School-Based Obesity Prevention Programs' Impact on Increased Longevity in African American Children

Purpose: Excess weight in children has been linked to earlier and higher death rates in adulthood. Because of increasing obesity rates in children, unhealthy eating habits, and a lack of physical activity, this may be the first generation that has a shorter life expectancy than their parents. Life expectancy has improved for many Americans, however African Americans (AA) consistently have a lower life expectancy rate when compared to Whites. According to the CDC, health disparities between AA and other racial and ethnic populations are prominent and apparent in life expectancy, death rates, infant mortality, and other measures of health risk behaviors. Obesity in children and adolescents is a worldwide epidemic that is anticipated to worsen over time and those affected most by obesity-related illnesses are ethnic minority children. The effectiveness of school-based obesity prevention programs differ across racial/ethnic groups. The purpose of this systematic review is to understand the school-based research literature regarding evidence-based obesity prevention programs (or interventions) and their effectiveness with AA children compared to the general population of children.

Method: Ten databases were included in the systematic search. The search was limited to scholarly peer-reviewed journal articles published up to September 2013. Twelve studies meeting a priori inclusion criteria (high quality studies) were extracted from 230 reports.  An additional five studies that were not randomized control trials (low quality studies) were included to provide an exhaustive review. Studies were assessed using Population, Intervention, Comparison, and Outcome (PICO) criteria and Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) were applied to all studies. Outcome attainment was determined by: 1) whether or not there was a statistically significant finding in the desired direction for program effectiveness, and 2) whether a study showed high, moderate, low, or very low methodological rigor.

Results: Findings for this study revealed that of the four interventions (nutrition modification focused, exercise focused, health education focused, and hybrid focused) the ones that were most effective were those that incorporated physical activity for at least 35 minutes daily for 10 months (29.4%). Health education integrated into classroom curriculum across multiple subjects was also effective (23.5%). However, there was not an effect found in the hybrid (35.3%) and nutrition modification-only interventions (11.8%). The hybrid intervention did not integrate into classroom curriculum as deeply as the education only interventions.  Also, the physical activity components of the hybrid programs were not as rigorous nor as long in duration as the exercise-only programs.

Implications/Conclusions: Increased longevity can be obtained through effective school-based obesity prevention programs. However for programs to be effective for AA children, they must be created based on a culturally appropriate theoretical paradigm(s) within a strong hybrid (vigorous physical activity and health education integrated across multiple classroom subjects) intervention. Selected theoretical paradigms will be discussed within this treatment context. The social work profession holds a unique position to address obesity from the individual, family, group, organization, community, and policy perspectives. Social workers and the profession should seek to become more actively engaged in coalitions, research, and scholarship on obesity.