Randomized Controlled Trial of Healthy Harlem's Get Fit Program: An After-School Intervention for Childhood Overweight and Obesity in the Harlem Children's Zone

Introduction

Childhood obesity is one of the most critical public health problems our nation is facing. While the most recent data suggest that escalating rates of obesity may be slowing or even leveling off, the prevalence of childhood obesity remains a serious public health concern; 31% of children ages 10 to 17 had overweight or obesity in 2016.^1–3

Because excess weight among children has been linked with poor academic outcomes^4–6 and increased risk for long-term health consequences, including cancer, hypertension, type 2 diabetes, and heart disease,^7–10 community officials, school administrators, and medical and policy researchers have tested many interventions designed to reduce the prevalence of overweight and obesity among children. Shape-Up Somerville (SUP), a community-based participatory research study aimed at changing household, school, and community environments to prevent and reduce childhood obesity in Somerville, Massachusetts, conducted from 2002 to 2005, showed a reduction in BMI z-score over 2 years.¹¹ The Mind, Exercise, Nutrition, Do it (MEND) Program—an integrated, multicomponent healthy lifestyle program randomly assigned to children with obesity in the UK—found greater reductions in waist circumference and BMI z-scores of children assigned to the intervention group compared with those in the control group.¹² Other interventions have also found reductions in BMI.^13–16

Although these studies show promising paths toward continued progress in reducing obesity, recent reviews have stated that published research evaluating the effects of many childhood obesity interventions have been based on small samples with limited generalizability to larger populations.^14,17,18 Additional research is also warranted on potential gender-based differences in the effectiveness of obesity interventions. Although some programs have been more successful with girls than boys, existing research is largely mixed.^19,20

In this article, we use data from a randomized controlled trial conducted in 2012 to 2014 to evaluate the effectiveness of a multifaceted and comprehensive program for promoting healthy lifestyles of middle and high school students who attend Harlem Children's Zone (HCZ) after-school programming in central Harlem, New York. We focus on a component of the HCZ Healthy Harlem intervention called Get Fit that provided students with overweight or obesity in after-school programs with 60 minutes of moderate-to-vigorous physical activity per day and guided students in setting and monitoring nutrition...