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Since 1990, obesity rates in American children -; particularly in rural and underserved areas -; have skyrocketed due to a variety of factors, including more sedentary human behavior and an increase in food swamps, or communities with both limited access to fresh fruits and vegetables as well as excessive access to fast food.

In a recent study, Crystal Lim, tinidazole kidney a researcher and pediatric psychologist at the University of Missouri, and her team reviewed 72 obesity prevention programs that were implemented in rural elementary, middle and high schools from 1990 to 2020 across the United States, England and Australia to identify the strategies that worked best to help young people live healthier lifestyles. They found that programs that combine both nutrition and exercise components over an extended period of time had the most success in changing students' daily behaviors.

The findings can help provide inspiration for rural school districts in underserved areas who are interested in implementing similar programs, as well as help identify the roles teachers, parents and community members can play in combatting the issue of childhood obesity.

There seemed to be different variations in how the programs were implemented, as some programs focused solely on the nutrition aspect and others focused solely on the exercise aspect. Some interventions were a one-time event while others lasted the entire school year."

Crystal Lim, associate professor in the MU School of Health Professions and lead author on the study

Lim also found that most of the successfully implemented programs included evidence-based strategies to create effective, long-lasting behavior changes, including goal setting, problem solving and self-regulation techniques.

"My biggest recommendation going forward is we should make these interventions more fun and engaging for kids so that the healthy behaviors become activities they look forward to as opposed to dread," Lim said. "An example can be playing 'dodgeball' or 'capture the flag' during P.E. class rather than running miles or doing pushups. Goal setting can help lead to gradual and practical changes, such as drinking three glasses of water per day instead of two, and then tracking the results over time."

While reviewing the past research literature, Lim found that teachers were most often the ones implementing the interventions, but a multi-pronged approach is more successful.

"Teachers can implement nutrition and exercise concepts into their classrooms. Rather than math problems about the speed of an airplane, for example, what about math problems regarding the speed of a marathon runner or the number of calories consumed in a day," Lim said. "Another strategy is taking short breaks to allow kids to stretch and be active, as it is not realistic for them to sit still for most of the school day."

School districts and administrators can play an integral role as well in creating a healthy school environment.

"Whether it is reassessing what foods we offer in vending machines, in the school cafeteria or at school celebrations, we need to set up the school environment so that the healthy choice becomes the 'easy' choice and the 'cool' choice," Lim said. "When kids see their peers and role models eating healthy, hydrating and exercising, they are more likely to engage in those behaviors themselves."

Finally, parents and community members can help students continue healthy behaviors outside the classroom.

"To make a simple activity like going for a walk more fun and engaging, consider listening to music, bringing a soccer ball or turning it into a scavenger hunt," Lim said. "Community organizations, such as MU Extension, churches and YMCAs can be leveraged as well to continue the conversation outside the classroom."

"School-based obesity prevention programs in rural communities: a scoping review" was recently published in Joanna Briggs Institute of Evidence Synthesis. Funding for the study was provided by the National Institutes of Health.