Power-up: a collaborative after-school program to prevent obesity in African American children

Abstract

Background: Schools represent a key potential venue for addressing childhood obesity.

Objective: To assess the feasibility of Power-Up, an after-school program to decrease obesity risk among African American children, using community-based participatory research (CBPR) principles.

Methods: Teachers led 14 weekly nutrition and physical activity sessions during afterschool care at the Woodlawn Community School on Chicago's South Side. Forty African American children ages 5 to 12 participated; their 28 parents discussed similar topics weekly at pickup time, and families practiced relevant skills at home. Pre- and post-intervention anthropometrics, blood pressure, dietary measures, and health knowledge and beliefs for children and parents were compared in univariate analysis.

Results: At baseline, 26% of children were overweight; 28% were obese. Post-intervention, mean body mass index (BMI) z scores decreased from 1.05 to 0.81 (p<.0001). Changes were more pronounced for overweight (-0.206 z-score units) than for obese children (-0.062 z-score units; p=.01). Girls decreased their combined prevalence of overweight/obesity from 52% to 46%; prevalence across these categories did not change for boys. The prevalence of healthful attitudes rose, including plans to "eat more foods that are good for you" (77% to 90%; p=.027) and "planning to try some new sports" (80% to 88%; p=.007).

Conclusion: Children in the Power-Up program reduced mean BMI z scores significantly. The after-school venue proved feasible. The use of CBPR principles helped to integrate Power-Up into school activities and contributed to likelihood of sustainability. Engaging parents effectively in the afterschool time frame proved challenging; additional strategies to engage parents are under development. Plans are underway to evaluate this intervention through a randomized study.

Figure 1. Pre- and Post-Intervention Prevalence of Overweight and Obesity by Gender

Figure 2. Change in Children’s BMI z Score by Baseline Weight Strata and Gender

Change in BMI z-score units from baseline to post-intervention as calculated by paired t test, for all participants (bars shown at left), and stratified by weight category and by gender. A decrease in BMI z score for overweight or obese participants indicates movement in the direction of normal weight category. Children within the normal weight category also decreased their BMI z score; this did not reflect weight loss, because they continued growing in height during a period of less rapid weight gain.