The HEALTHY Study Dr. Stanley Bassin, Ed.D. Institute for Clinical and Translational Science...

The HEALTHY StudyThe HEALTHY Study

Dr. Stanley Bassin, Ed.D.Dr. Stanley Bassin, Ed.D.Institute for Clinical and Translational Institute for Clinical and Translational

Science Science University of California, Irvine University of California, Irvine

School of MedicineSchool of MedicineCo-InvestigatorCo-Investigator

Funded by Funded by National Institute of Diabetes and Digestive and National Institute of Diabetes and Digestive and

Kidney DiseasesKidney DiseasesNational Institutes of HealthNational Institutes of Health

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National Multi Site School Based National Multi Site School Based Studies peer reviewed findings:Studies peer reviewed findings:

•Not Successful in Making Not Successful in Making Changes in Biological Changes in Biological Markers within School Day.Markers within School Day.

•Changes only seen in Fitness, Changes only seen in Fitness, if there were any changes at if there were any changes at all.all.

•Most studies focus on Most studies focus on Elementary Age Children.Elementary Age Children.

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Obesity EpidemicObesity Epidemic

Prevalence of adult obesity has Prevalence of adult obesity has doubled in the last 30 years.doubled in the last 30 years.

Relative increase has been Relative increase has been greater among young people greater among young people under 18 under 18

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Type 2 DiabetesType 2 DiabetesType 2 DiabetesType 2 Diabetes

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Diabetes ManagementPRE

Obesity Insulin resistance

Genetic susceptibilityFamily history Environmental factors Beginning in utero

Obesity in California Obesity in California ChildrenChildren

32% are overweight or obese32% are overweight or obese Pacific Islanders(42%), Latinos(40%), Pacific Islanders(42%), Latinos(40%),

American Indians(37%)American Indians(37%)

75% of overweight children 75% of overweight children will become overweight or will become overweight or obese adultsobese adults

CAN A COORDINATED CAN A COORDINATED SCHOOL HEALTH SCHOOL HEALTH INTERVENTION PROGRAM,INTERVENTION PROGRAM,

REDUCE RISK FACTORSREDUCE RISK FACTORS FOR TYPE 2 DIABETES?FOR TYPE 2 DIABETES?

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42 middle schools42 middle schools 6 @ 7 field centers6 @ 7 field centers 21 randomized to intervention 21 randomized to intervention 21 to control (data collection only)21 to control (data collection only)

Eligible schools Eligible schools ≥ ≥ 50% minority and/or50% minority and/or

≥ ≥ 50% eligible for free/reduced lunch50% eligible for free/reduced lunch Eligible 6Eligible 6thth graders took PE, had graders took PE, had

no diabetes, provided no diabetes, provided consent/assentconsent/assent

NutritionNutrition

BehaviorBehavior

Physical EducationPhysical Education

Communication/Social-Communication/Social-MarketingMarketing

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Implementation of goals and strategiesImplementation of goals and strategies Food service staff training each semesterFood service staff training each semester School wide taste testsSchool wide taste tests Learning activitiesLearning activities Cafeteria improvements and messagingCafeteria improvements and messaging Research dietitian on center staff for Research dietitian on center staff for mentoringmentoring

Brief classroom-based lessons and activitiesBrief classroom-based lessons and activities Teacher training each semesterTeacher training each semester 1 aide per school1 aide per school Family outreach newslettersFamily outreach newsletters School break family plans and materialsSchool break family plans and materials Health promotion coordinator on center Health promotion coordinator on center staffstaff

Lesson plans for MVPALesson plans for MVPA Equipment ($1000 per school for the 3 year Equipment ($1000 per school for the 3 year study)study) 1 teacher aide per school1 teacher aide per school PE teacher training each semester PE teacher training each semester Physical activity coordinator on center staff Physical activity coordinator on center staff for weekly teacher mentoring.for weekly teacher mentoring.

School-wide messaging – posters, School-wide messaging – posters, announcements, bannersannouncements, banners Events and activitiesEvents and activities Student peer assistantsStudent peer assistants Student development of media campaignsStudent development of media campaigns

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BaselineBaseline End of End of StudyStudy ChangeChange P-valueP-value

BMI ≥ 85th PercentileBMI ≥ 85th Percentile .72.72

ControlControl 100%100% 84.1%84.1% -15.9%-15.9%

InterventionIntervention 100%100% 83.5%83.5% -16.5%-16.5%

BMI BMI ≥ 95th Percentile≥ 95th Percentile .04.04

ControlControl 61.7%61.7% 53.2%53.2% -8.5%-8.5%

InterventionIntervention 59.8%59.8% 48.3%48.3% -11.5%-11.5%

BMI z-scoreBMI z-score .06.06

ControlControl 1.801.80 1.661.66 -0.14-0.14

InterventionIntervention 1.801.80 1.621.62 -0.17-0.17

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BaselineEnd of Study

Change P-Value

Fasting Insulin ≥ 30 µU/ml .31

Control 13.7% 20.5% 6.8%

Intervention 12.2% 18.2% 6.0%

Fasting Insulin (μU/dL) .04

Control 18.5 22.6 4.1

Intervention 17.9 21.5 3.6

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Blood Pressure Categories in Males by Blood Pressure Categories in Males by Race/EthnicityRace/Ethnicity

Number of laps completed for the 20-Meter Number of laps completed for the 20-Meter Shuttle Test used as a proxy for fitnessShuttle Test used as a proxy for fitness

Fitness in schools equivalent at end of Fitness in schools equivalent at end of studystudy 21 laps in 621 laps in 6thth grade and 27 laps in 8 grade and 27 laps in 8thth

gradegrade Consistent with other reports, boys had Consistent with other reports, boys had

higher levels of fitness than girls higher levels of fitness than girls 35 and 21 laps, respectively, in 835 and 21 laps, respectively, in 8thth grade grade

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Overall, fitness levels were low at both Overall, fitness levels were low at both baseline and end of studybaseline and end of study Almost 2/3 of students were classified as Almost 2/3 of students were classified as

below average in 8below average in 8thth grade grade Supports national trendSupports national trend

LimitationsLimitations The 20-MST may lack precisionThe 20-MST may lack precision The physical education intervention may The physical education intervention may

not have been sufficientnot have been sufficient

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Data were collected at baseline Data were collected at baseline and annually for Intervention and and annually for Intervention and Control schoolsControl schoolsAdministrative data, including number Administrative data, including number

of students, mandated school days, of students, mandated school days, new programs, and changes in new programs, and changes in management and administrationmanagement and administration

Factors related to the physical Factors related to the physical education environmenteducation environment

Factors related to the nutrition and Factors related to the nutrition and food service environmentfood service environment

Intervention (N=21)Intervention (N=21) Control (N=21)Control (N=21)

66thth 77thth 88thth 66thth 77thth 88thth

Mean PE class Mean PE class length (minutes)length (minutes) 5454 5454 5555 5757 6060 5555

Mean PE classes Mean PE classes per 2 weeksper 2 weeks 7.77.7 7.57.5 7.77.7 6.76.7 6.96.9 7.17.1

Mean % MVPAMean % MVPA 39.639.6 43.243.2 41.541.5 38.438.4 37.937.9 35.435.4

Number of schools with the following:Number of schools with the following:

l PE classes > 27 PE classes > 27 weeks of yearweeks of year 1818 2020 2020 1515 1717 1616

l Classes have ≤ 30 Classes have ≤ 30 students per teacherstudents per teacher 88 77 88 55 88 77

l Increased PA in Increased PA in response to govern-response to govern-ment mandatement mandate

55 44 33 66 33 33

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Despite an intensive intervention Despite an intensive intervention implemented with high levels of fidelity, implemented with high levels of fidelity, there were few differences between there were few differences between Intervention and Control schools with Intervention and Control schools with respect to:respect to: Food service administrationFood service administration New academic programsNew academic programs Changes in administration at the Changes in administration at the

district or school leveldistrict or school level Physical education Physical education

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With regard to the food environment:With regard to the food environment: Equal numbers of Intervention and Control Equal numbers of Intervention and Control

schools eliminated vending machinesschools eliminated vending machines The quality of foods improved substantially The quality of foods improved substantially

in Intervention schoolsin Intervention schools More Intervention schools reduced full fat More Intervention schools reduced full fat

and sugar-added beveragesand sugar-added beverages

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Changes in local, state, and federal Changes in local, state, and federal policies and mandates influenced all policies and mandates influenced all schools during study.schools during study.

Participation in the HEALTHY study Participation in the HEALTHY study may have influenced the may have influenced the environment and awareness in environment and awareness in Control schools.Control schools.

Reports of health screening values Reports of health screening values sent to parents at baseline may have sent to parents at baseline may have raised awareness and influenced raised awareness and influenced behavior.behavior.

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Recent data from the National Health Recent data from the National Health and Nutrition Examination Survey and Nutrition Examination Survey (NHANES) suggest that rapid increases (NHANES) suggest that rapid increases in pediatric obesity may be slowing in pediatric obesity may be slowing down.down.

HEALTHY data suggest decreases in HEALTHY data suggest decreases in combined rates of overweight and combined rates of overweight and obesity in high risk US middle school obesity in high risk US middle school students.students.

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A multi-component, (School A multi-component, (School Coordinated Health) school-based Coordinated Health) school-based program appears to favorably affect program appears to favorably affect various indicators of adiposity, blood various indicators of adiposity, blood pressure, and insulin among low pressure, and insulin among low income, ethnically diverse youth.income, ethnically diverse youth.

The secular trends in overweight and The secular trends in overweight and obesity are encouraging and need to obesity are encouraging and need to be replicated in other longitudinal be replicated in other longitudinal cohorts.cohorts.

These results have implications for These results have implications for school-based policies.school-based policies.