Longitudinal Changes of Breakfast and Physical Activity Behaviors of

Children in 5th Grade

Brianna D. Higgins, Emily N. Werner, Abigail

Gilman, Patricia A. Shewokis,

Stella Lucia Volpe, FACSM

Department of Nutrition Sciences

Drexel University, Philadelphia, PA

Importance of Breakfast and Physical Activity in Children

• Key behaviors associated with excess weight gain among youth and adolescents

• Infrequent breakfast consumption

• Infrequent physical activity

(Barlow, Pediatrics. 2007;120 Suppl 4:S164-192)

(Freedman et al., J Pediatr. 2007;150(1):12-17.e12; Sinha et al. NEJM. 2002;346(11):802-810; Wiegand et al., Eur

J Endocrinol. 2004;151(2):199-206; Fernandez et al., J Pediatr. 2004;145(4), 439-444; Skoczen et al., Exp Clin

Endocrinol Diabetes. 2015;123(4):252-259; Bekkers et al., PloS one. 2012;7(12):e51801)

Measure How Defined for Children Associations with Health

Status

Body Mass

Index (BMI)

Weight-to-height ratio (kg/m2)

≥ 95th percentile for

sex and age

Increased risk for

cardiovascular disease

Impaired glucose tolerance

Type 2 diabetes mellitus

Abdominal

Obesity

Waist circumference

≥ 90th percentile for

sex and age

Increased risk for metabolic and

cardiovascular diseases

Insulin resistance

Hypertension

Hypercholesterolemia

Current Childhood Obesity Rates

• United States

• 16% overweight

• 17% obese

• Philadelphia, PA

• 15% overweight

• 25% obese

• 57% of children, 6 to 11 years of age, categorized as overweight or obese

(http://www.cdc.gov/obesity/data/childhood.html; http://www.cdc.gov/HealthyYouth/obesity/facts.htm;

http://www.cdc.gov/nccdphp/dch/programs/CommunitiesPuttingPreventiontoWork/communities/profiles/both-

pa_philadelphia.htm; http://www.phila.gov/health/pdfs/Obesity_in_Philadelphia_3.10.10.pdf)

Effective Strategies to Prevent Childhood Obesity

• Multi-component, community-based approaches show promise to be effective

• School-based

• Institute of Medicine recommends that schools be the focal point for childhood obesity prevention

• No other institution has as much contact with children

• Play a pivotal role in promoting healthy behaviors to prevent obesity

(Summerbell et al., Cochrane Database Syst Rev. 2005;CD001871; Gortmaker et al., Arch Pediatr Adolesc Med

1999;153:409-418; Koplan et al., J Am Diet Assoc. 2005; 105(1), 131-138; Baranowski, et al., Am J Health Behav.

2002; 26(6), 486-493)

Purpose

• To assess the changes in the number of days of breakfast consumption and days spent participating in 60 minutes of physical activity per week, over the 2014 to 2015 school year, in children in the fifth grade provided a school-based health intervention

Methods

• 13 schools recruited to participate in a three-year school-based intervention

• From five counties in Greater Philadelphia Area

• Chester, Delaware, Montgomery, Bucks, Philadelphia

• Mixture of public, charter and parochial schools

• Children followed from 4th through 6th grades

Methods

• Randomized into three levels of intervention

• 4 Core Schools

• 5 Level 1 Schools

• 4 Control Schools

Partner Programs for Core Schools

Vetri Foundation

For Children

Eatiquette 1 to 2 days per week

Up to 4 Culinary Classrooms per school year

Greener Partners Monthly in-classroom Seed-2-Snack lessons

2 Farm Explorer visits per year

Fit Essentials One 45-minute fitness period per week, with one take-away fitness

assignment to complete outside of school

Biannual cardiovascular health, muscular strength, balance and

flexibility measurements

Philadelphia Union 2 coach/player visits per year (90 minutes each)

Villanova

University

VioScreen accounts for all students in grade for parental completion

Focus group with 10 students per school per focus group

Partner Programs for Level 1 Schools

Vetri Foundation For

Children

No programming

Greener Partners 4 in-classroom Seed-2-Snack lessons

1 Farm Explorer visit per year

Fit Essentials One 45-minute fitness period per month, with one take-away fitness

assignment to complete outside of school

Biannual cardiovascular health, muscular strength, balance and

flexibility measurements

Philadelphia Union 1 coach/player visits per year (90 minutes each)

Villanova Unviersity No programming

Partner Programs for Control Schools

Vetri Foundation For

Children

No programming

Greener Partners No programming

Fit Essentials No programming

Philadelphia Union No programming

Villanova University No programming

Measurements

• Population analyzed

• Children in 5th grade

• During 2014 to 2015 school year

• Health behaviors

• Youth Behavior Survey Questionnaire

• 26-question multiple choice survey

• Beginning and end of school year

Example Questions fromYouth Behavior Survey Questionnaire

• During the past 7 days, on how many days did you eat breakfast?

• During the past 7 days, on how many days were you physically active for a total of at least 60 minutes per day? (Add up all the time you spent in any kind of physical activity that increased your heart rate and made you breathe hard some of the time)

o 0 days

o 1 days

o 2 days

o 3 days

o 4 days

o 5 days

o 6 days

o 7 days

Statistical Analyses

• IBM SPSS standard edition 23 software

• Microsoft Excel 2015

• Descriptive Statistics

• Age

• Anthropometric Measures

• Matched paired t-tests

• From beginning to end of school year

• Change in number of days

• Breakfast consumed

• Participated in 60 minutes of physical activity

Variable Core

(n = 216)

Level 1

(n = 234)

Control

(n = 153)

Age (years) 10.3 ± 0.5 10.2 ± 0.5 10.2 ± 0.4

Body weight (kilograms [kg]) 41.5 ± 12.5 43.2 ± 11.6 41.5 ± 16.2

Height (centimeters [cm]) 144.1 ± 12.4 144.1 ± 7.0 144.7 ± 8.3

Body mass index (kg/m2) 19.6 ± 4.6 20.7 ± 4.7 20.7 ± 5.1

Waist circumference (cm) 66.7 ± 11.4 72.5 ± 13.4 68.2 ± 12.3

Values represent mean + standard deviation

Participant Characteristics ~ Baseline

Variable Core

(n = 213)

Level 1

(n = 244)

Control

(n = 141)

Age (years) 10.8 ± 0.5 10.8 ± 0.5 10.8 ± 0.6

Body weight (kilograms [kg]) 46.3 ± 13.9 47.2 ± 13.7 47.7 ± 15.6

Height (centimeters [cm]) 149.5 ± 7.7 152.2 ± 89.8 148.9 ± 8.1

Body mass index (kg/m2) 20.4 ± 4.8 23.3 ± 13.9 21.2 ± 5.2

Waist circumference (cm) 69.5 ± 11.8 70.5 ± 11.6 69.9 ± 12.6

Values represent mean + standard deviation

Participant Characteristics ~ Post-intervention

P>0.05; Values represent mean ± standard deviation

0

1

2

3

4

5

6

7

8

9

Core Level 1 Control

Num

ber

of

Days o

f C

onsum

ption

Change in Breakfast Consumption

Baseline Follow-Up

N=232N=211 N=204 N=245 N=141 N=154

0

1

2

3

4

5

6

7

8

Core Level 1 Control

Nu

mbe

r of

Da

ys o

f M

eeting 6

0 m

ins P

A

Change in Physical Activity Participation

Baseline Follow-Up

P>0.05; Values represent mean ± standard deviation

N=211 N=201 N=236 N=244 N=141 N=143

Conclusions

• No significant changes were observed in children in the 5th

grade, from the beginning to the end of the school year in

• Daily breakfast consumption

• Number of days engaged in 60 minutes of physical activity

• Although this school-based intervention may not have resulted in significant changes in healthy behaviors over one school year, the larger three-year intervention may result in positive changes

Independence Blue Cross Foundation