A study from the Harvard T. H. Chan School of Public Health – which appears in the CDC’s journal Preventing Chronic Disease (PCD) – explored the breadth of dissemination of evidence-based obesity prevention programs throughout public schools in the United States and also researched the possibility that such programs may be unintentionally furthering weight stigma and disordered weight-control behaviors.
There is a gap in knowledge regarding the use of evidence-based obesity prevention programs in schools in the United States. Kenney et al. conducted this study to determine the frequency of their implementation. They also hypothesized that, in the absence of such programs, other programs that are being used could be inadvertently promoting weight stigma.
To execute this study, the authors targeted U.S. public school principals by gathering data from a representative sample of public kindergarten through twelfth-grade schools. From this dataset, 247 principals (or a selected colleague) completed a survey which addressed respondents’ perspectives on their school’s wellness policies and obesity prevention programs.
Based on a pre-defined list of interventions, the authors were able to determine if those reported were evidence-based or not. Of those programs that were developed onsite, the survey questioned the range of activities that were involved in each program in an effort to assess the possibility of weight stigma exacerbation or disordered weight-control behaviors. Such activities could include calorie-counting competitions or student body mass index (BMI) reporting. Respondents were also asked to report on bullying behaviors in their respective schools, obesity prevention program effectiveness, and barriers and facilitators to program success.
After conducting both quantitative and qualitative analyses, the team found that a little less than half (47%) of schools employed any kind of obesity prevention program. Of that group, about 7% of schools reported the use of a pre-developed program and only 3% reported using an evidence-based program. Another 15% of schools reported the use of interventions that are centered around individual students’ or staff members’ weights, and about 11% employed staff weight-loss competitions. Respondents noted that barriers to effective implementation included financial, training, and time. Finally, an evidence or science basis was rarely used as criteria for the selection of wellness programs.
The team concluded that it is rare to find implementation of evidence-based obesity prevention programs in U.S. schools. Additionally, some programs that are currently being used might be furthering weight stigma by centering around individuals’ actual weight rather than promoting healthy eating and physical activity. To help counter the childhood obesity epidemic, the authors recommend that public health practitioners place more effort into supporting the implementation of evidence-based obesity prevention programs in schools.
This study was conducted through the Strategic Training in the Prevention of Eating Disorders (STRIPED) program (https://www.hsph.harvard.edu/striped).
Podcast
Lead author Erica Kenney, ScD, answers questions about this study, which looked at how frequently U.S. schools used evidence-based obesity prevention programs and how often schools implement programs that may unintentionally worsen weight stigma among students. Listen Now
Kenney EL, Wintner S, Lee RM, Austin SB. Obesity Prevention Interventions in US Public Schools: Are Schools Using Programs That Promote Weight Stigma? Prev Chronic Dis, 2017;14:160605. DOI: https://doi.org/10.5888/pcd14.160605.