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NHLBI Obesity Research

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The objective the Pathways study was to evaluate the effectiveness of a school-based, multi-component intervention for reducing percentage body fat in American Indian schoolchildren. NHLBI initiated the study in 1987, as a partnership between five universities and seven American Indian communities: Gila River Indian Community, Tohono O’odham (University of Arizona); White Mountain Apache, San Carlos Apache (Johns Hopkins University); Oglala Lakota, Sicangu Lakota (University of Minnesota); and Navajo (University of New Mexico). The University of North Carolina-Chapel Hill served as the coordinating center for the study.

Pathways was a randomized controlled trial that tested a school-based intervention for the primary prevention of obesity in 41 schools in 7 communities and 1,704 preadolescent American Indians. The intervention to improve diet and physical activity consisted of four components: classroom curriculum, food service, physical activity, and family involvement. The classroom curricula were designed to promote healthful eating behaviors and to increase physical activity. The food service intervention provided nutrient guidelines and practical tools for reducing the fat content of school meals. The physical education program aimed at increasing energy expenditure by implementing a minimum of three 30-minute sessions per week of moderate-to-vigorous physical activity. The family-involvement component aimed to assist families in creating a supportive environment for healthy behaviors and provide a forum for discussion.

There was no significant difference in the percent body fat or in body mass index (BMI) between the intervention and control schools. However, there was a significant reduction in saturated and total fat content of school lunches served in the intervention schools compared to the control schools. These results documented the feasibility of implementing a multi-component program for obesity prevention in elementary schools serving American Indian communities.

Selected References:

Caballero B, Clay T, Davis SM, et al. Pathways: a school-based, randomized controlled trial for the prevention of obesity in American Indian schoolchildren. Am J Clin Nutr 2003;78:1030-8.

Last Updated March 2011

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