Feasibility Study of a School-based Health Center Intervention to Decrease Metabolic Syndrome

Risks in Overweight/Obese Teens

Alberta Kong, MD, MPH

Andrew Sussman, PhD, MCRP

Carolina Yahne, PhD

Betty Skipper, PhD

Nina Wallerstein, DrPH

1st Annual UNM National Health Disparities Conference May 24, 2011

Background

Up to 44% of obese teens have metabolic syndrome.

Greater prevalence of metabolic syndrome among Mexican-American adolescents

Adolescents visit their medical care providers infrequently, especially for preventive care

School-based health centers (SBHCs), offer a logical alternative to reach adolescents given that they spend a significant portion of their day at school

Adolescents Committed to Improvement of

Nutrition and Physical Activity

Phase 1: Use an adaptive community-based participatory research approach to create a school-based health center intervention for overweight/obese teens

Phase 2: Feasibility testing of the school-based health center intervention against standard care for weight loss

R21 HL092533 NIH/NHLBI

Hypothesis

Adolescents receiving the intervention condition will demonstrate a greater decrease in mean BMI percentile when compared to adolescents receiving standard care. Secondary outcomes: mean insulin resistance (by

HOMA IR), HDL-C, triglycerides, and systolic blood pressure

Phase 2: Feasibility Trial

Recruit students with BMI ≥85%-ile and their parents from intervention school

Intervention: 8 motivational interviewing sessions with clinical provider at the school’s clinic

Standard care: 1 visit with clinical provider at the school’s clinic & self-help materials

Intervention Arm Control Arm

Recruit students with BMI ≥85%-ile and their parents from

control school

Screening/Enrollment NumbersIntervention Control

Screened 49 52

-Diabetes 0 0

-BMI<85%ile 15 18

-BMI≥40 2 * 0

-Stage 2 HTN 0 1

-Medications that interfere with weight

0 0

-Non-ambulatory 2 * 0

-12th graders 0 4

Enrolled 31 29

* 1 student at the intervention school was not ambulatory and had a BMI ≥ 40

Participant CharacteristicsVariable Intervention

(N=31)Control(N=29)

p-value

Gender* Female Male

61% 39%

62% 38%

1.00

Ethnicity* Hispanic Non-Hispanic

84% 16%

66% 34%

0.14

Age years mean (SE)** 15.0 (0.2) 14.6 (0.1) 0.12

BMI %-ile mean (SE)** 94.6 (0.8) 94.2 (0.8) 0.58

HOMA IR mean (SE)** 3.8 (0.7) 2.8 (0.3) 0.54

*Fisher’s exact test used for discrete variables.**Wilcoxon rank sum test used for continuous variables.

Participation Rate

Intervention(N=31)

Control(N=29)

Moved (out of state): 2 1

Dropped out: 1

2

Pregnant: 0 1

Transferred to another school:

0 2

Completers: 28 = 90% 23 = 79%

Significant Difference in BMI Percentile

93

93.2

93.4

93.6

93.8

94

94.2

94.4

94.6

94.8

95

Pre Post

BM

I Pe

rce

nti

le

InterventionControl

p = 0.04 (N = 28)

(N = 23)

Significant Difference in Waist Circumference

89

89.5

90

90.5

91

91.5

92

Pre Post

cm Intervention

Control

p = 0.04(N = 28)

(N = 23)

No Significant Difference in Insulin Resistance

0

0.5

1

1.5

2

2.5

3

3.5

4

4.5

Pre Post

HO

MA

-IR Intervention

Control

p = 1.00

(N = 28)

(N = 23)

No Significant Difference inSystolic Blood Pressure

0

5

10

15

20

25

30

35

40

45

Pre Post

Pe

rce

nti

le

InterventionControl

p = 0.66

(N = 28)

(N = 23)

No Significant Difference inTriglycerides

100

105

110

115

120

125

130

135

Pre Post

mg

/dL

InterventionControl

p = 0.62

(N = 28)

(N = 23)

No Significant Difference in HDL

30

32

34

36

38

40

42

44

46

48

50

Pre Post

mg

/dL

InterventionControl

p = 0.62 (N = 28)

(N = 23)

Satisfaction of Intervention

Topic 28 Students(0-5 Likert scale)

25 Parents (0-5 Likert scale)

Usefulness of DVD

3.1 (26 students) 4.0 (6 parents)

Usefulness of toolkit handouts

4.0 (27 students) 3.7 (23 parents)

Provider 4.4 (28 students) Did not ask

Overall 4.4 (28 students) 4.3 (25 parents)

Satisfaction of Intervention

Parent: “I am very satisfied with the ACTION Project. It was more than I expected when I signed up ___ & ___. Their doctor was impressed with the changes they made and the things they learned. Overall, they were much healthier through out the school year and rarely got sick. The 'gifts' they received were great incentives and I appreciated the feedback 'pink slips' I received after their visits.”

Satisfaction of Intervention Parent: “I just want to say thanks for this

ACTION project, because this has motivated my son to be more aware of his health and it has motivated him to work out more, and this is good, I hope you will continue with this project, thanks a lot.”

Student: “I just want to thank the woman I met for each visit. She was a great listener and really nice.”

Student: “I really enjoyed it and thought it was cool.”

Conclusions

A school-base health center intervention program consisting of 8 motivational interviewing sessions with overweight/ obese high school students and their parents was feasible.

Students receiving the intervention had significantly greater pre-post improvement in BMI percentile as compared to the standard care group.

Acknowledgements

Funded by NIH/NHLBI, R21HL092533 Bionutrition and research nursing services

from the UNM CTSC grant # DHHS/NIH/NCRR UL1RR031977

PI (AK) time was funded in part by NIH/NCRR KL2 Scholar Award, KL22RR031976

2 urban participating high schools, parents, and students

UNM SBHC program, Department of Family and Community Medicine