A program pairing healthy young adults with urban middle school students helped the adolescents adopt healthy habits, active lifestyles and a healthy weight, according to a new study from the University of Maryland School of Medicine. The study, published August 2 in the journal Pediatrics, found that linking African American, inner city adolescents in Baltimore with one-on-one mentorship from college students prevented the schoolchildren from becoming overweight for at least two years after the mentorship experience. Researchers found the adolescents ate fewer snacks and desserts, and engaged in active play more often. The rate of overweight/obesity in the group declined five percent.
The home- and community-based intervention — a program called Challenge! — shows promise as a way to have a major impact on children's lives, according to the study's lead author, Maureen M. Black, Ph.D., John A. Scholl, M.D., and Mary Louise Scholl, M.D., Professor of Pediatrics at the University of Maryland School of Medicine. The rate of childhood obesity in America has tripled in the past three decades, particularly among low income, urban children. Parents alone are often unable to prevent excessive weight gain among their children. More than three-quarters of the caregivers of children in the Challenge! study were overweight or obese themselves.
"Obesity puts children at risk for health problems now, during their adolescence, and certainly as they get older," says Dr. Black. "It places nearly every system in a child's body at risk — the cardiovascular system, the musculoskeletal system, the endocrine system, and can also compromise a child's mental health. Ultimately, obesity affects longevity. Childhood obesity is a defining public health issue of our time."
Various existing obesity outreach programs target children in large groups, such as at school or at church, but Dr. Black and her colleagues noted that home-based interventions are lacking. With the help of an advisory board made up of urban youths in Baltimore, the researchers developed the Challenge! program as a way to bring "personal trainers" directly to children's homes to demonstrate for them how to live in a healthy way.
"We tried to normalize being healthy and taking care of yourself," says Dr. Black. The program even included a rap developed by a West Baltimore performer specifically for Challenge! "We wanted to make it normal and cool to be healthy and fit," Dr. Black adds.
The study enrolled 235 primarily African American children ages 11 through 16, all from low income, urban West Baltimore communities surrounding the University of Maryland School of Medicine. About 38 percent of the children were already overweight. Half of the kids were randomly assigned to the mentorship program Dr. Black and her colleagues designed, with a control group assigned to no intervention. For mentors, researchers recruited healthy African American students or recent African American graduates from Baltimore area colleges to visit one-on-one with the children for 12 sessions.
"These were very active sessions," says Dr. Black. "The mentors were not just talking to them. In every session they had food, and they often made the food together in the child's home. The mentors took the children to the corner store or to a nearby fast-food restaurant to learn about healthy choices. They visited the skating rink or went hiking in a state park to learn the importance of being physically active."
One of the challenges in working with adolescents, Dr. Black explains, is that they are just beginning to become independent and to have their own money to spend. Their parents provide many meals, so the adolescents' food choices are limited. The mentors focused on snacks and making healthy choices when the adolescents are on their own. For example, the kids learned how make healthy food choices at corner stores and fast food restaurants, and how important it is to choose to drink water over sugary sodas. The program also provided information and recipes for the parents, but the focus was on helping the kids to make better choices for themselves.
"No family that wants their adolescent to be fat, but it's very difficult to change behavior patterns," Dr. Black says. "That's what we were trying to do: to change eating and activity patterns for these adolescents."
The results were significant: after two years, the rate of overweight/obesity among children enrolled in the mentorship program declined five percent, while it rose 11 percent among children in the control group. The children chose better foods, were more physically active and ate fewer snacks and desserts than the control group. Adolescence is a time when many children gain excessive weight, but judging by their Body Mass Indexes, the kids in the mentorship program did not. Maybe just as importantly, says Dr. Black, the adolescents had fun.
"The kids loved it," says Dr. Black. "The college students we chose were just wonderful. They really cared about those kids and about the community. The adolescents and their families loved them. They program was so enthusiastically embraced that we initiated a graduation ceremony to celebrate their accomplishments — no one wanted the program to end."
The study was funded by the Maternal and Child Health Bureau of the U.S. Department of Health and Human Services and the National Institute for Child Health and Human Development.
Spurred on by the Challenge! program's success, Dr. Black and her team have begun a new study focusing on middle school girls. They worked with four Baltimore City middle schools during the 2009-2010 school year, and will work with eight middle schools during the upcoming 2010-2011 school year. This time, the study targets children on two levels. The individual level outreach is similar to the original Challenge! program, enrolling girls in small groups with a mentor. The school level promotes a school-wide social environment that emphasizes healthy options. That school level approach encourages schools to promote opportunities for healthy living, to get rid of candy-sale fundraisers, to hold health fairs for students and to hold taste tests that compare choices such as baked potato chips over fried. All of the schools involved in that study will receive the individual level intervention, with small-group mentors for their students. Half of the schools also will receive the school level approach.
Dr. Black says similar programs exist here and there, but it is only recently that researchers have scientifically developed and evaluated comprehensive outreach programs to target childhood obesity. School-based interventions such as the one she is currently studying are rare, she adds.
"Dr. Black's fight against childhood obesity is a perfect example of our mission to improve the lives of people in our community and beyond," says E. Albert Reece, M.D., Ph.D., M.B.A., vice president for medical affairs at the University of Maryland and the John Z. and Akiko K. Bowers Distinguished Professor and dean of the School of Medicine. "All of our top-tier researchers are striving to develop innovative strategies to better human health. One of the most important questions today in medicine and, indeed, in society is how to keep our future generations healthy and fit. I'm confident Dr. Black's work will lead to improvements in better health and quality of life for our children."
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