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Lessons Learned From the HEALTHY Primary Prevention Trial of Risk Factors for Type 2 Diabetes in Middle School Youth

  • Pediatric Type 2 Diabetes (PS Zeitler, Section Editor)
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Abstract

The HEALTHY trial was designed to take a primary prevention approach to risk factors for type 2 diabetes in youth, primarily obesity. The study involved over 6,000 students at 42 middle schools across the U.S. Half received an integrated intervention program of components addressing the school food environment, physical education, lifestyle behaviors, and promotional messaging. The intervention was designed to be more comprehensive than previous efforts, and the research was amply funded. Although the primary objective of reducing the percentage of overweight and obesity in schools that received the intervention program, as compared with control schools, was not obtained, key secondary outcomes indicated an intervention effect. In retrospect, senior investigators involved in the study’s design, conduct, and analysis discuss weaknesses and strengths and offer recommendations for future research efforts that address prevention of childhood obesity from a public health perspective.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of outstanding importance

  1. Ogden CL, Carroll MD, Curtin LR, et al. Prevalence of high body mass index in US children and adolescents, 2007-2008. JAMA. 2010;303:242–9.

    Article  PubMed  CAS  Google Scholar 

  2. • Weiss MD, Dziura J, Burgert TS, et al. Obesity and the metabolic syndrome in children and adolescents. N Engl J Med. 2004;350:2362–74. Documentation of cardiometabolic risk associated with childhood obesity. Provides compelling support for prevention and treatment programs..

    Article  PubMed  CAS  Google Scholar 

  3. Story M. School-based approaches for preventing and treating obesity. Int J Obes. 1999;23:S43–51.

    Article  Google Scholar 

  4. American Academy of Pediatrics. Physical fitness and activity in schools. Pediatrics. 2000;105:1156.

    Article  Google Scholar 

  5. National Center for Chronic Disease Prevention and Health Promotion. Guidelines for school and community programs to promote lifelong physical activity among young people. J Sch Heal. 1997;67:202–19.

    Article  Google Scholar 

  6. •• Summerbell CD, Waters E, Edmunds LD, et al. Interventions for preventing obesity in children. Cochrane Database Syst Rev. 2005;3:1–70. A systematic review of childhood obesity prevention studies that places the current manuscript in the context of existing literature..

    Google Scholar 

  7. •• HEALTHY Study Group. A school-based intervention for diabetes risk reduction. N Engl J Med. 2010;363:443–53. The primary findings of the HEALTHY primary prevention trial..

    Article  Google Scholar 

  8. • HEALTHY Study Group. HEALTHY study rationale, design and methods: moderating risk of type 2 diabetes in multi-ethnic middle school students. Int J Obes. 2009;33:S4–S20. In-depth presentation of the design of HEALTHY for those desiring more detailed information..

    Google Scholar 

  9. Drews KL, Harrell JS, Thompson D, et al. Recruitment and retention strategies and methods in the HEALTHY study. Int J Obes. 2009;33:S21–8.

    Article  Google Scholar 

  10. Gillis B, Mobley C, Stadler DD, et al. Rationale, design and methods of the HEALTHY study nutrition intervention component. Int J Obes. 2009;33:S29–36.

    Article  Google Scholar 

  11. McMurray RG, Bassin S, Jago R, et al. Rationale, design and methods of the HEALTHY study physical education intervention component. Int J Obes. 2009;33:S37–43.

    Article  Google Scholar 

  12. Venditti EM, Elliot DL, Faith MS, et al. Rationale, design and methods of the HEALTHY study behavior intervention component. Int J Obes. 2009;33:S44–51.

    Article  Google Scholar 

  13. DeBar LL, Schneider M, Ford EG, et al. Social marketing-based communications to integrate and support the HEALTHY study intervention. Int J Obes. 2009;33:S52–9.

    Article  Google Scholar 

  14. Schneider M, Hall WJ, Hernandez AE, et al. Rationale, design and methods for process evaluation in the HEALTHY study. Int J Obes. 2009;33:S60–7.

    Article  Google Scholar 

  15. Weigensberg MJ, Ball GD, Shaibi GQ, et al. Decreased B-cell function in overweight Latino children with impaired fasting glucose. Diabetes Care. 2005;28:2519–24.

    Article  PubMed  Google Scholar 

  16. Nathan DM, Davidson MB, DeFronzo RA, et al. Impaired fasting glucose and impaired glucose tolerance. Diabetes Care. 2007;30:253–9.

    Google Scholar 

  17. Weiss R, Taksali SE, Tamborlane WV, et al. Predictors of changes in glucose tolerance status in obese youth. Diabetes Care. 2005;28:902–9.

    Article  PubMed  Google Scholar 

  18. Ford ES, Li C, Imperatore G, Cook S. Age, sex, and ethnic variations in serum insulin concentrations among US youth. Diabetes Care. 2006;29:2605–11.

    Article  PubMed  CAS  Google Scholar 

  19. Goran MI, Gower BA. Longitudinal study on pubertal insulin resistance. Diabetes. 2001;50:2444–50.

    Article  PubMed  CAS  Google Scholar 

  20. Duncan GE, Li SM, Zhou XH. Prevalence and trends of a metabolic syndrome phenotype among US adolescents, 1999-2000. Diabetes Care. 2004;27:2438–43.

    Article  PubMed  Google Scholar 

  21. Viner RM, Segal TY, Lichtarowicz K, Hindmarsh P. Prevalence of insulin resistance syndrome in obesity. Arch Dis. 2005;90:10–4.

    Article  CAS  Google Scholar 

  22. McKenzie TL, Catellier DJ, Conway T, et al. Girls' activity levels and lesson contexts in middle school PE – TAAG baseline. Med Sci Sports Exerc. 2006;38:1229–35.

    Article  PubMed  Google Scholar 

  23. Fairclough S, Stratton G. Physical activity levels in middle and high school physical education – a review. Ped Exerc Sci. 2005;17:217–36.

    Google Scholar 

  24. McKenzie TL, Stone EJ, Feldman HA, et al. Effects of the CATCH physical education intervention teacher types and lesson location. Am J Prev Med. 2001;21:101–9.

    Article  PubMed  CAS  Google Scholar 

  25. Van Beurden E, Barnett LM, Zask A, et al. Can we skill and activate children through primary school physical education lessons? "Move it, Groove it" – a collaborative health promotion intervention. Prev Med. 2003;36:493–501.

    Article  PubMed  Google Scholar 

  26. McKenzie TL, Sallis JF, Prochaska JJ, et al. Evaluation of a two-year middle school physical education intervention – MSPAN. Med Sci Sports Exerc. 2004;36:1382–8.

    Article  PubMed  Google Scholar 

  27. Gutin B, Cucuzzo N, Islam S, et al. Physical training, lifestyle education, and coronary risk factors in obese girls. Med Sci Sports Exerc. 1996;28:19–23.

    PubMed  CAS  Google Scholar 

  28. McMurray RG, Bauman MJ, Harrell JS, et al. Effects of improvement in aerobic power on resting insulin and glucose concentrations in children. Eur J Appl Physiol. 2000;81:132–9.

    Article  PubMed  CAS  Google Scholar 

  29. Hall WJ, Zeveloff A, Steckler A, et al. Process evaluation results from the HEALTHY physical education intervention. Heal Educ Res. 2011. doi:10.1093/her/cyr107.

  30. Schneider M, DeBar L, Calingo A, et al. The effect of a communications campaign on middle school students’ nutrition and physical activity: results of the HEALTHY study. Journal of Health Communications. in press.

  31. • Marcus MD, Foster GD, El Ghormli L, et al. Shifts in BMI category and associated cardiometabolic risk: prospective results from HEALTHY study. Pediatrics. 2012;129:e983. doi:10.1542/peds.2011-2696. Specific information about changes in cardiometabolic risk in the HEALTHY cohort..

    Article  PubMed  Google Scholar 

  32. Siega-Riz AM, El Ghormli L, Mobley C, et al. The effects of the HEALTHY study intervention on middle school student dietary intakes. International Journal of Behavioral Nutrition and Physical Activity 2011;8:7, http://www.ijbnpa.org/content/8/1/7.

  33. Jago R, McMurray RG, Drews KL, et al. HEALTHY intervention – fitness, physical activity and metabolic syndrome results. Med Sci Sports Exerc. 2011;43:1513–22.

    Article  PubMed  Google Scholar 

  34. Hill RJ, Davies PS. The validity of self-reported energy intake as determined using the doubly labeled water technique. Br J Nutr. 2001;85:415–30.

    Article  PubMed  CAS  Google Scholar 

  35. Moore JB, Hanes Jr JC, Barbeau P, et al. Validation of the physical activity questionnaire for older children in children of different races. Pediatr Exerc Sci. 2007;19:6–19.

    PubMed  Google Scholar 

  36. Koepp GA, Snedden BJ, Flynn L, et al. Feasibility analysis of standing desks for sixth graders. Infant, Child, Adolescent Nutr. 2012;4:89. doi:10.1177/1941406412439414.

    Article  Google Scholar 

  37. O’Neill JR, Pate RR, Hooker SP. The contribution of dance to daily physical activity among adolescent girls. Int J Behav Nutr Phys Act. 2011;8:87. doi:10.1186/1479-5868-8-87.

    Article  PubMed  Google Scholar 

  38. Mobley CC, Stadler DD, Staten MA, et al. Effect of nutrition changes on foods selected by students in a middle school-based diabetes prevention intervention program – the HEALTHY experience. J Sch Heal. 2012;82:82–90.

    Article  Google Scholar 

  39. Hartstein J, Cullen KW, Virus A, et al. Impact of the HEALTHY study on vending machine offerings in middle schools. Journal of Child Nutrition & Management 2011;35, http://www.schoolnutrition.org/Content.aspx?id=16353.

  40. USDA Food and Nutrition Service. Nutrition standards in the national school lunch and school breakfast programs final rule. Fed Regist. 2012;77(17):4087–167.

    Google Scholar 

  41. Madsen KA. School-based body mass index screening and parent notification: a statewide natural experiment. Arch Pediatr Adolesc Med. 2011;165(11):987–92.

    Article  PubMed  Google Scholar 

  42. Hedley AA, Ogden CL, Johnson CL, et al. Prevalence of overweight and obesity among US children, adolescents, and adults, 1999-2002. JAMA. 2004;291:2847–50.

    Article  PubMed  CAS  Google Scholar 

  43. Kaufman F, Hirst K, Buse J, et al. Effect of secular trends on a primary prevention trial: the HEALTHY study experience. Childhood Obesity 2011;7(4), doi: 10.1089/chi.2011.0044, http://www.liebertonline.com/doi/pdfplus/10.1089/chi.2011.0044.

  44. von Hippel PT, Powell B, Downey DB, Rowland NJ. The effect of school on overweight in childhood: gain in body mass index during the school year and during summer vacation. Am J Public Health. 2007;97(4):696–702.

    Article  Google Scholar 

  45. Borradaile KE, Sherman S, Vander Veur SS, et al. Snacking in children – the role of urban corner stores. Pediatrics. 2009;124(5):1293–8.

    Article  PubMed  Google Scholar 

  46. Levine JA, vander Weg MW, Hill JO, Klesges RC. Non-exercise activity thermogenesis – the crouching tiger hidden dragon of societal weight gain. Arterioscler Thromb Vasc Biol. 2006;26:729–36.

    Article  PubMed  CAS  Google Scholar 

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Acknowledgments

We wish to thank the administration, faculty, staff, students, and their families at the middle schools and school districts that participated in the HEALTHY study.

This work was completed with funding from NIDDK/NIH Grants U01-DK61230, U01-DK61249, U01-DK61231, and U01-DK61223, with additional support from the American Diabetes Association.

HEALTHY intervention materials are available for download at http://www.healthystudy.org/.

Disclosure

Conflicts of interest: M.D. Marcus has received a subcontract from George Washington University (part of a Cooperative agreement from NIDDK) and has been on the Scientific Advisory Board for United Health Care. K. Hirst has received grant support from NIDDK; also, travel to study meetings was covered; the NIDDK grant covered all activity, including committee work and data analysis, but not under a fee but under a cost-reimbursable grant. F. Kaufman has received grant support from NIDDK; also, travel to study meetings was covered. G.D. Foster has received grant support from NIH/NIDDK; also, travel to study meetings was covered; he has received salary support from a grant and has been on the Scientific Advisory Board for United Health Group, ConAgra Food, Tate and Lyle. T. Baranowski received grant support from NIDDK; also, travel to study meetings was covered; he also serves on the Publications and Presentations Committee for the HEALTHY trial (NIDDK).

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Authors and Affiliations

  1. University of Pittsburgh School of Medicine, 3811 O’Hara Street, Pittsburgh, PA, 15213, USA

    Marsha D. Marcus

  2. George Washington University Biostatistics Center, 6110 Executive Boulevard, Suite 750, Rockville, MD, 20852, USA

    Kathryn Hirst

  3. Children’s Hospital Los Angeles, 4650 Sunset Boulevard, MS 61, Los Angeles, CA, 90027, USA

    Francine Kaufman

  4. Temple University Center for Obesity Research and Education, 3223 North Broad Street, Philadelphia, PA, 19140, USA

    Gary D. Foster

  5. Baylor College of Medicine Children’s Nutrition Research Center, 1100 Bates Street, Houston, TX, 77030, USA

    Tom Baranowski

Authors
  1. Marsha D. Marcus
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  2. Kathryn Hirst
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  3. Francine Kaufman
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  4. Gary D. Foster
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  5. Tom Baranowski
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Corresponding author

Correspondence to Kathryn Hirst.

Additional information

ClinicalTrials.com registration: NCT00458029

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Marcus, M.D., Hirst, K., Kaufman, F. et al. Lessons Learned From the HEALTHY Primary Prevention Trial of Risk Factors for Type 2 Diabetes in Middle School Youth. Curr Diab Rep 13, 63–71 (2013). https://doi.org/10.1007/s11892-012-0333-0

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  • DOI: https://doi.org/10.1007/s11892-012-0333-0

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