1. ©2016 MFMER | slide-1 Elementary School-based Obesity Intervention Utilizing an Educational Curriculum Natalie Gentile, MD PGY-2 Family Medicine Mayo Clinic Rochester STFM Annual Spring Conference 2016 May 1, 2016 Minneapolis, MN

2. ©2016 MFMER | slide-2 Disclosures None

3. ©2016 MFMER | slide-3 Background  Pediatric obesity is a significant public health problem with a prevalence of 16.9% among U.S. children  School-based obesity interventions show promise for reducing adiposity in elementary age children but there is mixed evidence about their effectiveness overall  5-2-1-0

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5. ©2016 MFMER | slide-5 Objectives  Implement a standardized group 5-2-1-0 curriculum within the school setting  Evaluate impact of the 5-2-1-0 curriculum on health behavior

6. ©2016 MFMER | slide-6 Methods Fifty-one (of 183) 2nd and 3rd grade students at a local elementary school in Rochester, MN 5-2-1-0 educational curriculum, pre-study Healthy Habits survey, Omron HJ-321 pedometer Pre survey, initial height and weight, pedometers worn while awake for 7 consecutive days

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8. ©2016 MFMER | slide-8 Methods Study design: Cluster randomized controlled field trial with 4 classes in each group Intervention classrooms received 5-2-1-0 curriculum in 30 minute sessions Post study procedures: Post-study Healthy Habits survey, height and weight re-measured, pedometers worn for 7 consecutive days

9. ©2016 MFMER | slide-9 Data Analysis REDCap Chi-square test for categorical variables and Wilcoxon rank sum test for continuous variables Multivariate models included age, sex and insurance status

10. ©2016 MFMER | slide-10 Comparison of Healthy Habits Pre and Post Intervention

11. ©2016 MFMER | slide-11 Comparison of Objective Outcomes Pre and Post Intervention

12. ©2016 MFMER | slide-12 Discussion  The 5-2-1-0 intervention utilized in this study was feasible, but not robust enough to impact outcomes  This study highlights the need for tailored obesity prevention programs based on socioeconomic status and age of the target group

13. ©2016 MFMER | slide-13 Limitations  Study participation and completion rate was lower than predicted  Significant number of children who were overweight or obese (BMI ≥ 85) in intervention group at baseline  Step counts increased from pre- to post- intervention but our overall step count was lower than predicted  Younger age of participants  Compliance with pedometer wear

14. ©2016 MFMER | slide-14 Next steps  Trial school personnel doing curriculum  Utilize research grade pedometers or accelerometers  Utilize larger samples or more robust methods of recruiting families  Complete the study in an afterschool or evening setting

15. ©2016 MFMER | slide-15 Next steps  Evaluate for knowledge acquisition and retention as an outcome  Incorporate the caregivers in the education sessions to ensure consistent knowledge in the home  Explore this intervention in a setting with a more socioeconomically diverse population

16. ©2016 MFMER | slide-16 Acknowledgements Brian Lynch, MD Amie Jones, MD Seema Kumar, MD Valeria Cristiani, MD for developing the protocol Bridget Biggs, PhD for developing the surveys Kimberly Griffin, RN for teaching the 5-2-1-0 curriculum Brent Lexvold RD, LD, and Lisa Lenoch, RN for devising the curriculum Cindy McHugh, LPN for data collection Local elementary school and the School Board in Rochester, MN for allowing us to conduct this study at their facility Olmsted County Public Health for allowing their public health nursing staff to participate in the project. Supported by a grant from the Ben and Zelma Dorson Family Charitable Foundation; Funding through the Mayo Clinic Department of Family Medicine; CTSA Grant UL1 TR000135 from the National Center for Advancing Translational Sciences (NCATS)

17. ©2016 MFMER | slide-17 Questions & Discussion