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Eat Well and Keep Moving

Steven L. Gortmaker, PhD; Lilian W. Y. Cheung, ScD, RD; Karen E. Peterson, RD, ScD; Ginny Chomitz, PhD; Jay Hammond Cradle, MS; Hank Dart, MS; Mary Kay Fox, MEd, RD; Reba B. Bullock, MEd; Arthur M. Sobol, MS; Graham Colditz, MD, DrPH; Alison E. Field, ScD; Nan Laird, PhD

Arch Pediatr Adolesc Med. 1999;153:975-983.

Objective  To evaluate the impact of a school-based interdisciplinary health behavior intervention on diet and physical activity among children in grades 4 and 5.

Design  A quasiexperimental field trial with 6 intervention and 8 matched control schools. Outcomes were assessed longitudinally using preintervention (fall 1995) and follow-up (spring 1997) student survey food frequency and activity measures and follow-up 24-hour recall measures of diet and activity. Change was also assessed using yearly repeated cross-sectional surveys of all grade 5 students from 1995 through 1997.

Participants  Longitudinal data were collected from 479 students initially in grade 4 in Baltimore, Md, public schools; 91% were African American. Repeated 24-hour recall measures in 1997 were collected for a random subsample of 336 students. Cross-sectional survey data were collected from all grade 5 students in 1995, 1996, and 1997 (n=2103).

Intervention  The Eat Well and Keep Moving Program was taught by classroom teachers over 2 years in math, science, language arts, and social studies classes. Materials provided links to school food services and families and provided training and wellness programs for teachers and other staff members. Intervention materials focused on decreasing consumption of foods high in total and saturated fat and increasing fruit and vegetable intake, as well as reducing television viewing and increasing physical activity.

Main Outcome Measures  Dietary intake and physical activity measured via repeated 24-hour recall were primary end points, with additional food frequency and activity measures.

Results  The 24-hour recall measures indicated that, after controlling for baseline covariates, the percentages of total energy from fat and saturated fat were reduced among students in intervention compared with control schools (-1.4%; 95% confidence interval [CI], -2.8 to -0.04; P=.04 and -0.60%; 95% CI, -1.2 to -0.01; P=.05). There was an increase in fruit and vegetable intake (0.36 servings/4184 kJ; 95% CI, 0.10-0.62; P=.01), in vitamin C intake (8.8 mg/4184 kJ; 95% CI, 2.0-16; P=.01), and in fiber consumption (0.7 g/4184 kJ; 95% CI, 0.0-1.4; P=.05). Television viewing was marginally reduced (-0.55 h/d; 95% CI, -1.04 to 0.04; P=.06). Analysis of longitudinal and repeated cross-sectional food frequency data indicated similar significant decreases in the percentages of total energy from fat and saturated fat.

Conclusion  Evaluation of the Eat Well and Keep Moving Program indicates effectiveness in improving dietary intake of students and reducing television viewing.

From the Departments of Health and Social Behavior (Dr Gortmaker and Mr Sobol), Nutrition (Drs Cheung, Peterson, and Chomitz and Messrs Cradle and Dart), Maternal and Child Health (Dr Peterson), Epidemiology (Dr Colditz), and Biostatistics (Dr Laird), Harvard School of Public Health, and the Channing Laboratories, Department of Medicine, Brigham and Women's Hospital (Dr Colditz and Field), Boston, Mass; Abt Associates, Cambridge, Mass (Ms Fox); and Baltimore City Public Schools, Baltimore, Md (Ms Bullock).

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