"Use of the internet and videos made learning fun for these students," said Marilyn Frenn, Ph.D., R.N., lead author of the report and an associate professor of nursing at Marquette University in Milwaukee. "It is the way that the youth of today learns."
Researchers at Marquette University Nursing School, in conjunction with the City of Milwaukee Health Department, used an interactive internet program and short videos to reduce fat intake and increase exercise levels of low-income seventh graders. The Web-based component included radio buttons, colorful graphics, discussion boards and online nursing students to answer questions.
Studies have shown that lower income children are at a higher risk for obesity than children from higher income families, with blacks and Hispanics at the highest risk.
The study included 137 culturally diverse middle school students. Almost 90 percent of the students were either receiving free or reduced-cost lunches at school, indicating they were from low-income families. Forty-eight percent of the students were Hispanic, 24 percent black, 6 percent Caucasian and 3 percent Native American.
"In the transition from middle school to high school, students' diets worsen with an increase in high-fat junk food and a decrease in exercise," Frenn said. "We want to create a culture that is healthier, getting exercise up and the dietary fat down."
The more internet/video sessions the students attended at school, the greater the positive impact. Students who attended at least half of the sessions increased the amount of exercise and reduced the fat in their diets, researchers found.
Those who completed more than half the sessions increased their levels of moderate/vigorous activity an average 22 minutes compared to a 66-minute decrease for the controls.
"Most of these children live in areas where they may have limited access to safe, affordable places to exercise, so we had them make their own suggestions for exercising," Frenn said. "They came up with ideas such as jumping jacks or push-ups while watching television or videos."
The percentage of dietary fat decreased from 30.7 to 29.9 percent of calories in students participating in half of the sessions. Those in the control group had 31.5 percent dietary fat on pre-test and 31.7 percent on post-test. The combination of increased activity and lower dietary fat should result in losing half a pound per week. Habits of students in the control group would lead to slow weight gain, Frenn said.
"We focused on kids becoming aware of what they were eating," she said. "The program encourages them to eat a balanced diet every day. Most kids just need help evaluating what they are eating as compared with recommended amounts.
"By the end, they know how many calories they should eat and the percentage of those calories that should come from fat, she said. "They learn that eating fast food more than once a week increases their chances of obesity." Frenn said the Milwaukee school cafeteria program was low-fat and healthy. But many students skipped breakfast so they could sleep later or bought sodas and chips on the way to school and skipped lunch. "We encouraged them to at least drink low-fat milk and have a granola bar for breakfast."
Researchers also encouraged students to ask parents for a favorite fruit or vegetable at the store instead of junk food. Students received recipes online for low-fat snacks and breakfast foods.
The study showed that low-income students generally had less family support for diet and exercise. They also found that teenage girls needed more support in increasing their physical activity. "If there was more support, there was higher activity," Frenn said. Children with stronger family support were more apt to reach dietary goals than children who relied on their peers or were in an early stage of change, i.e., merely contemplating future changes.
When the researchers looked at students' ZIP codes, they found that Hispanic students in communities with strong cultural ties were more likely to succeed in lowering dietary fat and had stronger family support than those living in more culturally diverse areas. "Although this area was low-income, there was a cultural center, outdoor markets, stores and clinics," Frenn said. "It was a more cohesive neighborhood. There was a protective effect for those kids, when compared to the culturally diverse ZIP code just next door." Researchers say a larger study that follows the students over time is still needed. They're also studying the idea of using a CD for schools without classroom internet access.
Co-authors were Shelly Malin, Ph.D., R.N.; Yvonne Greer, M.P.H., R.D., C.D. and Roger L. Brown, Ph.D.
Abstract P302