Trends in Health Behavior and Weight Outcomes Following Enhanced Afterschool Programming Participation: A Pragmatic Quasi-experimental Study

Background: The United States needs to increase access to effective obesity prevention and treatment programming for impoverished youth at risk for health disparities. Although interventions targeting schools are recommended, schools rarely implement evidence-based obesity programing.Methods: Using a pragmatic quasi-experimental design, we report on the effectiveness of adding structured nutrition education and minimum physical activity (PA) requirements to standard middle school onsite afterschool programming. Programming was evaluated over three school years (2016- 2018) to determine: 1) impact on healthy weight and target healthy behavior attainment; and 2) whether target behavior improvement was associated with afterschool program attendance and weight change.Results: In response to 601 recruitment letters 13% (76 students) enrolled (62% Hispanic, 46% girls, 72% with BMI > 85 th %ile, 49% with BMI > 95 th %ile). With low baseline attainment of 7 target behaviors including:1) daily breakfast and lunch (32%); 2) 2-3 servings fruit/day (53%); 3) > 3 servings vegetables/day (29%); 4) 8 cups sugar-free beverages (SFB)/day and <1 cup sugary beverage/day (9%); 5) > 8 hours sleep/night (75%); 6) > 7 hours PA/week (21%); and 7) < 1 unhealthy snack (US) and <1 fast food meal/week (25%), the calculated composite score was 2.5 out of 7. Of students with BMI > 85 th %ile, 44% maintained or decreased BMI Z-score. There were non-significant trends in improvements in BMI Z-score and target consumption of: fruit, vegetables, SFB, and US food. Students with higher afterschool attendance ( > 75%) had greater non-significant improvements in composite score, BMI Z-score, and in most target behaviors (5/7) compared to students with lower afterschool attendance (<75%). Although not significant, improvements in composite score attainment and most target behaviors (5/7) were associated with decreases in BMI Z-score. Sleep improvements were significantly associated with BMI Z-score decrease (Beta=-0.05, 95% CI (-0.1,-0.003), p=0.038.) Conclusions : Enhancement of existing afterschool programming with health oriented elements and minimum physical activity requirements demonstrates trends toward improvement in several health behaviors and weight outcomes. Addition of enhanced programming increases access to health activities and may bring us closer to solving issue of obesity in at-risk youth in impoverished communities.Trial registration: ClinicalTrials.gov identifier (NCT number): NCT03565744. Registered 21 June 2018 – Retrospectively registerd, https://register.clinicaltrials.gov/prs/app/action/LoginUser?ts=1&cx=-jg9qo4.