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Planet Health

Steven L. Gortmaker, PhD; Karen Peterson, RD, ScD; Jean Wiecha, PhD; Arthur M. Sobol, AM; Sujata Dixit, PhD; Mary Kay Fox, MEd, RD; Nan Laird, PhD

Arch Pediatr Adolesc Med. 1999;153:409-418.

Objective  To evaluate the impact of a school-based health behavior intervention known as Planet Health on obesity among boys and girls in grades 6 to 8.

Design  Randomized, controlled field trial with 5 intervention and 5 control schools. Outcomes were assessed using preintervention (fall 1995) and follow-up measures (spring 1997), including prevalence, incidence, and remission of obesity.

Participants  A group of 1295 ethnically diverse grade 6 and 7 students from public schools in 4 Massachusetts communities.

Intervention  Students participated in a school-based interdisciplinary intervention over 2 school years. Planet Health sessions were included within existing curricula using classroom teachers in 4 major subjects and physical education. Sessions focused on decreasing television viewing, decreasing consumption of high-fat foods, increasing fruit and vegetable intake, and increasing moderate and vigorous physical activity.

Main Outcome Measures  Obesity was defined as a composite indicator based on both a body mass index and a triceps skinfold value greater than or equal to age- and sex-specific 85th percentiles. Because schools were randomized, rather than students, the generalized estimating equation method was used to adjust for individual-level covariates under cluster randomization.

Results  The prevalence of obesity among girls in intervention schools was reduced compared with controls, controlling for baseline obesity (odds ratio, 0.47; 95% confidence interval, 0.24-0.93; P = .03), with no differences found among boys. There was greater remission of obesity among intervention girls vs control girls (odds ratio, 2.16; 95% confidence interval, 1.07-4.35; P = .04). The intervention reduced television hours among both girls and boys, and increased fruit and vegetable consumption and resulted in a smaller increment in total energy intake among girls. Reductions in television viewing predicted obesity change and mediated the intervention effect. Among girls, each hour of reduction in television viewing predicted reduced obesity prevalence (odds ratio, 0.85; 95% confidence interval, 0.75-0.97; P = .02).

Conclusion  Planet Health decreased obesity among female students, indicating a promising school-based approach to reducing obesity among youth.

From the Departments of Health and Social Behavior (Drs Gortmaker, Wiecha, and Dixit and Mr Sobol), Maternal and Child Health (Dr Peterson), Nutrition (Dr Peterson), and Biostatistics (Dr Laird), Harvard School of Public Health, Boston, Mass; the Department of Human Nutrition and Dietetics, University of Illinois at Chicago (Dr Dixit); and Abt Associates, Cambridge, Mass (Ms Fox).

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