Impact of the HEROS (Healthy Eating to Reduce Obesity through Schools) Study on healthy food choices and obesity among middle school students in Guilford County (North Carolina) schools.

摘要

The prevalence of overweight among adolescents in the U.S. has increased rapidly over the past two decades. This problem is closely related to poor dietary behaviors. Two preliminary, school-based studies were conducted in Guilford County Schools, which demonstrated that: (1) cafeteria environments do not foster healthy eating, and (2) a milk promotion program is a feasible intervention. These studies provided the rationale for the HEROS (Healthy Eating to Reduce Obesity through Schools) Study. The central hypotheses were that by increasing the availability of fruits, vegetables, and dairy products (FVD) and the awareness of the health benefits of choosing FVD: (1) intake would increase; and (2) the prevalence of obesity would decrease among middle school students.; Participants were 489 seventh grade students from six schools (e.g., paired for socioeconomic status and ethnicity). The schools were randomly assigned to control or intervention groups. Intervention components were implemented over 23 weeks. Intervention components included: (1) nutrition education through curriculum, school dinners, and mailing information to families and (2) changes to cafeteria environments to increase the availability and awareness of FVD. Outcome measures were taken pre- and post-intervention and included: (1) estimated FVD intake at school lunch using the O'Connell School Food Diary; (2) estimated overall daily FVD intake using the Youth and Adolescent Food Frequency Questionnaire; and (3) overweight and obesity prevalence using body mass index and triceps skinfold thickness. Analysis of variance and Chi-square analyses were used to test for significant differences between groups at baseline. Change scores were calculated for pre- and post-intervention measures. A general linear model was used to test for intervention effects on these outcome variables. Significance was identified at p ≤ 0.05.; The intervention group significantly increased their vegetable intake at school lunch by 1/5 of a serving (0.19 +/- 0.14, p 0.04), whereas the control group decreased their intake by 1/7 of a serving (-0.14 +/- 0.07). African Americans in the intervention group significantly increased their daily vegetable intake by 1/3 of a serving (0.33 +/- 0.25, p 0.001), compared to their control counterparts who decreased their intake by 1/3 of a serving (-0.34 +/- 0.22). No significant improvements were found for fruit or dairy product consumption or the prevalence of overweight or obesity. It was concluded that the HEROS intervention increased vegetable consumption both at school and throughout the entire day, indicating a promising school-based approach for improving the eating habits of adolescents, especially African Americans.