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Title: Sustained impact of the "Healthy Habits, Healthy Girls – Brazil" school-based randomized controlled trial for adolescents living in low-income communities

item BARCO LEME, ANA - Children'S Nutrition Research Center (CNRC)
item BARANOWSKI, TOM - Children'S Nutrition Research Center (CNRC)
item Thompson, Deborah - Debbe
item NICKLAS, THERESA - Children'S Nutrition Research Center (CNRC)
item PHILIPPI, SONIA - Universidade De Sao Paulo

Submitted to: Preventive Medicine Reports
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 4/19/2018
Publication Date: 4/26/2018
Citation: Barco Leme, A.C., Baranowski, T., Thompson, D.J., Nicklas, T., Philippi, S.T. 2018. Sustained impact of the "Healthy Habits, Healthy Girls – Brazil" school-based randomized controlled trial for adolescents living in low-income communities. Preventive Medicine Reports. 10:346-352. doi:10.1016/j.pmedr.2018.04.013.

Interpretive Summary: "Healthy-Habits, Healthy Girls – Brazil" was an obesity prevention intervention for high school girls that also targeted disordered eating behaviors in the attempt to attain synergy in outcomes. This cluster (school) randomized design was implemented in 10 public schools in Sao Paulo, Brazil. The intervention did not have a detectable effect on body mass index, the primary outcome. A small effect was detected on waist circumference, but increases were detected in TV time on weekdays and weekend days. This trial provides no support for attaining synergy in outcomes by combining obesity and disordered eating prevention procedures.

Technical Abstract: Pediatric obesity is a major public health concern in low- and middle-income countries, such as Brazil. There is an urgent need for preventive programs for adolescents and, the assessment of their sustained impact. This paper reports the longer-term (6-month post intervention) effects of the "H3G-Brazil" obesity prevention program on weight status and weight-related behaviors. A cluster randomized controlled trial starting with 10 public schools in the city of Sao Paulo, Brazil involved 253 adolescent girls [mean (se) age=15.6 (0.87) years]. Body mass index (BMI), waist circumference (WC), dietary intake, physical activity (PA) and sedentary behaviors (SB) were assessed at baseline, immediate post-intervention and 6-month post-intervention (follow-up). ANCOVA was performed using intention to treat principles. There was no effect on BMI, the primary outcome. Although, meaningful increases occurred in waist circumference for both groups, the intervention group presented a lower increase (F=3.31, p=0.04). This effect size, however, was lower than the criterion for small (d=0.102). Unfortunately, significant results favored the control group for time spent on TV/weekdays (F=5.13, p=0.01), TV/weekends (F=5.46, p=0.01) and sedentary behaviors/weekdays (F=5.32, p=0.04). No other significant results were found. This obesity prevention intervention among Brazilian adolescent girls did not have the desire effect on BMI. The significantly lower increase in waist circumference in the intervention groups is inconsistent with the adverse changes detected in sedentary time.