Evaluation of Interventions in the Clinical and School Settings to Address Child Obesity: A Step Forward in Translation Open Access

Cheung, Patricia Chungmen (2017)

Permanent URL: https://etd.library.emory.edu/concern/etds/gx41mj58q?locale=en


Importance: Cardiometabolic risk factors in childhood cause atherosclerosis and early mortality. Interventions to prevent and treat cardiometabolic risk factors in childhood have been developed in numerous venues including clinical and school settings. Wide-scale intervention implementation has, however, been limited in part because of narrow consideration to setting-level processes

Objective: This dissertation sought to evaluate the implementation of interventions in the clinical and elementary school settings designed to address poor body composition and fitness.

Methods: Study 1 used a pre-post study design to examine the impact of a continuing medical education program on weight-related counseling practices among 102 Georgia pediatricians. Study 2 assessed the impact of a state-wide, voluntary, school-based intervention on opportunities for physical activity offered by elementary schools by comparing intervention and non-intervention schools. Study 3 explored the 2012-2013 the cross-sectional relationship between physical activity opportunities and health-related fitness aggregated at the school level across 1,176 Georgia elementary schools.


Study 1: Participation in the MOC program resulted in an increased and sustained documentation frequency of each of the recommended counseling components six months after completion of the intervention across all practice and pediatrician characteristics.

Study 2: Compared to non-intervention schools, intervention schools reported providing 36 more minutes of physical activity each week, even after controlling for baseline physical activity opportunities, school demographics, and other school characteristics.

Study 3: The amount of time that schools reported providing for physical activity (e.g. physical education, recess, etc.) was not associated with student fitness or body composition aggregated at the school-level, although before-school physical activity was weakly related to student fitness, and recess time was moderately associated with body composition.

Conclusions: Setting-level outcomes, including pediatrician counseling in the clinic and physical activity opportunities provided by the elementary school, increased as a result of two interventions delivered in respective venues. The impact of these outcomes on child-level health is likely moderate. However, small changes among a sizeable population or over an extended period of time may be impactful, and future work should investigate the long-term impacts of these interventions across diverse populations, alone or in combination with others, on child health outcomes.

Table of Contents

I. Chapter 1: Introduction to Cardiorespiratory Endurance, Body Composition, and Obesogenic Behaviors. 1

a. Introduction. 1

b. Importance of Health-Related Fitness. 1

c. Health Behaviors Influencing Childhood Cardiorespiratory Endurance and Body Composition 3

d. The Case for Setting-level Outcomes: Translational Research. 4

e. Interventional Settings. 6

II. Chapter 2: Study Rationales, Objectives and Hypotheses. 8

a. Intervening on Weight-Related Counseling in the Clinical Setting. 9

1. Measuring the impact of behavioral therapy in the clinical setting: Physician counseling 13

2. Study 1: Impact of a Maintenance of Certification program on weight-related counseling 14

b. Intervening on Physical Activity Opportunities in the School Setting. 16

1. Measuring the impact of physical activity interventions in the school setting: Physical activity opportunities. 21

2. Study 2: Impact of Power Up for 30 on school physical activity opportunities. 24

3. Measuring the impact of physical activity interventions in the school setting: Cardiorespiratory endurance and body composition. 26

1. Cardiorespiratory endurance. 27

2. Body Composition. 29

4. Study 3: Association between school physical activity opportunities and health-related fitness. 32

III. Chapter 3: Impact of an American Board of Pediatrics Maintenance of Certification on Weight-related Counseling at Well-Child Check-Ups. 35

a. Abstract 36

b. Background. 37

c. Methods. 38

1. Study design and population. 40

2. Data Collection. 41

3. Study measures. 41

4. Statistical analysis. 42

d. Results. 43

e. Discussion. 49

1. Strengths. 51

2. Limitations. 51

f. Conclusion. 52

IV. Chapter 4: Impact of a Georgia Elementary School-Based Intervention on Physical Activity Opportunities: A Quasi-Experimental Study. 58

a. Abstract 59

b. Background. 60

c. Methods. 61

1. Intervention. 62

2. Study population. 62

3. Data collection. 65

4. Study measures. 65

5. Analysis. 67

d. Results. 68

e. Discussion. 74

f. Conclusion. 78

V. Chapter 5: Statewide Study of Elementary School Physical Activity Opportunities, Student Body Composition, and Student Aerobic Capacity. 83

a. Abstract 84

b. Introduction. 85

c. Methods. 86

1. Data collection. 86

2. Study measures. 88

3. Analysis. 90

d. Results. 92

4. Aerobic capacity. 94

5. Body composition. 97

e. Discussion. 97

6. Strengths. 102

7. Limitations. 102

f. Conclusion. 103

VI. Chapter 6: Implications. 122

a. Key Findings. 123

b. Limitations. 125

c. Future Directions. 126

VII. References. 128

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