VANCOUVER, British Columbia — An obesity intervention program incorporated into a seventh-grade curriculum showed sustained improvements in participants, researchers report.

"The program was developed by a teacher and is meant to be embedded within the curriculum, so it uses the natural accountability of school," said study investigator Suzanne Lazorick, MD, MPH, associate professor of pediatrics and public health at East Carolina University in Greenville, North Carolina.

The MATCH program — Motivating Adolescents With Technology to Choose Health — is based on social cognitive and self-determination theories, and is designed to induce behavioral changes and teach students the life skills required to make healthy choices. It integrates exercises like calculating average calorie intake into math class, and writing essays on topics such as how to talk a friend out of starting to smoke into English class.

"The lessons in different subjects complement wellness lessons in health and science," said Dr. Lazorick. It also includes skill-building and educational activities.

"Because it's done over several months, the key concepts can be repeated and applied," she explained.

Dr. Lazorick presented the research here at the Pediatric Academic Societies and Asian Society for Pediatric Research Joint Meeting.

The MATCH program was implemented in seventh-grade classes in schools in rural North Carolina with limited resources and high rates of obesity.

In a pilot study of the MATCH program conducted at a single school, Dr. Lazorick's team demonstrated that the program improved weight status over a 4-year period (Child Obes. 2014;10:25-33).

In 2008, MATCH was expanded to 4 schools, although implementation was rushed because of a tight deadline imposed by the State Legislature. Two of those schools were included in the current analysis, and another school served as a control school.

 
This is something really exciting and really different.
 

The children were assessed with the body mass index (BMI) Z-score, which is the difference in standard deviations between a child's BMI and the average BMI for his or her age and sex group. A Z-score decrease of 0.5 is associated with a decrease in cardiometabolic risk factors (Arch Dis Child. 2010;95:256-261).

When studies use average change in weight, "you don't know if everybody did about the same, or whether some did better and some did worse," Dr. Lazorick explained. "We wanted to know how many of them decreased enough to make a difference to them individually."

In this study, the MATCH group consisted of 189 students and the control group consisted of 127 students.

The students in the MATCH group were less likely to be black than those in the control group (64% vs 73%; P = .054), and were less likely to be on the school lunch program (71% vs 96%; P < .001).

At baseline, mean BMI-Z scores were higher in the MATCH group than in the control group (1.10 vs 0.92, P = .076).

More students in the MATCH group than in the control group were lost at 4-year follow-up (45% vs 32%; P = .018). For those retained at 4 years, there was no difference in sex, age, or weight.

At follow-up, more students in the MATCH group than in the control group had transitioned from being overweight to being a healthy weight (40% vs 26%).

In addition, more students in the MATCH group than in the control group had achieved a decrease in Z-score of at least 0.5.

Table. BMI Z-Score Decrease of at Least 0.5 at Follow-up

Category MATCH Group, % Control Group, % P
Healthy weight 25 17 .349
Overweight 30 9 .058
Obese 13 8 .573
All 22 13 .063

 

Although the number of students who achieved a Z-score decrease of at least 0.5 was not significantly different between the MATCH and control groups, it did trend toward significance, and the mean slope analysis showed significance, Dr. Lazorick reported.

"The mean slope is the best of the data we have because it adjusts for the fact that there were some differences at baseline, and that we might have lost some of the less overweight kids. That kind of modeling adjusts for other factors, and it did show significance," she explained.

The program is now in 17 schools, and results continue to be encouraging. "We've designed it to fit in with the current seventh-grade curriculum, not just the North Carolina curriculum," Dr. Lazorick said. "I think it could potentially be in every school."

The results were met with enthusiasm from the audience.

"I feel much more optimistic than I did 15 minutes ago," said Sheila Gahagan, MD, MPH, professor of pediatrics at the University of California, San Diego, after the presentation.

"Going to obesity conferences is usually very depressing because we know that the rate of obesity is rising. We do all these interventions and you make little changes in weight, but this is something really exciting and really different," she told Medscape Medical News. "This is the kind of intervention that could be implemented quite easily in all kinds of different settings."

"You're going to need a champion in each school," she added. "That's probably going to be the hard part, because teachers are busy. If it's seen as just one more thing they have to do, it probably won't be as potent an intervention as it was in this study."

Dr. Lazorick and Dr. Gahagan have disclosed no relevant financial relationships.

Pediatric Academic Societies (PAS) and Asian Society for Pediatric Research (ASPR) Joint Meeting: Abstract 1155.5. Presented May 3, 2014.

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