New Moves was designed to prevent a broad range of weight-related problems in adolescent girls. The intervention did not lead to significant changes in the girls’ percent body fat or BMI, but improvements were seen within the domains of sedentary activity, physical activity (stage of change, goal-setting, and self-efficacy), dietary intake (stage of change and goal-setting), eating patterns (portion control behaviors and stage of change for breakfast eating), unhealthy weight control behaviors, and body/self image. Additionally, intervention girls reported that they felt more support for being physically active from friends, teachers, and family members and more support for healthy eating by friends and teachers. Finally, the vast majority of the girls and their parents indicated high levels of satisfaction with New Moves and 100% said they would recommend the program to others.
School-based obesity prevention programs have had limited success in changing weight status, with greater success in changing weight-related knowledge, attitudes, and behaviors. 55–61
Similarly, in the current study, no change was seen in weight status, but changes were seen in attitudes and behaviors. A large focus of New Moves was on goal-setting, and notable increases were found in goal-setting for both physical activity and eating behaviors. The decrease in sedentary behaviors of approximately 30 minutes/day among intervention girls was a positive change. Additionally, while control girls tended to decrease their physical activity, levels remained fairly constant in the intervention girls. Intervention girls advanced in their stage of change for breakfast eating, which is important given that breakfast has been found to be protective for excessive weight gain.62, 63
Given the large portion sizes of food to which young people are exposed 64, 65
; the changes found in portion control behaviors among intervention girls were positive.
Girls participating in New Moves decreased their use of unhealthy weight control behaviors and had improved body image and self-worth. Given that unhealthy weight control behaviors predict excessive weight gain, extreme weight control behaviors, and binge eating among adolescents 66
; the decrease in unhealthy weight control behaviors may help in preventing future weight gain and risk for eating disorders. Similar to findings described in the obesity prevention literature, interventions aimed at preventing risk factors for eating disorders have shown mixed results. In a meta-analytic review of eating disorder prevention programs, 51% of the programs reduced risk factors for eating disorders, such as dieting and body dissatisfaction.67
Thus, although New Moves addressed a broader range of weight-related outcomes than most eating disorder prevention programs, it compared favorably in terms of its impact on risk factors for eating disorders. Of note, binge eating was not targeted as one of the key objectives in New Moves and differences were not found between the two conditions. Given its relevance for both obesity and eating disorders 5, 68, 69
and the girls’ discussions of emotional eating, it is suggested that future interventions target binge eating.
Study strengths and limitations need to be taken into account in interpreting the findings. The diverse nature of the participants, drawn from schools serving high percentages of low-income youth, with over 75% of the girls from racial/ethnic minorities, is a study strength, as it is crucial to find ways to meet the needs of these girls. The implementation of New Moves within a school setting makes the program accessible to all students; however, there are difficulties inherent to involving parents and helping youth make changes in their eating and activity behaviors within a school setting. For example, only one fifth of parents attended the parent–daughter retreat day. The high level of response (94% at follow-up) and the strong evaluation tools are study strengths, although 26% of the girls were missing DXA assessments of body composition at either baseline or follow-up assessments, primarily due to concerns about doing a required urine test and logistic difficulties in getting to the clinic (e.g., moved, did not want to miss class).
The use of a control group that received an all-girls physical education class allowed for the recruitment of similar girls into both conditions and an examination of the effect of New Moves activities above and beyond the all-girls physical education class. However, in examining the findings it is important to note that the control group also received an intervention (i.e., an all-girls class composed of girls with sedentary lifestyles). Some studies have found that all-girls physical education classes provide a more positive learning experience than coeducational classes and lead to more active participation of girls.70, 71
The control girls’ participation in a physical education class during the intervention period may explain the larger differences found at follow-up than at post-class, particularly with regard to physical activity outcomes and measures of a supportive environment. The intervention effect may have been larger had it also been possible to evaluate the impact of an all-girls physical activity environment. Additionally, given the program’s focus on long-term behavioral change, and trends toward improvements in outcomes from post-class to follow-up assessments in intervention girls as compared to control girls, a longer follow-up period may have revealed further differences between the groups.