Childhood obesity is a national epidemic that presents a major public health issue, and threatens to increase chronic health problems like diabetes, heart disease, and stroke. Several of the 17 YEP grantee programs address this issue with innovative approaches to physical activity and nutrition. Three YEP grantees provided novel ideas and compelling results.
The EYES Project is sponsored by the CUNY–Medgar Evers. This program targets 35 at-risk youth from the Crown Heights area of Brooklyn, NY, ages 12-17, whose racial and ethnic composition is 80% Black and 20% Hispanic. EYES students are economically disadvantaged, with all students qualified for free and reduced price meals. Thirty-seven percent live below the poverty line, with $23,496 as the median family income. Eighteen percent of the parents are unemployed, and 56.2% receive public assistance. Students participate in an after-school program, from 3:30-6PM, and complete a mandated six-week intensive summer program, with afternoons devoted almost exclusively to fitness.
The EYES wellness programming is based on both a comprehensive nutrition curriculum and an intensive regular exercise regimen. The EYES nutrition program is a two-pronged approach. The “Outside the Body” program began with a certified nutritionist providing knowledge on how the body works and what it means to be healthy. A field trip component allows EYES youth to visit food cooperatives and observe how to shop for healthy foods. In the “Inside the Body” program, the EYES nutritionist teaches students how to eat the right foods and why. The nutrition classes meet twice a week for 45 weeks in the fall and spring for a total of 90 hours.
The exercise component of EYES is a four-pronged approach, including Bootcamp Aerobics, SocaMotion (Caribbean Soca dance steps to keep fit), karate, and a Wii fitness program. The fitness classes meet 11.5 hours per week for 45 weeks in the fall and spring. In the summer, the sessions are offered from 9AM-5PM, Mondays through Fridays, eight hours per day, five days per week, for six weeks. The key to the EYES fitness program is the comprehensive nature of the exercise and nutrition sessions in terms of both intensity and duration. Group exercise sessions are provided by a certified exercise instructor from the local community who is also a motivational role model for the students.
The results showed impressive reductions in average body weight and body mass index in the cohort of 35 EYES students (Figures 3-12 and 3-13). From baseline to the end of Year 2, body weight showed a progressive decrease, with EYES students losing an average of 20 pounds, from a mean of 145 pounds to 125 pounds. BMI reflected this decrease dropping from 24.1 to 20.7, which placed EYES students in the healthy range.
Clearly, EYES is a model of intensive exercise dosage and prescription combined with an equally comprehensive nutrition program. It is a template for success to address obesity in minority youth. Exercise programming performed in a group setting lends support through group dynamics. Exercise group leadership by passionate, motivational role models is viewed as a vital factor. Group leaders continuously set goals for the youth and participated in all the exercise sessions. In essence, the EYES Project staff made fitness and nutrition the “thing to do,” and built trust with each student; all key factors to the program’s success (view the EYES Project video).
The CSULB Youth Empowered for Success Sí Se Puede (YES!) project focuses on 34 different Latino students each year from Hamilton Middle School. At Hamilton, 94% of its students qualify for free and reduced hot lunch and poverty levels are nearly twice the national average. Fifty-five percent of the 7th graders in the Hamilton zipcode are overweight or obese. As a part of the YES! after-school program, students complete 90 minutes of physical activity twice per week. During the four-week YES! summer program, students performed four hours of physical activity in the 49er Sports Camp each afternoon. A survey of assets related to health, fitness, and nutrition behaviors was administered pre- and post-program. Body weight, height, and BMI were all measured. Body fat was measured using a two-lead bio-impedance system.
Pre-program measurements were compared to those taken after the program finished. Figures 3-14 and 3-15 show pre- and post-program physiologic data for body fat and BMI. While YES! students grew nearly 2.5 inches, body weight increased proportionally less, resulting in a significant decrease in BMI percentile (p< .002). Percent fat was significantly reduced at the post-assessment (p< .002). Not surprisingly, fat mass also decreased significantly from 32.3 pounds to 27.8 pounds, while fat-free mass increased significantly from 80.3 to 88.8 pounds (p<.002). Pre-post survey results for three assets in support of physical activity were assessed, including self-efficacy, family social support, and friend social support. All three assets in support of physical activity improved significantly (p< .02).
The YES! Sí Se Puede Project has significantly impacted fitness measures and fitness-related youth assets in Hispanic middle school students. Statistically significant improvements were found in a variety of measures related to obesity outcomes, including BMI, fat mass, and fat-free mass. YES! has improved the BMI profile of its students, and re-shaped body composition to a much more healthy status by reducing fat and increasing fat-free mass (view the YES! video).
The Marquette YES program serves 50 disadvantaged Hispanic middle school students at Bruce Guadalupe Community School in urban Milwaukee, Wisconsin. Seventy-five percent of students are eligible for free or reduced hot lunch and most are bilingual. The rising rates of obesity in the Hispanic population, potentially leading to chronic diseases later in life, is a paramount issue in this Hispanic student population. Prior to the YES program, 77% of the cohort fell into either the overweight or obese category. The major fitness goal of the YES program was to increase the percentage of healthy weight YES students by more than 30% by decreasing the percentage of students in the at-risk and overweight categories, while maintaining or decreasing the percentage of YES students in the obese category. This hypothesis was based on the notion that little movement in BMI could be achieved in the obese category due to students being too firmly entrenched. Figure 3-16 shows BMI categories with statistically significant movement to more healthy weight categories, not only from the overweight category, but also from the obese category.
The percentage of obese students in the cohort decreased from 47.6% of the YES cohort (20 students) to 36% (15 students). Students in the overweight category decreased by one-half from 28.6% (12 students) to 14% (6 students) over the first two years of the YES program. Conversely, the number and percentage of students in the healthy weight and at-risk categories increased as the cohort profile shifted to more healthy BMIs. The results show a statistically significant change in weight classification (time vs group, p< .007). Finally, push-ups and curl-ups, as evidence of general fitness improvement and increased upper extremity and core strength, both improved significantly (p< .001) (Figures 3-17 and 3-18).
Marquette’s YES program assessed an innovative six-week trial lunch program in nine YES participants at the Bruce Guadalupe Community School (BGCS). Assessment of kilocalories (calories) in standard BGCS lunches revealed the average lunch content was 956 calories, with a range of 616 to 2,621 calories for an individual lunch offered. For grades 6-8, the US Department of Agriculture’s (USDA) recommended calorie range for lunch is 600-700 calories. Thus, BGCS middle school students were clearly consuming calories in excess of recommended guidelines prior to the trial program.
In the trial lunch program, a registered dietician designed a daily lunch menu using the food exchange system. Calories were tightly controlled averaging only 522 calories per lunch over the six-week trial period, reducing each lunch by an estimated average of 434 calories. The standard (pre-trial) lunch versus test-trial lunch nutritional composition and calories are shown in Figure 3-19. Multiplied over a 27-day trial lunch program, YEP students reduced calorie intake by a total of 11,718 calories, which is equivalent to a predicted weight loss of 3.3 pounds if activity levels remain unchanged. Only lunch content was controlled, while students were free to eat their usual breakfast at school and dinner at home.
The data in Figure 3-20 represent average body weight in this sub-cohort of nine students prior to the trial (Baseline), and body weights taken during the six-week intervention. Body weight was also measured five weeks after the trial lunch program ended. Body weight decreased progressively over the six-week lunch trial (p< .001). At six weeks the weight loss averaged 3.5 pounds below pre-trial weights. This amount of weight loss is extremely close to the predicted weight loss of 3.3 pounds from the analysis of reduced caloric intake. Hypothetically, multiplying the trial lunch program over an entire school year containing eight months of school lunches, a 3.5-pound weight loss in six weeks could yield more than a 15-pound weight loss over an entire year. After the lunch program ended, body weight rebounded within five weeks, adding to the conclusion that: 1) The six-week trial lunch program was effective at reducing body weight in Hispanic middle school students; and 2) Controlling school lunch calorie content over the long-term could be very effective in weight control. The trial lunch program suggests that weight can be strongly influenced by adjusting lunch programming over a relatively short time frame. This test nutrition program has resulted in discussion at the school level and in Marquette’s YES program about school lunches. (View the YES video).