Smart Bodies Research Component

Process Evaluation

In order to evaluate the design and instrumentation of the Smart Bodies (SB) program, researchers from the Louisiana State University School of Human Ecology and Department of Kinesiology conducted a six month pilot study in four elementary schools in East Baton Rouge Parish in the Spring of 2005. Only 4th and 5th grade students (with parental consent) in each of the four pilot schools were include in the pilot investigation.

Students’ heights and weights were measured to determine the number of children who were overweight or at-risk of becoming overweight (based on BMI-for-age percentiles). Surveys were administered to assess students’ nutrition and physical activity knowledge and attitudes. Physical activity duration and intensity were measured using accelerometers.

To be truly effective, we wanted to ensure that the program also addressed the needs and motivations of those who actually implement the program - the teachers. Through the use of focus group discussions (FGD), we were able to determine if the SB program satisfies the professional and educational needs of teachers. Professional and educational needs covered a broad scope of concerns, including: perception of nutrition education and physical activity, perception of training, curricula content, implementation procedures, and delivery methods. Four FGD were conducted among 38 teachers who participated in the program for a minimum of 12 weeks. Questions used in the FGD were based on the PRECEDE/PROCEED theoretical model. Use of the theoretical model enabled researchers to classify information from the FGD into predisposing, reinforcing, and enabling factors.

Outcome Evaluation

The effectiveness of the SB program to promote child wellness and prevent childhood obesity was evaluated through a 2-year formal research project. The study was approved by the LSU and LSU AgCenter Institutional Review Boards.

The primary goals of the research project were as follows:

(1) Increase consumption of fruits and vegetables served at school,

(2) Increase nutrition and physical activity knowledge and willingness to participate in physical activity,

(3) Increase parent awareness of their child’s weight status, and

(4) Decrease the number of students in the overweight or obese categories.

The two-year formal investigation was conducted among fourteen elementary schools in East Baton Rouge Parish. Schools were stratified based upon school size (enrollment), the number of students receiving free and reduced price lunch, and state school performance scores. After schools were stratified, they were pair-matched and randomly assigned to a treatment (intervention) or control group.

The school performance scores of the 14 schools included in the study were as follows: one received a rating of “2 stars”, eight received a rating of “1 star” and five received a rating of “academically unacceptable.” Only 4th and 5th grade students with parental consent were included in the research.

Data Collection: Students completed surveys before and after the 12-week program. A subsample of students wore activity monitors on their wrists for seven days before and after the program to assess physical activity objectively.

Heights and weights were also measured, and Body Mass Index-for-age percentile health reports were generated and given to the school principals and mailed home to parents of students in the intervention group. A random sample of parents from both groups was asked to complete a brief questionnaire. Analysis of the formal research data suggests that:

Objective 1: Fruits and Vegetables

Students participating in SB (intervention) significantly increased their knowledge about the health benefits of eating fruits and vegetables (p < .05).

Students participating in SB significantly increased their self-efficacy scores for the following questions (p<.05) related to healthy eating habits:

Intervention students reported that they felt confident that they could:
- drink a glass of their favorite juice for breakfast,
- eat their favorite fruit instead of their usual dessert with lunch,
- eat their favorite fruit instead of their favorite cookie or candy bar,
- eat two or more servings of fruit or fruit juice each day, and
- eat five or more servings of fruits and vegetables each day.

Objective 2: Physical Activity

Analysis of the variables related to physical activity suggests that the SB intervention did have a positive effect on children’s knowledge about physical activity. Using a pre-post test design, as compared to the control group, children who participated in the SB program increased their knowledge about the benefits of physical activity (p < .05).

During this project, we were able to assess activity levels on a small subsample of children by using accelerometers to assess their physical activity levels over the course of one week. The analysis of the pre-post test data revealed a trend suggesting that the children who experienced the SB intervention had higher overall physical activity levels than those who did not [F(1, 56)= 2.97, p = .09]. Additionally, there was clear evidence that children had higher activity counts during Take 10! than at lunch, during physical education lessons, and during after school hours, supporting the premise that incorporating Take 10! during the school day is a viable means to increase children’s overall levels of physical activity.

Objective 3: Parent and School Awareness of Child’s BMI Status

Body Mass Index health reports were effective in increasing both school and parent awareness of children’s weight status.

Parents of 40 children who had been randomly selected from each of two weight categories (Healthy Weight & At Risk/Overweight) were mailed a BMI report and compared to parents who did not. After receiving the report, parents were 4.5 times more likely to accurately identify their child’s weight category. Parents of at risk or overweight children had increased concern while those of healthy weight children expressed less concern compared to parents without access to the report.

Objective 4: Children’s Weight Status

One-year follow-up measurements of heights and weights were conducted in April of 2007 to assess whether the prevalence of overweight among the cohort had declined.

Baseline data showed that 36.9% and 39.5% of children were overweight or obese in the control and intervention groups, respectively.

One-year follow-up measurements showed that the percentage of students considered overweight or obese remained the same among the intervention group students, whereas a slight increase was observed in the control group students.

This finding is remarkable considering that the SB program was not designed to be a weight-loss intervention. Rather,the program appeared to equip the students with the knowledge and intention necessary for them to adopt positive lifestyle behaviors.

Publications:

Tuuri G, Zanovec M, Silverman L, Geaghan J, Solmon M, Holston D, Guarino A, Roy H, Murphy E. "Smart Bodies" school wellness program increased children's knowledge of healthy nutrition practices and self-efficacy to consume fruit and vegetables. Appetite. 2009;52:445-451. doi: 10.1016/j.appet.2008.12.007

Lakkakula AP, Zanovec M, Silverman L, Murphy E, Tuuri G. Black Children with High Preferences for Fruits and Vegetables Are at Less Risk of Being at Risk of Overweight or Overweight. J Am Diet Assoc. 2008;108:1912-1915. doi: 10.1016/j.jada.2008.08.019

Lakkakula AP, Zanovec M, Murphy EP, Tuuri G. High opinions of fruits and vegetables (F&V) are associated with lower risk of overweight in African American children. FASEB J. 2008;22:680.687.

Silverman L, Holston DM, Tuuri G, Solmon M, Keenan M, Zanovec M, Murphy E. Evaluating the Impact of the Smart Bodies School-Based Intervention Program to Increase Fruit and Vegetable Consumption in Elementary School Students. J Am Diet Assoc. 2007;107:A89. doi: 10.1016/j.jada.2007.05.232

Moore DS, Solmon M, Tuuri G, Silverman L, Zanovec M, Guarino A, Roy H, Murphy EP. A Comparison of Children's Physical Activity Levels During School and Out-of-School Activities. Med Sci Sports Exerc. 2007;39:S490. doi: 10.1249/01.mss.0000274949.30346.1e

Lakkakula A, Tuuri G, Zanovec M, Guarino A, Solmon M. Evaluating the effectiveness of a BMI health report: Are parents aware of their child's weight status? LAHPERD J. 2007;70:15-20.

Holston D, Zanovec M, Murphy E. Smart Bodies: An Educational Campaign to Make Louisiana Children More Active, Healthier. Louisiana Agriculture. 2007;50:10.

Lakkakula A, Tuuri G, Zanovec M, Monroe P, Guarino A, Solmon M, Murphy E, Roy H. Evaluation of the effectiveness of a Body Mass Index-for-age percentile health report in raising parent awareness of their child's weight status. Obesity. 2006;14:A250.