Heewon Lee

Adolescents Demonstrate Improvement in Obesity Risk Behaviors after Completion of Choice, Control & Change, a Curriculum Addressing Personal Agency and Autonomous Motivation

BACKGROUND The rapid increase of obesity and diabetes risk beginning in youth, particularly those from disadvantaged communities, calls for prevention efforts. OBJECTIVE To examine the impact of a curriculum intervention, Choice, Control & Change, on the adoption of the energy balance-related behaviors of decreasing sweetened drinks, packaged snacks, fast food, and leisure screen time, and increasing water, fruits and vegetables, and physical activity, and on potential psychosocial mediators of the behaviors. DESIGN Ten middle schools were randomly assigned within matched pairs to either intervention or comparison/delayed control conditions during the 2006-2007 school year. SUBJECTS/SETTING Students were from low-income New York City neighborhoods; 562 were in the intervention condition, and 574 in the comparison condition. INTERVENTION Students received the 24 Choice, Control & Change lessons that used science inquiry investigations to enhance motivation for action, and social cognitive and self-determination theories to increase personal agency and autonomous motivation to take action. MAIN OUTCOME MEASURES Self-report instruments to measure energy balance-related behaviors targeted by the curriculum and potential psychosocial mediators of the behaviors. STATISTICAL ANALYSES Analysis of covariance with group (intervention/control) as a fixed factor and pretest as covariate. RESULTS Students in intervention schools compared to the delayed intervention controls reported consumption of considerably fewer sweetened drinks and packaged snacks, smaller sizes of fast food, increased intentional walking for exercise, and decreased leisure screen time, but showed no increases in their intakes of water, fruits, and vegetables. They showed substantial increases in positive outcome expectations about the behaviors, self-efficacy, goal intentions, competence, and autonomy. CONCLUSIONS The Choice, Control & Change curriculum was effective in improving many of the specifically targeted behaviors related to reducing obesity risk, indicating that combining inquiry-based science education and behavioral theory is a promising approach.

Children who are pressured to eat at home consume fewer high-fat foods in laboratory test meals.

Parents use greater pressure to eat with children who weigh less, but the impact of this practice is unclear. The purpose of this cross-sectional study was to determine the association between parental reports of eating pressure and childrens actual intake across four identical ad libitum meals. Sixty-eight ethnically diverse, 4- to 6-year-old children from New York, NY, participated in this study from 2005 to 2007. Eating pressure was measured by the Child Feeding Questionnaire. Height and weight were measured and converted to body mass index z scores. Meals consisted of macaroni and cheese, string beans, carrots, grapes, graham crackers, cheese sticks, milk, pudding, and a sugar-sweetened beverage. Multiple regressions were performed to determine the extent to which pressure to eat predicted food intake after adjusting for BMI z score and child weight concern. Pressure to eat was negatively associated with child BMI z score (r=-0.37; P<0.01), energy intake (β=-.30; P<0.05), and energy density (β=-.28; P<0.05). In addition, pressure was negatively associated with intake of macaroni and cheese (β=-.26; P<0.05), whole milk (β=-.27; P<0.05), and pudding (β=-.33; P<0.01), but positively associated with vegetable intake (β=.43; P<0.01). However, both vegetable and milk consumption were low, so results should be interpreted with caution. These findings suggest that greater pressure to eat is associated with lower intake of some high-fat foods in the laboratory, where no pressure is applied.