A multicomponent school-based intervention
has demonstrated partial success in reducing adiposity and diabetes
risk in high-risk sixth-grade students.

The US federally funded study, called “HEALTHY,” failed to
decrease the combined prevalence of overweight and obesity but did
reduce obesity rates and fasting insulin when compared with
non-intervention schools.

The study appears in the New England Journal of Medicine
to coincide with presentation of the results at the 70th annual
scientific sessions of the American Diabetes Association (ADA) in
Orlando, Florida. The study was co-funded by the National Institute
for Diabetes and Digestive and Kidney Diseases, part of the
National Institutes of Health, and the ADA.

The goal of the HEALTHY study was to determine whether healthier
food choices, an increase in physical activity, and
health-promoting activities and awareness campaigns would reduce
risk factors for Type 2 diabetes.

Because Type 2 diabetes disproportionately affects ethnic
minorities and low-income individuals, the study was conducted in
schools with a preponderance of children from these groups.

Using a cluster design, 42 schools were randomly assigned to
intervention or no intervention (control). A total of 4603 children
participated; their mean age was 11.3 years, 54.3% were Hispanic,
18% were African American, and 75% were eligible for free or
reduced-price meals.

The intervention lasted from the beginning of sixth grade to the
end of the eighth grade. It had three components: Healthier choices
in the cafeteria, snack bars, class events, and vending machines;
longer, more intense periods of physical activity; and activities
and awareness campaigns that promoted long-term healthy
behaviors.

The study’s primary outcome - the combined prevalence of
overweight and obesity - fell by 4.1% in control schools and by
4.5% in intervention schools, a non-significant difference.

The reduction in overweight and obesity in control schools was
“a welcome but unexpected finding,” remarked Gary Foster (Temple
University, Philadelphia), the study’s lead author. “Future
analyses will try to clarify the reasons for the improvement in
these schools.”

Some other outcomes did differ between intervention and control
schools. For instance, students in intervention schools who were
overweight/obese in the sixth grade were 21% less likely to be
obese at the end of the eighth grade compared with their
counterparts in control schools.

Furthermore, intervention schools had a significantly lower
percentage of students with a waist circumference at or above the
90th percentile at the end of the study (21.3% vs 22.7%).
Additionally, mean insulin levels in the eighth grade were
significantly lower in students in intervention versus control
schools (16.9 vs 17.4 U/ml).

The investigators conclude: “These changes may reduce the risk
of childhood-onset Type 2 diabetes.”

“We will only stop the diabetes epidemic if we continue to test
innovative approaches to help children make healthy lifestyle
choices,” remarked Richard Bergenstal, president of Medicine and
Science at the ADA. “The HEALTHY Study shows us an effective
approach that can be implemented to improve the outcomes of a large
number of youth at very high risk of diabetes.”

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Springer Healthcare Limited. © Springer Healthcare Ltd;
2010

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