviors in middle school girls and boys. This study extends beyond the previous research on Planet Health by including a larger sample, more recent data, and data for boys.

From November 2002 to May 2004, the Massachusetts Department of Public Health carried out the 5-2-1 Go! study using a 2-arm, group-randomized design in 13 Massachusetts middle schools. The intervention arm was designed to promote healthful nutrition and physical activity and reduce overweight, and included 2 tools, the Planet Health curriculum23,26 and the School Health Index for Physical Activity and Healthy Eating: A Self-Assessment and Planning Guide, Middle/High School Version (SHI).27 The Planet Health curriculum includes health messages focused on physical activity, television viewing, and consumption of fruits, vegetables, and fats that are provided in the major subject area and physical education classes. The SHI is a tool developed by the Centers for Disease Control and Prevention to assist schools in assessing their physical activity and nutrition policies and programs.27 The SHI consists of multiple modules to help schools address nutrition and physical activity in various domains of the school such as nutrition services, physical education, and school policies and environment.27

All study procedures were approved by the institutional review boards of the Massachusetts Department of Public Health and Harvard School of Public Health, Boston. Schools were recruited from 289 Massachusetts middle schools taking part in the Massachusetts Department of Public Health Enhanced School Health Services Program. All schools were contacted through letters and telephone calls, and the 16 schools that indicated they wanted to participate were enrolled in 5-2-1 Go! The study used a group-randomized design in which middle schools were the unit of randomization and students were the unit of analysis.28 The 16 schools were stratified by type (parochial vs public), and public schools were further stratified by racial/ethnic composition (≥75% or <75% white). Schools within each group were then randomly assigned to the intervention, which included both Planet Health and the SHI, or the control condition. Control schools were asked to work with only module 1 of the SHI, focused on school policies and environment, and to make an action plan and prepare a report on their progress on the plan at the end of year 2 of the study. Subsequent to randomization and before the baseline assessment, 2 intervention schools and 1 control school dropped out, leaving 6 intervention and 7 control schools in the study. Additional details about 5-2-1 Go! methods have been published previously.29

All students from the 13 schools who were in the sixth and seventh grades at baseline were eligible to participate. Informed consent was obtained before assessment. A total of 1839 students completed the baseline assessment. Students completed self-report questionnaires on physical activity, sedentary behaviors, diet, and disordered weight-control behaviors at baseline in November 2002 and at follow-up in May 2004. Disordered weight-control items (self-induced vomiting or use of laxatives or diet pills to lose or control weight in the last 30 days) were adapted from the Centers for Disease Control and Prevention Youth Risk Behavioral Surveillance System survey30; we created a binary variable representing disordered weight-control behaviors if students reported engaging in at least 1 of the behaviors. A validation study with girls examining a disordered weight-control measure closely adapted from the Youth Risk Behavioral Surveillance System items used in 5-2-1 Go! found that the measure had a sensitivity of 0.93 and a specificity of 0.86.31 To characterize the social environment, we computed the prevalence of disordered weight-control behaviors in each school at baseline. We used this variable as a school-level covariate to adjust for the social environment relating to disordered weight-control behaviors of students in the school,32,33 along with a random effect for school within intervention group to capture any additional unmeasured school-level influences.

From the baseline cohort of 1839 students, 1664 completed the follow-up questionnaire and were included in the longitudinal cohort (90.5% of baseline). From the longitudinal cohort, we excluded respondents if there was missing information on sex or disordered weight-control behaviors at baseline or follow-up (n = 156), leaving 1508 students (90.6% of the longitudinal sample and 82.0% of the baseline sample) (Figure). We further excluded students who reported disordered weight-control behaviors at baseline (n = 57; 3.8% [26 of 775] of girls and 4.3% [31 of 733] of boys; 3.7% from control vs 4.2% from intervention schools with P = .71) from statistical analyses; thus, our total analytic sample was 1451 students (749 girls and 702 boys) who did not report disordered weight-control behaviors at baseline. At baseline, control and intervention schools did not differ by grade (P = .23), race/ethnicity (P = .21), or overweight (defined here as body mass index [calculated as weight in kilograms divided by height in meters squared] ≥85th percentile for age and sex; P = .93) (Table 1), indicating that randomization resulted in a satisfactory balance of student characteristics across the intervention conditions.

Place holder to copy figure label and caption
Figure.

Flowchart of schools and students through 5-2-1 Go! intervention during 2 school years.

Graphic Jump Location
Table Graphic Jump LocationTable 1. Characteristics of Middle Schools at Baseline and of Analytic Sample of Participants in 5-2-1 Go! Intervention Triala

We used multivariate logistic regression models with generalized estimating equation methods34 to estimate ORs and 95% CIs that account for the clustered sampling design. All models included intervention condition, school-level baseline prevalence of disordered weight-control behaviors, sex, and an intervention condition × sex interaction term. Additional models also controlled for grade, race/ethnicity, and overweight. All statistical analyses were performed using SAS software (version 9.1; SAS Institute Inc, Cary, NC).

At follow-up, a sizable protective effect of the intervention on disordered weight-control behaviors was observed for girls. After 2 school years, 3.6% (15 of 422) of girls in control schools compared with 1.2% (4 of 327) of girls in intervention schools reported new disordered weight-control behaviors. The multivariate odds of adopting disordered weight-control behaviors were reduced by two thirds in girls in intervention schools compared with girls in control schools (OR, 0.33; 95% CI, 0.11-0.97) (Table 2). In subsequent multivariate models that also controlled for grade, race/ethnicity, and overweight, the magnitude of the effect estimate associated with the intervention for girls remained stable, changing less than 10%, but the CI widened to include the null value of 1.0. No added covariates were statistically significant. No protective effect of the intervention was observed for boys. At follow-up, 2.7% (11 of 415) of boys in control schools compared with 2.4% (7 of 287) of boys in intervention schools reported new disordered weight-control behaviors (Table 2).

Table Graphic Jump LocationTable 2. Effect of 5-2-1 Go! Intervention on 2-Year Incidence of Disordered Weight-Control Behaviors in Middle School Childrena

The results of the 5-2-1 Go! trial provide encouraging evidence that a middle school–based intervention that has been shown to be effective in reducing obesity in early adolescent girls23 can also prevent adoption of disordered weight-control behaviors. The risk of reporting self-induced vomiting or use of laxatives or diet pills to control weight at follow-up after 2 school years was reduced by two thirds in girls in the intervention schools compared with the control schools. The present study expands on previous work to evaluate the Planet Health intervention effect24 by including a larger number of schools (13 vs 10) and girls (749 vs 480) and more recently collected data (2002-2004 vs 1995-1997). In addition, the Massachusetts Department of Public Health oversaw both the implementation protocol and conduct of 5-2-1 Go!; thus, the findings suggest more generalized effectiveness of the intervention model in school settings. The magnitude of risk reduction in the 5-2-1 Go! trial is comparable to that found for girls participating in the first evaluation of Planet Health24 (OR, 0.41; 95% CI, 0.22-0.75), a robust protective effect that has held up in 2 rigorously designed randomized controlled trials.

Findings from other studies may provide some insight into the protective effect documented in our intervention. In a small randomized controlled trial in 8- to 10-year-old girls that assessed the effect of an intervention to promote dance and reduce television viewing for overweight prevention, Robinson et al35 found that girls in the intervention arm experienced a reduction in weight and shape concerns, although 2 other nutrition and physical activity interventions in adolescent girls and boys did not find an intervention effect on body dissatisfaction and weight concerns36 or body image.37 In an eating disorders prevention randomized controlled trial conducted in 14- to 19-year-old high school and college female students with moderate body dissatisfaction, an arm of the intervention that focused on healthful nutrition and physical activity was associated with reduced body dissatisfaction and bulimic symptoms compared with the assessment-only arm, and reduced risk of obesity onset in female students who were not obese at baseline.38 It is possible that our Planet Health24 and 5-2-1 Go! findings of a protective effect on disordered weight-control behaviors in early adolescent girls may be achieved through a reduction in unhealthful weight concerns and body dissatisfaction, but further research will be needed to identify the mechanism of the observed protective effect.

The present study has several limitations. The 5-2-1 Go! trial may not have been sufficiently powered to detect differences in intervention effect on the addition of multiple covariates to regression models. The observations that grade, race/ethnicity, and overweight did not differ across intervention conditions at baseline after randomization and that the effect estimate associated with the intervention changed little (<10%) on the introduction of these covariates are reassuring and suggest that our results are not likely to be substantially confounded.39 We could not examine possible race/ethnicity differences in intervention effects, but because eating disorders affect all racial/ethnic groups,4043 further study will be critical. While the measure of disordered weight-control behaviors used in our study has high sensitivity and specificity in girls,31 it is not known whether measure performance is comparable in boys.

In 2004, the National Institutes of Health called for pioneering research collaborations between the eating disorders and obesity prevention fields.44 The present study adds novel empirical evidence in support of the viability of integrating obesity and eating disorders prevention initiatives. New research efforts will need to identify protective strategies for early adolescent boys also and to understand the mechanism of Planet Health and other strategies in school settings that integrate obesity and eating disorders prevention.

Correspondence: S. Bryn Austin, ScD, Division of Adolescent and Young Adult Medicine, Children's Hospital, 300 Longwood Ave, Boston, MA 02115 (bryn.austin@childrens.harvard.edu).

Accepted for Publication: April 5, 2007.

Author Contributions: Dr Austin had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: Austin, Wiecha, Troped, and Peterson. Acquisition of data: Wiecha, Troped, and Peterson. Analysis and interpretation of data: Austin, Kim, Wiecha, Troped, Feldman, and Peterson. Drafting of the manuscript: Austin, Kim, Troped, and Feldman. Critical revision of the manuscript for important intellectual content: Austin, Kim, Wiecha, Troped, Feldman, and Peterson. Statistical analysis: Austin, Kim, and Feldman. Obtained funding: Wiecha and Peterson. Administrative, technical, and material support: Kim, Wiecha, Feldman, and Peterson. Study supervision: Austin. Design and implementation of the 5-2-1 Go! intervention trial: Wiecha, Troped, and Peterson.

Financial Disclosure: Drs Wiecha and Peterson receive royalties as coauthors of the Planet Health curriculum.

Funding/Support: This study was supported by the Leadership Education in Adolescent Health project, Maternal and Child Health Bureau, Health Resources and Service Administration grant 6T71-MC00009-15-01 from the US Department of Health and Human Services (Dr Austin); by the Berkowitz Family Legal Sea Foods Fellowship in Public Health Nutrition at the Harvard School of Public Health (Dr Kim); and by a subcontract from the Massachusetts Department of Public Health (MDPH) under Centers for Disease Control and Prevention Cooperative Agreement U48/CCU115807 with MDPH.

Disclaimer: The authors are not employees of the MDPH, which is not responsible for the accuracy of the reported results or the views expressed by the authors.

Additional Contributions: Maria Bettencourt, MPH; Vanessa Cavallaro, MS, RD; Kathleen Grattan, MPH; Solomon Mezgebu, MSc; Wee Lock Ooi, ScD; and Julie Robarts, MPH, RD, at the MDPH participated in the design and implementation of 5-2-1 Go! and Daniel Finkelstein, PhD, contributed to the data analyses.

Goldbloom  DSKennedy  SHBrownell  K, Fairburn CG, eds.ed Medical complications of anorexia nervosa. Eating Disorders and Obesity: A Comprehensive Handbook. New York, NY Guilford Press1995;266- 270
Mitchell  JEBrownell  KD, Fairburn CG, eds.ed Medical complications of bulimia nervosa. Eating Disorders and Obesity: A Comprehensive Handbook. New York, NY Guilford Press1995;271- 275
Yager  JDevlin  MJHalmi  KA  et al.  Practice Guideline for the Treatment of Patients With Eating DisordersArlington, VA: American Psychiatric Association. http://www.psych.org/psych_pract/treatg/pg/prac_guide.cfmAccessed November 20, 2006
Field  AECamargo  CA  JrTaylor  CB  et al.  Overweight, weight concerns, and bulimic behaviors among girls and boys. J Am Acad Child Adolesc Psychiatry 1999;38 (6) 754- 760
PubMed Link to Article
Haines  JNeumark-Sztainer  D Prevention of obesity and eating disorders: a consideration of shared risk factors [published online ahead of print September 8, 2006]. Health Educ Res 2006;21 (6) 770- 782
PubMed Link to Article
Marcus  MDKalarchian  MA Binge eating in children and adolescents. Int J Eat Disord 2003;34(suppl)S47- S57
PubMed Link to Article
Neumark-Sztainer  DHannan  PJ Weight-related behaviors among adolescent girls and boys: results from a national survey. Arch Pediatr Adolesc Med 2000;154 (6) 569- 577
PubMed Link to Article
Shisslak  CMCrago  MThompson  JK, Smolak L, eds.ed Risk and protective factors in the development of eating disorders. Body Image, Eating Disorders, and Obesity in Youth: Assessment, Prevention, and Treatment. Washington, DC American Psychological Association2001;103- 125
Stice  EPresnell  KSpangler  D Risk factors for binge eating onset in adolescent girls: a 2-year prospective investigation. Health Psychol 2002;21 (2) 131- 138
PubMed Link to Article
Yanovski  SZ Binge eating disorder and obesity in 2003: could treating an eating disorder have a positive effect on the obesity epidemic? Int J Eat Disord 2003;34(suppl)S117- S120
PubMed Link to Article
Ogden  CLFlegal  KMCarroll  MDJohnson  CL Prevalence and trends in overweight among US children and adolescents, 1999-2000. JAMA 2002;288 (14) 1728- 1732
PubMed Link to Article
Troiano  RPFlegal  KMKuczmarski  RJCampbell  SMJohnson  CL Overweight prevalence and trends for children and adolescents: the National Health and Nutrition Examination Surveys, 1963 to 1991. Arch Pediatr Adolesc Med 1995;149 (10) 1085- 1091
PubMed Link to Article
Morrison  JABarton  BABiro  FMDaniels  SRSprecher  DL Overweight, fat patterning, and cardiovascular disease risk factors in black and white boys. J Pediatr 1999;135 (4) 451- 457
PubMed Link to Article
Must  ASpadano  JCoakley  EHField  AEColditz  GDietz  WH The disease burden associated with overweight and obesity. JAMA 1999;282 (16) 1523- 1529
PubMed Link to Article
Must  AStrauss  RS Risks and consequences of childhood and adolescent obesity. Int J Obes Relat Metab Disord 1999 Mar;23Suppl 2S2- 11
PubMed Link to Article
Sinha  RFisch  GTeague  B  et al.  Prevalence of impaired glucose tolerance among children and adolescents with marked obesity. N Engl J Med 2002;346 (11) 802- 810[published correction appears in N Engl J Med 2002;346 (22) 1756
PubMed Link to Article
Thompson  DEdelsberg  JColditz  GABird  APOster  G Lifetime health and economic consequences of obesity. Arch Intern Med 1999;159 (18) 2177- 2183
PubMed Link to Article
Thompson  DEdelsberg  JKinsey  KLOster  G Estimated economic costs of obesity to U.S. business. Am J Health Promot 1998;13 (2) 120- 127
PubMed Link to Article
Wolf  AMColditz  G Current estimates of the economic cost of obesity in the United States. Obes Res 1998;6 (2) 97- 106
PubMed Link to Article
Austin  SB Prevention research in eating disorders: theory and new directions. Psychol Med 2000;30 (6) 1249- 1262
PubMed Link to Article
Irving  LMNeumark-Sztainer  D Integrating the prevention of eating disorders and obesity: feasible or futile? Prev Med 2002;34 (3) 299- 309
PubMed Link to Article
Neumark-Sztainer  D Can we simultaneously work toward the prevention of obesity and eating disorders in children and adolescents? Int J Eat Disord 2005;38 (3) 220- 227
PubMed Link to Article
Gortmaker  SLPeterson  KEWiecha  J  et al.  Reducing obesity via a school-based interdisciplinary intervention among youth: Planet Health. Arch Pediatr Adolesc Med 1999;153 (4) 409- 418
PubMed Link to Article
Austin  SBField  AEWiecha  JPeterson  KEGortmaker  SL The impact of a school-based obesity prevention trial on disordered weight control behaviors in early adolescent girls. Arch Pediatr Adolesc Med 2005;159 (3) 225- 230
PubMed Link to Article
Flay  BR Efficacy and effectiveness trials (and other phases of research) in the development of health promotion programs. Prev Med 1986;15 (5) 451- 474
PubMed Link to Article
Carter  JWiecha  JPeterson  KGortmaker  SL Planet Health: An Interdisciplinary Curriculum for Teaching Middle School Nutrition and Physical Activity.  Champaign, IL Human Kinetics Publishers Inc2001;
Centers for Disease Control and Prevention, School Health Index. http://www.cdc.gov/healthyyouth/shi/Accessed August 7, 2006
Donner  AKlar  N Design and Analysis of Cluster Randomization Trials in Health Research.  London, UK Edward Arnold Publications Ltd2000;
Wiecha  JLFinkelstein  DTroped  PJFragala  MPeterson  KE School vending machine and fast-food restaurant use are associated with sugar-sweetened beverage intake in youth J Am Diet Assoc 2006;106 (10) 1624- 1630
PubMed Link to Article
Brener  NDCollins  JLKann  LWarren  CWWilliams  BI Reliability of the Youth Risk Behavior Survey questionnaire. Am J Epidemiol 1995;141 (6) 575- 580
PubMed
Field  AETaylor  CBCelio  AColditz  GA Comparison of self-report to interview assessment of bulimic behaviors among preadolescent and adolescent girls and boys. Int J Eat Disord 2004;35 (1) 86- 92
PubMed Link to Article
Eisenberg  MENeumark-Sztainer  DStory  MPerry  C The role of social norms and friends' influences on unhealthy weight-control behaviors among adolescent girls. Soc Sci Med 2005;60 (6) 1165- 1173
PubMed Link to Article
Austin  SB Population-based prevention of eating disorders: an application of the Rose prevention model. Prev Med 2001;32 (3) 268- 283
PubMed Link to Article
Liang  K-YZeger  SL Longitudinal data analysis using generalized linear models. Biometrika 1986;73 (1) 13- 22
Link to Article
Robinson  TNKillen  JDKraemer  HC  et al.  Dance and reducing television viewing to prevent weight gain in African-American girls: the Stanford GEMS pilot study. Ethn Dis 2003;13(1, suppl 1)S65- S67
PubMed
Gehrman  CAHovell  MFSallis  JFKeating  K The effects of a physical activity and nutrition intervention on body dissatisfaction, drive for thinness, and weight concerns in preadolescents. Body Image 2006;3 (4) 345- 351
Link to Article
Huang  JSNorman  GJZabinski  MFCalfas  KPatrick  K Body image and self-esteem among adolescents undergoing an intervention targeting dietary and physical activity behaviors [published online ahead of print January 5, 2007]. J Adolesc Health 2007;40 (3) 245- 251
PubMed Link to Article
Stice  EShaw  HBurton  EWade  E Dissonance and healthy weight eating disorder prevention programs: a randomized efficacy trial. J Consult Clin Psychol 2006;74 (2) 263- 275
PubMed Link to Article
Rothman  KJGreenland  S Modern Epidemiology. 2nd ed. Philadelphia, PA Lippincott Williams & Wilkins1998;
Robinson  TNKillen  JDLitt  I  et al.  Ethnicity and body dissatisfaction: are Hispanic and Asian girls at increased risk for eating disorders? J Adolesc Health 1996;19 (6) 384- 393
PubMed Link to Article
Striegel-Moore  RHDohm  FKraemer  HC  et al.  Eating disorders in white and black women. Am J Psychiatry 2003;160 (7) 1326- 1331
PubMed Link to Article
Striegel-Moore  RHSchreiber  GLo  ACrawford  PObarzanek  ERodin  J Eating disorder symptoms in a cohort of 11- to 16-year-old black and white girls: the NHLBI Growth and Health Study. Int J Eat Disord 2000;27 (1) 49- 66
PubMed Link to Article
Centers for Disease Control and Prevention, Youth Risk Behavioral Surveillance System; Youth Online Comprehensive Results. http://apps.nccd.cdc.gov/yrbss/index.aspAccessed November 19, 2006
National Institutes of Health Obesity Research Task Force, Strategic plan for NIH obesity research. http://obesityresearch.nih.gov/About/strategic-plan.htmAccessed November 21, 2006

Figures

Place holder to copy figure label and caption
Figure.

Flowchart of schools and students through 5-2-1 Go! intervention during 2 school years.

Graphic Jump Location

Tables

Table Graphic Jump LocationTable 1. Characteristics of Middle Schools at Baseline and of Analytic Sample of Participants in 5-2-1 Go! Intervention Triala
Table Graphic Jump LocationTable 2. Effect of 5-2-1 Go! Intervention on 2-Year Incidence of Disordered Weight-Control Behaviors in Middle School Childrena

References

Goldbloom  DSKennedy  SHBrownell  K, Fairburn CG, eds.ed Medical complications of anorexia nervosa. Eating Disorders and Obesity: A Comprehensive Handbook. New York, NY Guilford Press1995;266- 270
Mitchell  JEBrownell  KD, Fairburn CG, eds.ed Medical complications of bulimia nervosa. Eating Disorders and Obesity: A Comprehensive Handbook. New York, NY Guilford Press1995;271- 275
Yager  JDevlin  MJHalmi  KA  et al.  Practice Guideline for the Treatment of Patients With Eating DisordersArlington, VA: American Psychiatric Association. http://www.psych.org/psych_pract/treatg/pg/prac_guide.cfmAccessed November 20, 2006
Field  AECamargo  CA  JrTaylor  CB  et al.  Overweight, weight concerns, and bulimic behaviors among girls and boys. J Am Acad Child Adolesc Psychiatry 1999;38 (6) 754- 760
PubMed Link to Article
Haines  JNeumark-Sztainer  D Prevention of obesity and eating disorders: a consideration of shared risk factors [published online ahead of print September 8, 2006]. Health Educ Res 2006;21 (6) 770- 782
PubMed Link to Article
Marcus  MDKalarchian  MA Binge eating in children and adolescents. Int J Eat Disord 2003;34(suppl)S47- S57
PubMed Link to Article
Neumark-Sztainer  DHannan  PJ Weight-related behaviors among adolescent girls and boys: results from a national survey. Arch Pediatr Adolesc Med 2000;154 (6) 569- 577
PubMed Link to Article
Shisslak  CMCrago  MThompson  JK, Smolak L, eds.ed Risk and protective factors in the development of eating disorders. Body Image, Eating Disorders, and Obesity in Youth: Assessment, Prevention, and Treatment. Washington, DC American Psychological Association2001;103- 125
Stice  EPresnell  KSpangler  D Risk factors for binge eating onset in adolescent girls: a 2-year prospective investigation. Health Psychol 2002;21 (2) 131- 138
PubMed Link to Article
Yanovski  SZ Binge eating disorder and obesity in 2003: could treating an eating disorder have a positive effect on the obesity epidemic? Int J Eat Disord 2003;34(suppl)S117- S120
PubMed Link to Article
Ogden  CLFlegal  KMCarroll  MDJohnson  CL Prevalence and trends in overweight among US children and adolescents, 1999-2000. JAMA 2002;288 (14) 1728- 1732
PubMed Link to Article
Troiano  RPFlegal  KMKuczmarski  RJCampbell  SMJohnson  CL Overweight prevalence and trends for children and adolescents: the National Health and Nutrition Examination Surveys, 1963 to 1991. Arch Pediatr Adolesc Med 1995;149 (10) 1085- 1091
PubMed Link to Article
Morrison  JABarton  BABiro  FMDaniels  SRSprecher  DL Overweight, fat patterning, and cardiovascular disease risk factors in black and white boys. J Pediatr 1999;135 (4) 451- 457
PubMed Link to Article
Must  ASpadano  JCoakley  EHField  AEColditz  GDietz  WH The disease burden associated with overweight and obesity. JAMA 1999;282 (16) 1523- 1529
PubMed Link to Article
Must  AStrauss  RS Risks and consequences of childhood and adolescent obesity. Int J Obes Relat Metab Disord 1999 Mar;23Suppl 2S2- 11
PubMed Link to Article
Sinha  RFisch  GTeague  B  et al.  Prevalence of impaired glucose tolerance among children and adolescents with marked obesity. N Engl J Med 2002;346 (11) 802- 810[published correction appears in N Engl J Med 2002;346 (22) 1756
PubMed Link to Article
Thompson  DEdelsberg  JColditz  GABird  APOster  G Lifetime health and economic consequences of obesity. Arch Intern Med 1999;159 (18) 2177- 2183
PubMed Link to Article
Thompson  DEdelsberg  JKinsey  KLOster  G Estimated economic costs of obesity to U.S. business. Am J Health Promot 1998;13 (2) 120- 127
PubMed Link to Article
Wolf  AMColditz  G Current estimates of the economic cost of obesity in the United States. Obes Res 1998;6 (2) 97- 106
PubMed Link to Article
Austin  SB Prevention research in eating disorders: theory and new directions. Psychol Med 2000;30 (6) 1249- 1262
PubMed Link to Article
Irving  LMNeumark-Sztainer  D Integrating the prevention of eating disorders and obesity: feasible or futile? Prev Med 2002;34 (3) 299- 309
PubMed Link to Article
Neumark-Sztainer  D Can we simultaneously work toward the prevention of obesity and eating disorders in children and adolescents? Int J Eat Disord 2005;38 (3) 220- 227
PubMed Link to Article
Gortmaker  SLPeterson  KEWiecha  J  et al.  Reducing obesity via a school-based interdisciplinary intervention among youth: Planet Health. Arch Pediatr Adolesc Med 1999;153 (4) 409- 418
PubMed Link to Article
Austin  SBField  AEWiecha  JPeterson  KEGortmaker  SL The impact of a school-based obesity prevention trial on disordered weight control behaviors in early adolescent girls. Arch Pediatr Adolesc Med 2005;159 (3) 225- 230
PubMed Link to Article
Flay  BR Efficacy and effectiveness trials (and other phases of research) in the development of health promotion programs. Prev Med 1986;15 (5) 451- 474
PubMed Link to Article
Carter  JWiecha  JPeterson  KGortmaker  SL Planet Health: An Interdisciplinary Curriculum for Teaching Middle School Nutrition and Physical Activity.  Champaign, IL Human Kinetics Publishers Inc2001;
Centers for Disease Control and Prevention, School Health Index. http://www.cdc.gov/healthyyouth/shi/Accessed August 7, 2006
Donner  AKlar  N Design and Analysis of Cluster Randomization Trials in Health Research.  London, UK Edward Arnold Publications Ltd2000;
Wiecha  JLFinkelstein  DTroped  PJFragala  MPeterson  KE School vending machine and fast-food restaurant use are associated with sugar-sweetened beverage intake in youth J Am Diet Assoc 2006;106 (10) 1624- 1630
PubMed Link to Article
Brener  NDCollins  JLKann  LWarren  CWWilliams  BI Reliability of the Youth Risk Behavior Survey questionnaire. Am J Epidemiol 1995;141 (6) 575- 580
PubMed
Field  AETaylor  CBCelio  AColditz  GA Comparison of self-report to interview assessment of bulimic behaviors among preadolescent and adolescent girls and boys. Int J Eat Disord 2004;35 (1) 86- 92
PubMed Link to Article
Eisenberg  MENeumark-Sztainer  DStory  MPerry  C The role of social norms and friends' influences on unhealthy weight-control behaviors among adolescent girls. Soc Sci Med 2005;60 (6) 1165- 1173
PubMed Link to Article
Austin  SB Population-based prevention of eating disorders: an application of the Rose prevention model. Prev Med 2001;32 (3) 268- 283
PubMed Link to Article
Liang  K-YZeger  SL Longitudinal data analysis using generalized linear models. Biometrika 1986;73 (1) 13- 22
Link to Article
Robinson  TNKillen  JDKraemer  HC  et al.  Dance and reducing television viewing to prevent weight gain in African-American girls: the Stanford GEMS pilot study. Ethn Dis 2003;13(1, suppl 1)S65- S67
PubMed
Gehrman  CAHovell  MFSallis  JFKeating  K The effects of a physical activity and nutrition intervention on body dissatisfaction, drive for thinness, and weight concerns in preadolescents. Body Image 2006;3 (4) 345- 351
Link to Article
Huang  JSNorman  GJZabinski  MFCalfas  KPatrick  K Body image and self-esteem among adolescents undergoing an intervention targeting dietary and physical activity behaviors [published online ahead of print January 5, 2007]. J Adolesc Health 2007;40 (3) 245- 251
PubMed Link to Article
Stice  EShaw  HBurton  EWade  E Dissonance and healthy weight eating disorder prevention programs: a randomized efficacy trial. J Consult Clin Psychol 2006;74 (2) 263- 275
PubMed Link to Article
Rothman  KJGreenland  S Modern Epidemiology. 2nd ed. Philadelphia, PA Lippincott Williams & Wilkins1998;
Robinson  TNKillen  JDLitt  I  et al.  Ethnicity and body dissatisfaction: are Hispanic and Asian girls at increased risk for eating disorders? J Adolesc Health 1996;19 (6) 384- 393
PubMed Link to Article
Striegel-Moore  RHDohm  FKraemer  HC  et al.  Eating disorders in white and black women. Am J Psychiatry 2003;160 (7) 1326- 1331
PubMed Link to Article
Striegel-Moore  RHSchreiber  GLo  ACrawford  PObarzanek  ERodin  J Eating disorder symptoms in a cohort of 11- to 16-year-old black and white girls: the NHLBI Growth and Health Study. Int J Eat Disord 2000;27 (1) 49- 66
PubMed Link to Article
Centers for Disease Control and Prevention, Youth Risk Behavioral Surveillance System; Youth Online Comprehensive Results. http://apps.nccd.cdc.gov/yrbss/index.aspAccessed November 19, 2006
National Institutes of Health Obesity Research Task Force, Strategic plan for NIH obesity research. http://obesityresearch.nih.gov/About/strategic-plan.htmAccessed November 21, 2006

Correspondence

CME
Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
Submit a Comment

Multimedia

Some tools below are only available to our subscribers or users with an online account.

Web of Science® Times Cited: 29

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Collections