Neumark-Sztainer DR, Friend SE, Flattum CF, Hannan PJ, Story MT, Bauer KW, Feldman SB, Petrich CA. (2010). New moves-preventing weight-related problems in adolescent girls a group-randomized study. American Journal of Preventive Medicine, 39 (5), 421-432.
Designed to improve dietary habits and increase physical activity to reduce obesity among girls, this school-based intervention delivered in a girls-only physical education class includes 8 nutrition and 8 social support lessons, individual counseling sessions, and maintenance activities. The study showed decreases in sedentary activity and unhealthy weight control behaviors and increases in portion control, body satisfaction, self-worth, and self-efficacy for physical activity.
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Weight-related problems are prevalent among adolescent girls and tend to be somewhat more frequent among ethnic and racial minorities. Forty-five percent of African American adolescent girls are overweight or obese, compared to 37 percent of White girls. Girls from low socioeconomic status (SES) backgrounds are more likely to be obese than girls from high-SES backgrounds. Obese adolescent girls are more likely than normal-weight girls to exhibit problems such as inadequate physical activity, poor eating behaviors, and unhealthy weight control behaviors (e.g., skipping meals, fasting, taking diet pills, smoking cigarettes for weight control). Sixty-six percent of obese girls have low levels of body satisfaction versus 38% of normal-weight girls.
Unhealthy weight control behaviors and body dissatisfaction have been found to predict excessive weight gain in adolescent girls, even when controlling for baseline weight. Given the health implications of obesity and unhealthy weight control behaviors, there is a strong need for interventions aimed at preventing weight-related problems, particularly among adolescent females and especially those from ethnic or racial minorities and from low-SES backgrounds.
New Moves is aimed at preventing weight-related problems such as obesity, inadequate physical activity, poor eating behaviors, unhealthy weight control practices, and body dissatisfaction in adolescent girls. Weight loss goals are not discussed. Rather, New Moves focuses on behavioral changes and aims to provide a supportive environment where all girls feel comfortable being physically active and discussing weight-related issues, regardless of their size, shape, or level of physical activity. The underlying philosophy of the program is that if girls feel good about themselves, they will want to take care of their bodies. Eight behavioral objectives are targeted throughout the New Moves program: (1) be more physically active, (2) limit sedentary time, (3) increase fruit and vegetable intake, (4) limit sugar-sweetened beverages, (5) eat breakfast every day, (6) pay attention to portion sizes and the body's signs of hunger and satiety, (7) avoid unhealthy weight control behaviors (e.g., skipping meals, fasting, taking diet pills, smoking cigarettes for weight control), and (8) focus on one's positive traits.
The program is administered to participants in an all-girls school physical education class (as an alternative to the regular coeducational physical education class). The curriculum is delivered over a 9-month school year (modifiable to a quarter or trimester schedule), with flexibility in the time and format of the program's delivery. The first semester of the year includes eight nutrition and eight social support lessons delivered in 50-minute class periods, plus individual counseling sessions with a New Moves coach. During the class, nutrition and social support lessons are offered once a week on alternating weeks. On the other 4 days of the week, participants attend the girls-only physical education class. The second semester consists of maintenance activities; for example, during weekly lunch bunches, girls are served healthy food and they engage in informal discussions on New Moves topics with New Moves staff. They also continue to receive individual coaching sessions.
The individual coaching sessions with the New Moves coach are scheduled for 15-20 minutes. The girls set personal goals for behavioral change based on the eight behavioral objectives and explore how to best achieve their goals and (if ready) make a plan for change. Motivational interviewing strategies are used to assist the girls in moving toward change.
Community Preventive Services Task Force Finding
The New Moves physical education class is approximately 16 weeks long. Girls participate in physical activity (Be Fit) 4 days per week and nutrition (Be Fueled) or social support/self-empowerment (Be Fab) classes 1 day per week. Be Fit sessions are taught 3 days per week by school physical education teachers and 1 day per week by different community guest instructors who expose the girls to fun activities (e.g., dance, hip hop, kickboxing) available in the community. Physical education teachers administering the New Moves program attend a 1-day training prior to the program and a 1/2-day training in the middle of the program. Individual coaching sessions are scheduled for 15-20 minutes, every 3-4 weeks depending on the girl's schedule and interest.
The primary audience for the New Moves program is adolescent girls who are overweight or are at risk of becoming overweight due to a sedentary lifestyle.
The New Moves program is designed to be administered to participants in school settings in an all-girls physical education class.
All of the materials needed to implement New Moves can be found on the New Moves intervention program Web site (http://www.newmovesonline.com).
About the Study
New Moves was evaluated using a group-randomized controlled design, with six intervention and six control high schools in the Minneapolis/St. Paul metropolitan area of Minnesota. Three intervention and three control schools participated in the study during the 2007-2008 school year, and another three intervention and three control schools participated in 2008-2009. High schools were recruited into the study on the condition they would participate as either control or intervention sites and were randomized into these conditions. Participating schools were in urban and inner suburbs and were selected because of their diverse student bodies. The percentage of students eligible for free or reduced-price school breakfast and lunch was 58% in the intervention schools and 56% in the control schools.
Participants in the intervention and control schools were invited to register for an all-girls physical education class as an alternative to their regular coeducational class. Recruitment materials were designed to appeal to inactive girls interested in healthy weight management. A class description was included in the school catalogue used for class registration, and posters and flyers about the program were displayed at the schools. Girls were screened for physical activity and eating disorder behaviors. More than 75% of the participants represented racial or ethnic minorities and nearly half were overweight or obese. The average age of participants was 15.8.
Girls in both intervention and control schools participated in an all-girls physical education class during the first semester of the school year. Girls in the intervention group received the New Moves curriculum during their physical education class and participated in other New Moves activities throughout the rest of the school year. Teachers in the control schools did not receive training on New Moves until after the study period and were free to conduct their physical education classes as they desired during the study period.
Evaluation assessments were administered to the participants at three time points: prior to the start of the fall physical education classes (baseline), immediately after the fall classes ended, and at the end of the school year, approximately 9 months from the beginning of the intervention (follow-up). Parents of girls in the intervention were mailed process surveys at follow-up. Baseline and follow-up assessments were conducted at the University of Minnesota General Clinical Research Center, and post-class assessments were carried out at school.
The intervention and control groups showed no significant difference in their decrease in average minutes of sedentary activity per day at the post-class assessment (n.s.). However, the intervention group did show a significant difference in decrease in sedentary activity compared to the control group at follow-up (p=.05).
There was no significant decrease in the percentage of intervention participants engaging in unhealthy eating behaviors compared to the control group at the post-class assessment (n.s.). However, the intervention group did show a significant decrease in the percentage of unhealthy eating behaviors compared to the control group at follow-up (p=.02).
Portion control was measured with the New Moves survey. Scores ranged from 4 to 16, with higher scores indicating greater portion control.
- The intervention group showed a significant increase in portion control compared to the control group at the post-class assessment (p=.04). The intervention group also showed a significant increase in portion control compared to the control group at follow-up (p=.01).
Body satisfaction was measured with the New Moves survey. Scores ranged from 10 to 60, with higher scores indicating greater body satisfaction.
- The intervention group did not show a significant increase in body satisfaction compared to the control group at the post-class assessment (n.s.). However, the intervention group showed a significant increase in body satisfaction compared to the control group at follow-up (p=.05).
Self-worth was measured using the Harter Scale. Scores ranged from 5 to 20, with higher scores indicating a greater sense of self-worth.
- The intervention group showed a significant increase in self-worth compared to the control group at the post-class assessment (p=.02). The intervention group also showed a significant increase in self-worth compared to the control group at follow-up (p=.03).
Self-efficacy for physical activity had a range of scores from 6 to 30, with higher scores indicating greater self-efficacy for physical activity.
- While the intervention group showed no significant increase in self-efficacy for physical activity compared to the control group at the post-class assessment (n.s.), the intervention group did show a significant increase in self-efficacy for physical activity at follow-up (p=.003).
Neumark-Sztainer, D., Croll, J., Story, M., Hannan, P. J., French, S. A., & Perry, C. (2002). Ethnic/racial differences in weight-related concerns and behaviors among adolescent girls and boys: Findings from Project EAT. Journal of Psychosomatic Research, 53 (5), 963-974.
Flattum C, Friend S, Story M, Neumark-Sztainer D. (2011). Evaluation of an individualized counseling approach as part of a multicomponent school-based program to prevent weight related problems among adolescent girls. Journal of the American Dietetic Association, 111 (8), 1218-1223.
Flattum C, Friend S, Neumark-Sztainer D, Story M. (2009). Motivational interviewing as a component of a school-based obesity prevention program for adolescent girls. Journal of the American Dietetic Association, 109 (1), 91-94.
Neumark-Sztainer D, Flattum C, Feldman S, & Petrich C. (2010). Striving to prevent obesity and other weight-related problems in adolescent girls: The New Moves approach. In J. A. O'Dea & M. Eriksen (Eds.) Childhood Obesity Prevention - International Research, Controversies, and Interventions, New York: Oxford University Press. (Ed.), 269-277.
Neumark-Sztainer, D. Flattum, C. F. Story, M. Feldman, S. Petrich, C. A. (2008). Dietary approaches to healthy weight management for adolescents: the New Moves model. Adolescent medicine: state of the art reviews, 19, 421-430.