A comprehensive whole-community approach to reduce childhood obesity shows promise

The World Health Organization reports that children who carry excess weight are more likely to stay overweight into adulthood and develop chronic diseases at a younger age. These include cardiovascular diseases (mainly heart disease and stroke), diabetes, musculoskeletal disorders like osteoarthritis, and certain cancers such as breast and colon.

Childhood obesity prevalence in the U.S. has decreased slightly for preschool children ages 2 to 5, but the rate for all children is still high at about 17%, affecting 12.7 million children and adolescents. [1] Trends also suggest that children from ethnic and lower socioeconomic groups are at increased risk for obesity. Hispanics and non-Hispanic blacks have the highest rates at 21.9% and 19.5%, respectively. [1] These disparities have sparked interest in using multilevel, multisector interventions for the prevention and control of childhood obesity, such as the Massachusetts Childhood Obesity Research Demonstration Project (MA-CORD).

The MA-CORD Project involved six community settings: federally qualified health centers, schools, after-school programs, community, early care and education, and the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). Examples of interventions within these settings included multidisciplinary weight management programs, evidence-based health education materials, teacher and after-school staff training, after-school curricula helping children to develop healthy habits, provision of physical activity supplies, and city coalitions built on existing initiatives to implement community-level policy and environmental change strategies.

To evaluate the effectiveness of MA-CORD among students, a new study by researchers from the Harvard Chan School, Mass General Hospital for children, and the Massachusetts Department of Public Health followed two ethnically diverse, low-income communities participating in the intervention.

Five Ways to Grow Healthy Poster
A poster features the MA-CORD target health behaviors [Source: Massachusetts Health Promotion Clearinghouse].
The research team examined changes in the prevalence of obesity and specific health behaviors (fruit and vegetable intake, sugary beverage and water consumption, physical activity, screen time, and sleep duration) among students in the two intervention communities compared with nine matched control communities. [2]

School interventions took place over two school years, from 2012 to 2014. Post-intervention, the seventh-graders in “Community 2” showed a statistically significant decrease of 2.7% in the prevalence of obesity compared with control communities. The fourth and seventh-grade students in both communities reported significant behavioral improvements for decreased sugar-sweetened beverage and increased water intake, while students in “Community 2” also improved behavior around decreased screen time. (The study authors noted that seventh-graders may have shown greater improvement because they had been receiving the school-based interventions since fifth grade, while younger grades measured had mostly received interventions from after school programs and community health centers that reached fewer children.) There were no significant differences reported in either community regarding fruit and vegetable intake, fruit juice, sleep duration, or physical activity.

“While our results were modest, they were achieved over a relatively short period of time, which is important given the substantial challenges of implementing a large-scale community initiative to address obesity,” said Rebecca Franckle, postdoctoral fellow at Harvard Chan School and lead author of the study.

Despite moderate results, Franckle and her co-authors noted that their study demonstrates the potential impact on obesity and behavioral change of a large-scale community intervention that employed many different sectors. Future interventions might consider the longer-term impact of such efforts, as observed by Denise Gaudette, an MA-CORD school district project coordinator and middle school health educator:

The MA-CORD Project made an impact in our community schools that was evident in the everyday experiences of our students. As I visited all the schools in our large district, I witnessed students, teachers and parents embracing behavior changes measured by the project goals. I met students who were more knowledge​able about the impact of getting more sleep and reducing sugar-sweetened beverages; and students who were more active on a daily basis. Now that I am back in the classroom, I am seeing that the children impacted by the many project interventions continue to carry these healthy attitudes and practice these behaviors, and will likely do so into adulthood.

Pamela Rivers, the Nursing and Health Services Director in another participating school district, added:

As an urban school district and a subset of the local community, it was a most exciting opportunity for the schools to partner with the Harvard Chan School of Public Health, the local community sectors, and the MA-CORD Project. The outcomes noting the significant decrease in the prevalence of obesity, particularly with the 7th graders, provides encouragement in the potential for future reduction in childhood obesity in association with specific behavioral targets. It is rewarding to experience participation in community-based initiatives with long-term sustained impacts.

Along with this school-based component, the July 2017 issue of Obesity includes research into the impact of the MA-CORD clinical intervention on BMI, as well as the WIC intervention on BMI and obesity related behaviors.



  1. Ogden CL, Carroll MD, Fryar CD, Flegal KM. Prevalence of obesity among adults and youth: United States, 2011–2014. NCHS data brief, no 219. Hyattsville, MD: National Center for Health Statistics. 2015.
  2. Franckle, R, et al. Student Obesity Prevalence and Behavioral Outcomes for the Massachusetts Childhood Obesity Research Demonstration Project. Obesity (2017) 25, 1173-1180.