Key Traits of Successful Pediatric Obesity Prevention Programs

The most successful pediatric obesity prevention programs take place over a stretch of time and seek to promote both access to more nutritious foods and more exercise, findings that researchers from the University of Missouri said should help shape future obesity prevention programs.

These findings are important, the researchers added, because they focus particularly on school-based programming that took place in rural areas, where chronic illnesses, including obesity, are more common.

Schools have long been important community partners in promoting pediatric public and population health. Kids spend most of their time in school and are greatly influenced by the food served there, the physical activity promoted, and the life skills imparted by their peers and teachers.

In rural areas, school-based prevention programs targeting obesity have been important, given the higher rates of childhood obesity in these regions. In 2015, data showed that US childhood obesity rates are higher in rural areas than in urban ones; in 2019, a follow-up study showed that access to more nutritious food was higher in urban and suburban areas.

But not every school-based prevention program was created equal, according to this latest study, led by Crystal Lim, a researcher and pediatric psychologist at the University of Missouri.

“There seemed to be different variations in how the programs were implemented, as some programs focused solely on the nutrition aspect and others focused solely on the exercise aspect,” Lim, also an associate professor in the MU School of Health Professions and lead author on the study, said in a statement. “Some interventions were a one-time event while others lasted the entire school year.”

Lim and colleagues looked at 72 school-based programs over a 30-year period, analyzing for characteristics that made programs successful. The study was international, and included programs that took place in the US plus Australia and England in elementary, middle, and high schools between 1990 and 2020.

The school-based programs that yielded the best results were ones that took place over a longer period of time, rather than one-time events, the researchers said. Additionally, programs that integrated both physical activity and nutritious food choices were more successful.

Lim and colleagues also emphasized the importance of consulting the evidence base; programs that used evidence-based strategies for goal-setting, problem-solving, and self-regulation were more successful.

“My biggest recommendation going forward is we should make these interventions more fun and engaging for kids so that the healthy behaviors become activities they look forward to as opposed to dread,” Lim said.

“An example can be playing ‘dodgeball’ or ‘capture the flag’ during P.E. class rather than running miles or doing pushups,” she added. “Goal setting can help lead to gradual and practical changes, such as drinking three glasses of water per day instead of two, and then tracking the results over time.”

Said otherwise, a healthy lifestyle cannot be portrayed as punitive; rather, kids need to learn that it can be fun to live healthily, Lim suggested.

Teachers are instrumental in helping these school-based programs be successful, the researchers added.

“Teachers can implement nutrition and exercise concepts into their classrooms. Rather than math problems about the speed of an airplane, for example, what about math problems regarding the speed of a marathon runner or the number of calories consumed in a day,” Lim stated. “Another strategy is taking short breaks to allow kids to stretch and be active, as it is not realistic for them to sit still for most of the school day.”

But it will also take the efforts of school administration to make pediatric obesity prevention programs thrive, Lim added.

“Whether it is reassessing what foods we offer in vending machines, in the school cafeteria or at school celebrations, we need to set up the school environment so that the healthy choice becomes the ‘easy’ choice and the ‘cool’ choice,” Lim said. “When kids see their peers and role models eating healthy, hydrating and exercising, they are more likely to engage in those behaviors themselves.”

And that’s not to mention the parents and community leaders, who must be involved in these programs so that healthy behavior change carriers over into the home, the other place kids spend most of their time.

“To make a simple activity like going for a walk more fun and engaging, consider listening to music, bringing a soccer ball or turning it into a scavenger hunt,” Lim said. “Community organizations, such as MU Extension, churches and YMCAs can be leveraged as well to continue the conversation outside the classroom.”