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Title: Lessons learned from the HEALTHY primary prevention trial of risk factors for type 2 diabetes in middle school youth

Author
item MARCUS, MARSHA - University Of Pittsburgh
item HIRST, KATHRYN - George Washington University
item KAUFMAN, FRANCINE - Children'S Hospital Los Angeles
item FOSTER, GARY - Temple University
item BARANOWSKI, TOM - Children'S Nutrition Research Center (CNRC)

Submitted to: Current Diabetes Reports
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 9/1/2012
Publication Date: 2/1/2013
Citation: Marcus, M.D., Hirst, K., Kaufman, F., Foster, G.D., Baranowski, T. 2013. Lessons learned from the HEALTHY primary prevention trial of risk factors for type 2 diabetes in middle school youth. Current Diabetes Reports. 13(1):63-71.

Interpretive Summary: The HEALTHY trial was designed to take a primary prevention approach to risk factors for type 2 diabetes in youth, primarily obesity. The study involved over 6,000 students at 42 middle schools across the U.S. Half received an integrated intervention program of components addressing the school food environment, physical education, lifestyle behaviors,and promotional messaging. The intervention was designed to be more comprehensive than previous efforts, and the research was amply funded. Although well-funded and designed and implemented by a large team of experts in diabetes prevention intervention, the HEALTHY middle school diabetes prevention trial did not have the desired effects on the primary outcome: participating child body mass index (BMI) percentile. In this manuscript, the senior investigators in the trial reviewed what was learned and made suggestions for what a next effort should include to increase the likely effectiveness, including intervening outside the school, e.g. with the family, in the neighborhood around the school, and making national school nutrition and physical activity policies more stringent.

Technical Abstract: The HEALTHY trial was designed to take a primary prevention approach to risk factors for type 2 diabetes in youth, primarily obesity. The study involved over 6,000 students at 42 middle schools across the U.S. Half received an integrated intervention program of components addressing the school food environment, physical education, lifestyle behaviors, and promotional messaging. The intervention was designed to be more comprehensive than previous efforts, and the research was amply funded. Although the primary objective of reducing the percentage of overweight and obesity in schools that received the intervention program, as compared with control schools, was not obtained, key secondary outcomes indicated an intervention effect. In retrospect, senior investigators involved in the study’s design, conduct, and analysis discuss weaknesses and strengths and offer recommendations for future research efforts that address prevention of childhood obesity from a public health perspective.