0 + 0 = 2

A puzzling study was just published in Obesity, the journal of the North American Association for the Study of Obesity (NAASO). It was puzzling not because of the unexpected results, but because despite finding their program was ineffective for preventing “inappropriate” weight gain among elementary students, the researchers were given a $2.1 million grant by the National Institutes of Health to expand it.

In October 2002, the Wise Mind pilot study enrolled 670 elementary students from four Louisiana schools, mostly Black minority children from economically disadvantaged families who were overweight. This school-based project was designed to be a primary weight gain prevention program by comprehensively addressing unhealthy eating and physical activity behaviors. The objective was to prevent inappropriate weight gain. This randomized controlled trial spanned two school years and 586 children completed the study. The researchers from Pennington Biomedical Research Center, in Baton Rouge, Louisiana, reported that total calories, dietary fats and protein had been reduced and physical activity had increased among the participants as compared to a control group, but...

After two years, it failed to produce differences in body weight as compared to the control group.

A secondary prevention program for overweight teenage Black girls and their overweight parents, called HIPTeens, was also completed by these same researchers. It was a randomized controlled trial of an internet-based weight loss intervention, incorporating education on healthy eating and nutrition, with interactive graphs to track exercise and weight loss. Its objective was weight loss and reduced body fat. The two year results were published last July in Obesity and reported that while there had been weight and body fat loss among the participants during the first six months, it had all been regained over the next 18 months, and...

After two years, it failed to produce any differences in body weight as compared to the control group.

The Pennington team was recently awarded a grant from the NIH of about $2.1 million, according to their press release, to do a more extensive study, called LA Health, building on the HIPTeens and Wise Mind projects. Their “team of behavior, nutrition, health and field science specialists will set up programs in 18 clusters of schools involving 2,500 4th through 6th graders,” they said.

According to the April 11, 2007 update at ClinicalTrials.gov (which offers up-to-date information on federally and privately supported clinical trials), the Pennington researchers described the important purpose of their study, reporting:

There is a worldwide pandemic of obesity with far-reaching consequences for the health of our nation. Obesity is the second leading cause of preventable death in the United States. Prevention of obesity, especially in children, has been deemed by public health policy makers to be one of the most important objectives for our country.....The results of this investigation will significantly impact public health policy related to obesity prevention in rural communities, minority communities, and in children from families that are economically disadvantaged.

Working with the LA Department of Health and the U.S.Department of Agriculture, they’d already recruited 2,036 students by the end of the first half of the 2006 school year and anticipated beginning the program this spring. The project’s 2006 Annual Report summarized the program and its objectives saying:

A consensus of opinion has formed that the recently observed increased prevalence of obesity is caused by environmental factors that favor easy access to high calorie foods and sedentary behavior....Specifically, LA Health will test the efficacy of two school-based prevention programs that are designed to prevent weight gain in children initially enrolled in grades 4 to 6, over a three-year period. The two approaches are derived from two pilot studies conducted by the scientific team on this project. One is called the HIPTeens project (a secondary prevention program) and the other is termed, the Wise Mind project (a primary prevention program)....

It is hypothesized that the combination of primary and secondary prevention will be more effective for preventing unhealthy weight gain in comparison to primary prevention alone because of the more powerful effect of the secondary prevention program upon children who are overweight or at risk for overweight.

In other words, neither program worked individually, but they believe that if they put them together they will.