Body Fat and Fitness Improvements in Hispanic and African
American Girls
Norma Olvera,1 PHD, Patrick Leung,2 PHD, Stephanie F. Kellam,1 MS, and Jian Liu,3 PHD
1
Health Program, Educational Psychology Department, University of Houston, 2Graduate College of Social
Work, University of Houston, and 3Health and Human Performance, University of Houston
All correspondence concerning this article should be addressed to Norma Olvera, PHD, Health Program,
Educational Psychology Department, University of Houston, 491 Farish Hall, Houston, TX 77204-5029,
USA. E-mail: [email protected]
Received August 6, 2012; revisions received April 29, 2013; accepted May 14, 2013
Objective The design of effective obesity interventions to reduce adiposity and increase fitness in minority
children is a public health priority. This study assessed the effectiveness of a summer intervention in lowering adiposity and increasing aerobic endurance in minority girls. Methods 99 Hispanic and African
American girls and their mothers participated. During the intervention, girls attended daily exercise, nutrition
education, and counseling sessions from 9:00 AM to 5:00 PM. Mothers attended 2-h weekly exercise, nutrition, and counseling sessions. Percent body fat, abdominal fat, and aerobic endurance (1-mile run/walk minutes) data were collected at pre- and post-intervention. Results A repeated-measures analysis of variance
was used to test differences in adiposity indicators and aerobic endurance. Findings indicated statistically significant reductions in percent body fat (p < .001), abdominal fat (p < .001), and 1-mile run/walk minutes
(p < .001). Conclusions This study demonstrated the effectiveness of a summer intervention in reducing
adiposity indicators and increasing aerobic endurance.
Key words
intervention outcome; obesity; children.
Based on the National Health and Nutrition Examination
Survey, 32% of children and adolescents (ages 2–19 years)
are classified as overweight and 17% as obese. Although
obesity affects children of all ages and genders, this health
problem is more pronounced in low-income and minority
children (Ogden, Carroll, Curtin, Lamb, & Flegal, 2010;
Ogden, Carroll, Kit, & Flegal, 2012). Major health consequences are associated with childhood obesity, including
increased risk factors for cardiovascular disease, metabolic
syndrome, and sleep apnea (Freedman, Mei, Srinivasan,
Berenson, & Dietz, 2007; Han, Lawlor, & Kimm, 2010;
Whitlock, Williams, Gold, Smith, & Shipman, 2005).
These findings point out the need to develop effective obesity interventions designed for children as a public health
priority.
Research has shown that implementation of physical
activity (PA) interventions might be an effective approach
to combat childhood obesity because they have yielded a
decrease in body fat and an increase in aerobic endurance
in children (Gutin, Yin, Johnson, & Barbeau, 2008; Gutin
et al., 2002; Howe, Harris, & Gutin, 2011). These studies
also suggested focusing on reducing body fat as an outcome of PA interventions because body fat has been more
associated with cardiovascular disease and metabolic syndrome than body mass index (BMI) (Janssen, Katzmarzyk,
& Ross, 2002; Weiss et al., 2004; Yusuf et al., 2004).
Furthermore, the use of BMI is limited and does not provide important information regarding changes in body
composition and it does not differentiate between lean
and fat mass (Biggard et al., 2004; Gutin, 2011).
According to the Centers for Disease Control and
Prevention (CDC, 2006), increasing PA in minority children is of great significance, given that they exhibit lower
levels of PA and sports participation than their white counterparts (CDC, 2003; Singh, Yu, Siashpush, & Kogan,
2008). The lowest rates of PA have been found in
Journal of Pediatric Psychology 38(9) pp. 987–996, 2013
doi:10.1093/jpepsy/jst041
Advance Access publication June 20, 2013
Journal of Pediatric Psychology vol. 38 no. 9 ß The Author 2013. Published by Oxford University Press on behalf of the Society of Pediatric Psychology.
All rights reserved. For permissions, please e-mail: [email protected]
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Olvera, Leung, Kellam, and Liu
overweight Hispanic (Butte, Puyau, Adolph, Vohra, &
Zakeri, 2007) and African American (Kevin et al., 2004)
girls. In sum, these findings provide strong evidence supporting the development of PA interventions targeting
minority girls.
Literature reviews indicate there is a paucity of PA
interventions designed to reduce adiposity indicators and
increase physical fitness in minority girls, particularly
Hispanic girls (Camacho-Miñano, LaVoi, & Barr-Anderson,
2011; Van Slujis, McMinn, & Griffin, 2008). PA interventions have been delivered primarily at school or community
settings and their outcomes have been mixed with regard
to their effectiveness. Barbeau et al.’s (2007) PA intervention targeting African American girls (ages 8–12) revealed a
significant decrease in percent body fat (%BF) and an increase in physical fitness. Davis et al. (2009) also reported
a reduction of multiple adiposity outcomes and fasting
glucose in overweight Latina girls after a combination of
nutrition, aerobics, and strength training interventions. In
contrast, findings from a series of pilot studies named Girls
Health Enrichment Multisite Studies (Beech et al., 2003;
Robinson et al., 2003; Story et al., 2003) revealed no significant changes in adiposity indicators or physical fitness
in minority girls (ages 8–10). Small sample size and low
attendance rates were offered as explanations for these
insignificant results.
While school- and community-based obesity interventions during the academic year still remain logical and
valuable venues for health promotion, summer break may
also be a critical time to intervene (Carrel, Clark, Peterson,
Eickoff, & Allen, 2007; von Hippel, Powell, Downey, &
Rowland, 2007). Research indicates summer aggravates
children’s risk for excessive weight gain and increased
body fat development (Downey & Boughton, 2007;
Gillis, McDowell & Bar-Or, 2005; von Hippel et al.,
2007). African American and Hispanic children seem to
be particularly vulnerable to increases in weight gain and
fatness during this time (von Hippel et al., 2007). Despite
the increased risk for obesity in minority children during
the summer, limited research has been conducted to test
the effectiveness of summer interventions to reduce adiposity or promote fitness in minority children. Baranowski
et al. (2003) conducted a 12-week pilot healthy lifestyle
intervention designed for African American girls and their
mothers. They found no statistically significant changes in
BMI or PA levels, although a trend toward a lower BMI was
observed in the treatment group. Other studies involving
white children, such as Gately et al. (2005), reported decreases in BMI and %BF in children aged 9–18 years who
participated in a residential camp for an average of 29 days.
However, none of these studies involved Hispanic children.
To fill this gap in the literature, the purpose of this study
was to assess the effectiveness of a predominantly PA
summer intervention designed to reduce adiposity and
increase aerobic endurance in Hispanic and African
American girls. Given the exploratory nature of this
study, it is hypothesized that at post-intervention, girls
would exhibit significant decreases in %BF, waist circumference (WC), and 1-mile run/walk minutes compared with
their baseline values.
Methods
Participants
The sample consisted of 99 minority girls with a mean age
of 11.2 years (SD 1.6 years) and their mothers with a
mean age of 38.8 years (SD 6.6 years). Girls and their
mothers participated in a 4-week healthy lifestyle summer
intervention known as BOUNCE (Behavior Opportunities
Uniting in Nutrition, Counseling, and Exercise). Data were
collected from three different cohorts of mother–daughter
pairs who participated during the summers of 2008
(cohort 1), 2009 (cohort 2), and 2010 (cohort 3). This
study included a nonexperimental design (one-group preand post-intervention). Study inclusion criteria consisted
of girls being (1) between the ages 9 and 14 years, (2) selfidentified as Hispanic or African American, (3) overweight
(BMI the 85th percentile) or obese (BMI the 95th
percentile), and (4) free from restrictions that would limit
participation in this intervention, as determined by a medical professional. Participants were recruited primarily
through referrals by school nurses and teachers and community outreach coordinators. Before baseline measurements, mothers and daughters were asked to sign
consent/assent forms. The University of Houston
Committee for the Protection of Human Subjects approved
the research protocols and consent/assent forms.
BOUNCE Intervention Description
Each cohort attended the BOUNCE intervention from 9
AM to 5 PM Monday through Friday during the month
of July. The BOUNCE day commonly consisted of three
to four 1-h exercise sessions, 1-h nutrition education session, and 1-h behavioral counseling session. A typical
BOUNCE day started with a flexibility session followed
by a sports skills or games session. Afterward, there was
a lunch and a nutrition lesson followed by a traditional
fitness, counseling, and dance session. Nutrition lessons
were focused on enhancing self-efficacy, knowledge, and
skills related to reducing the intake of sweetened beverages
and high-fat foods, and increasing the consumption of
diverse fruits and vegetables.
Body Fat and Fitness Improvements
The behavioral and counseling component focused on
promoting self-esteem, tackling body image concerns, and
developing effective coping strategies to deal with stressful
situations (i.e., avoiding emotional eating, and practicing
healthy techniques for expressing thoughts, feeling, and
emotions). Cognitive behavioral principles (Cooper,
Fairburn, & Hawker, 2003) were used to guide intervention focusing on cognitive restructuring, providing problem-solving strategies, using self-monitoring and stimulus
control techniques to promote healthier choices, and setting of behavioral goals regarding exercise, nutrition, and
relationships. We used motivational interviewing as a
method for communicating with participants about their
barriers and challenges with change and the possibilities to
engage in healthier behaviors that were consistent with
their goals. Reflective listing, content reflections, and positive affirmations were used to encourage participants to
express their reasons for and against change (Resnicow,
Davis, & Rollnick, 2006).
Considering that the BOUNCE intervention was primarily a PA intervention, the next section will describe in
detail the BOUNCE exercise program. As shown in Table I,
the BOUNCE exercise program consisted of group PA sessions of varied intensity or metabolic equivalent (MET)
based on Ridley’s compendium (Ridley, Ainsworth, &
Olds, 2008) for energy expenditure in youth (light ¼
2 METS, moderate ¼ 3–5 METS, vigorous ¼ 6 METS).
These PAs were grouped into flexibility, sports skills,
games, traditional fitness, and dancing categories. Each of
the cohorts was exposed to 3600 min (60 h) of PA for 4
weeks. This equals 900 min (15 h) per week and 180 min
(3 h) per day. Although the total number of minutes of
exposure to PA remained the same across three cohorts,
there were differences in the type and number of PAs offered to each cohort. Variation in type and duration of PAs
was a result of several factors, including participant preference, instructor availability, and weather conditions.
Each BOUNCE exercise session was standardized and
included approximately a 5-min warm-up, 20–50 min of
light to vigorous PA, and a 5-min cool-down phase.
Instructors certified by the nationally recognized Cooper
Institute led exercise sessions at a dance studio located
on a university campus. As part of the BOUNCE design,
mothers participated in a 2-h weekly session where they
received nutrition education, exercise training, and parenting strategies on how to support their daughters’ healthy
lifestyle program. A dietitian, an exercise physiologist, and
a child psychologist led sessions in English for all children
and English-speaking mothers. For Spanish-speaking
mothers, a health professional who spoke Spanish led
most of the sessions. However, some sessions were led in
Table I. Category and Duration of the BOUNCE Physical Activities
Duration (min)
Category
Flexibility
Ballet
Cohort 1
(2008)
Cohort 2
(2009)
Cohort 3
(2010)
Combined
90
0
120
Budokon
240
120
0
210
360
Pilates
210
180
120
510
Yoga
300
240
330
870
Sports skills
Kickball
0
60
60
120
Basketball
180
300
300
780
Soccer
Self-defense
180
180
300
240
300
240
780
660
300
Track and field
0
0
300
Tennis
120
120
0
240
Volleyball
240
60
120
420
Survivor games
60
75
75
210
Amazing race
60
75
75
210
Relays
Traditional fitness
180
30
0
210
Step aerobics
180
180
240
600
Spinning
240
420
420
1080
Games
Boot camp
Circuit training
0
60
60
120
60
240
240
540
Core training
180
0
0
180
Latin aerobics
180
120
0
300
240
240
240
720
Kickboxing
Dancing
Rumba/Zumba
60
180
180
420
Hip hop
120
180
180
480
Cheerleading
240
180
0
420
60
0
0
60
3600
3600
3600
10 800
Modern dance
Total
English with simultaneous translation in Spanish. When
children or mothers were absent, a packet with missed
BOUNCE content was given to them on their return or
mailed to their homes.
Cultural Adaptation
A significant contribution of the BOUNCE intervention is
the inclusion of messages that combine culture and core
values as a medium to motivate behavior change. Following
Resnicow, Baranowski, Ahluwalia, and Braithwaite’s
(1999) cultural sensitivity guidelines, the BOUNCE intervention was designed to address several cultural structures,
including (1) surface structure (e.g., inclusion of maternal
component, Latin and African American food in cooking
demonstration, Latin and hip hop dancing, employment of
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Olvera, Leung, Kellam, and Liu
Latin and African American instructors, and health-related
material in Spanish) and (2) deep structure (e.g., collectivism by having group goals, importance of respect and maternal role, and use of peer support) characteristic of the
community. Ancillary topics and activities were included in
response to participants’ requests (e.g., raising a child
within two cultures, normal adolescent development, and
strategies to deal with weight-related teasing/bullying).
Instruments
Data were collected at pre-intervention (1 week before intervention) and post- intervention (last 2 days of intervention), except for the accelerometer and attendance data,
which were collected daily during the intervention, and
demographic information was collected at pre-intervention
only.
Demographic and Attendance Data
Mothers and girls completed a demographic survey composed of questions such as age, education, and date and
place of birth. The percentage of participant attendance
was calculated as the number of days each participant attended divided by 20 days (number of days that the
BOUNCE intervention was offered) then multiplied by
100. This result was averaged across participants. Participants who came late or left early were recorded as having
attended that day. Girls were also asked about their participation in other structured summer programs besides
BOUNCE.
Adiposity Indicators
Participants’ %BF was obtained from a foot-to-foot bioelectrical impedance analysis using the Tanita TBF-310 series
scale at pre- and post-intervention. To control for variation
in level of hydration, participants were assessed on their
early morning arrival during data collection days. The
Tanita TBF-310 has been found to be a valid method to
assess %BF in a group of children. Children’s %BF generated by the Tanita TBF-310 has been associated with anthropometric measurements (e.g., sum of skinfolds and
WC), with intraclass correlation coefficients between 0.90
and 0.95 (Kettaneh et al., 2005). Other researchers such
as Radley et al. (2009) have suggested the use of Tanita
TBF-310 for obtaining group mean values rather then individual values in children. Participants’ abdominal fat was
assessed through WC measurements at pre- and post-intervention following guidelines by National Health and
Nutrition Examination Survey procedure (CDC, 2007).
To measure WC, research assistants placed a springgauge loaded, nonelastic, flexible measuring tape at a
point midway between the participant’s last rib of the rib
cage to the top of the iliac crest at the end of a normal
expiration. The WC measurements were taken twice. The
average of the two WC measurements was recorded as the
final WC value.
Participants’ body weight and height were measured to
the nearest 0.1 kg and 0.1 cm, respectively, using a scale
(Tanita TBF 310) and a portable stadiometer (Seca 213).
Each participant was instructed to remove her shoes and
socks or any heavy garments before stepping onto the
scale. Using the Quetelet’s index [body weight (kilograms)/height2 (meters)], BMI was calculated. BMI values
were then used to identify the age- and gender-specific
percentile for each child using CDC growth charts (CDC,
2012). Based on these percentiles, each child was classified
as overweight (85th–94th percentile) or obese (95th
percentile). According to the World Health Organization
(WHO, 2012) obesity classification, mothers with a
BMI 24.9 were classified as normal weight, with a
BMI ¼ 25–29.9 as overweight, and with a BMI 30 as
obese.
Physical Activity
To monitor girls’ changes in frequency, duration, and intensity of PA during the BOUNCE intervention, ActicalÕ
accelerometers (Mini Mitter, a Respironics Co., Bend, OR)
were used following protocols developed by Puyau,
Adolph, Vohra, Zakeri, and Butte (2004). The ActicalÕ accelerometer was programmed to collect data in 60-s epochs
from 9 AM until 5 PM every day Monday to Friday for 4
weeks. On completion of each 5-day intervention week,
accelerometer data (activity counts per minute) were downloaded into the ActicalÕ program and exported to an Excel
spreadsheet for initial analysis. In the initial examination,
data completeness was verified against an exercise log and
attendance roster. After this initial data screening, activity
counts were summed for each day and each activity.
Activity counts per minute were partitioned as moderateto-vigorous (MVPA: 1500 counts min1) using cutoff
points developed by Puyau et al. (2004).
Aerobic Endurance
Aerobic endurance was assessed in girls using the 1-mile
run/walk minutes. FitnessgramÕ guidelines were followed
for the assessment (Welk & Meredith, 2008) at baseline
and post-intervention. Girls were asked to complete the
1-mile distance in the fastest time possible. Trained research assistants were assigned to record three participants
at a time and score their lap number. The research assistants encouraged the participants to complete the test as
quickly as possible, although walking was permissible.
Body Fat and Fitness Improvements
Data Analysis
Descriptive statistics including means and standard deviations were calculated to identify basic characteristics of the
data and sample population. Variables were assessed for
normality by evaluating skewness and kurtosis. Changes in
various adiposity indicators at pre- and post-intervention
were tested using repeated-measures analysis of variance
(RM-ANOVA). Additionally, RM-ANOVA was used to control for baseline differences across cohorts. Alpha was set at
0.05. To allow comparison of effect size across the different
measures, eta2 (Cohen, 1988) was reported for each of the
clinical variables.
Table II. Demographic Characteristics of Sample
A total of 145 mother–daughter pairs were contacted for
eligibility. Twenty-six mother–daughter pairs were excluded because they did not meet inclusion criteria, and
14 pairs were excluded because they participated in multiple cohorts. Six mother–daughter pairs withdrew from
study participation due to illness, vacation, and lack of
transportation. As a result, the final sample was reduced
to 99 mother–daughter pairs. As shown in Table II, the
majority of the participants were of Hispanic origin.
However, while most of the girls were U.S.-born, mothers
were more likely to be born in Mexico or Central America.
More than half of the girls were attending sixth to eighth
grade. Mothers were more likely to have <12 years of
formal education, be married, be unemployed or classified
as a housewife, and have an annual household income of
<$30 000 for an average family size of five (SD 1.4).
Girls’ participation during the BOUNCE interventions
was high. The average attendance was 87, 86, and 95% for
cohorts 1, 2, and 3, respectively, with a combined average
attendance of 89% of the total days attended by participants. The most common reasons for absences for girls
included sickness, lack of transportation, and family vacation. Besides BOUNCE, only 16% of girls participated in
structured summer programs offered at their church or
Young Men’s Christian Organization during the summer.
The majority of the girls (84%) reported that they stayed at
home when they were not in BOUNCE. Maternal
BOUNCE attendance was lower than that of their
daughters. The average attendance for the mothers was
75, 72 and 77% for cohorts 1, 2, and 3, respectively,
with a combined average attendance of 75% of the total
days. The most common reasons for their absences were
lack of childcare and transportation and conflict with
schedule.
Child
38.8 (6.6)
11.2 (1.6)
Age (years.)
Mean (SD)
Self-described ethnicity (%)
Hispanic
78%
78%
African American
22%
22%
US
38%
93%
Mexico, Central America
62%
7%
11.1 (1.0)
6.1 (3.0)
Birth place (%)
If foreign-born, years in US
Mean (SD)
Marital status (%)
Single/never married
Results
Baseline Demographic Characteristics and
Attendance of the Study Sample
Mother
9%
Married or living with partner
77%
Divorced/widowed/separated
13%
Refused
1%
Education (%)
3rd–5th grade
0%
46%
6th–8th grade
9th–12th grade
16%
41%
54%
Some college
19%
College graduate or higher
17%
Vocational or technical
7%
Occupation (%)
Managerial/professional
Technician/sales
Administrative support
Service/manual skilled worker
12%
2%
8%
16%
Housewife
28%
Unemployed
34%
Annual household income (%)
<$20,000
36%
$20 001–$30 000
25%
>$30,001
25%
Don’t know
14%
Changes in Time Spent in MVPA During
BOUNCE Interventions
The combined daily mean MVPA was 61.8 14.9 min for
week 1, 79.9 23.3 daily minutes for week 2, 85.8 28.7
daily minutes for week 3, and 99.2 29.3 min for week 4.
An RM-ANOVA test was conducted to evaluate changes
in MVPA from week 1 to week 4. Results indicated a
significant increase in daily MVPA from week 1 to week
4 across the three cohorts [Wilks’ lambda ¼ 0.43,
F(1,81) ¼ 106.68, p < .001]. For cohorts 1, 2, and 3, the
4-week mean daily MVPA was 75.6, 98.0, and 70.7 min,
respectively. Results also revealed that, on average, 78% of
the girls met daily MVPA guidelines.
991
992
Olvera, Leung, Kellam, and Liu
Impact of BOUNCE Interventions on Adiposity
Indicators and Aerobic Endurance
that the girls’ 1-mile run/walk minutes decreased significantly from pre- (mean ¼ 17.61, SD 2.76) to post-intervention (mean ¼ 15.00, SD 3.36) [F(1,83) ¼ 75.68,
p < .001]. The results also suggest that there was a significant interaction effect between cohorts and 1-mile
run/walk minutes [F(2,83) ¼ 4.75; p ¼ .011]. The data indicate that cohort 2 (mean ¼ 14.07, SD .447) and cohort
3 (mean ¼ 14.01, SD .52) had a significantly lower
1-mile run/walk minutes than cohort 1 (mean ¼ 16.61,
SD .44) in the post-BOUNCE intervention.
There were no significant differences at baseline in %BF
(p ¼ .904), WC (p ¼ .802), and BMI (p ¼ .152) among participants from cohorts 1, 2, and 3. However, there was a
significant difference in 1-mile run/walk minutes among
cohorts 1, 2, and 3 (p < .05). Therefore, a 1-way
RM-ANOVA test was conducted to evaluate changes in
1-mile run/walk minutes after controlling for cohorts. As
a result, simple pre–post analyses for the entire group of
children were conducted for %BF, WC, and BMI. At the
pre-intervention, 85% the girls were classified as obese and
15% as overweight (BMI mean ¼ 30.06, SD 6.37), and
had high levels of %BF (mean ¼ 42.18, SD 6.69) and
WC (mean ¼ 93.93, SD 14.86). Similar to their
daughters, most of the mothers were likely to be obese
(55%) or overweight (37%) with a mean BMI ¼ 33.85
(SD 18.85), a mean %BF ¼ 40.50 (SD 6.96), and a
mean WC ¼ 98.43 cm (SD 15.19 cm).
An RM-ANOVA was conducted to test for pre–postBOUNCE intervention effects. As presented in Table III,
the girls’ %BF decreased significantly from pre- to postintervention [F(1,87) ¼ 46.14; p < 0.001] by a mean difference of 2.49 %BF points. In addition, the girls’ WC (cm)
also decreased significantly [F(1,87) ¼ 25.95; p < .001] by
a mean difference of 5.27 cm. BMI was also significantly
lower after the intervention [F(1,87) ¼ 5.82; p < .05] by a
mean difference of 0.410 kg/m2. Because there was a significant difference in 1-mile run/walk minutes in baseline
for cohorts 1, 2, and 3, a 1-way RM-ANOVA was conducted to further examine the interaction effect of cohort
by pre–post-BOUNCE intervention. The results indicate
Discussion
The purpose of this study was to assess the effectiveness of
BOUNCE in lowering adiposity (%BF and WC) and 1-mile
run/walk minutes in primarily obese minority girls. An innovative aspect of this study is its implementation during
the summer season, a period that has been known to place
children, particularly minority children, at increased risk
for excessive weight gain (Downey & Boughton, 2007;
Gillis et al., 2005; von Hippel et al., 2007). Summer
weight gain can be as much as 2.8% of ideal body
weight, and the average BMI growth may be more than
twice as fast for the summer months than for the school
year (Gillis et al., 2005). In this current study, a significant
reduction of 2.49 %BF points was observed, which is
greater than what would have expected in a control
group. Because this study used a one-group pretest–posttest design, reference %BF data from Gutin’s group obesity
control studies (Gutin et al., 2008, 2002; Howe et al.,
2011) were used to determine changes that might be expected in a control group. Based on these studies, it would
Table III. Pre- and Post-Intervention Changes in Adiposity Indicators and Aerobic Endurance
Combined (2008-2010)
Variable
%BF
M (SD)
Pre
Post
42.18
39.69
(6.69)
(7.38)
WC (cm)
93.93
88.30
M (SD)
(14.86)
(14.44)
153.52
154.01
(10.79)
(10.61)
159.16
157.60
(47.17)
(46.14)
30.06
29.65
(6.37)
(6.23)
17.43
15.00
(3.36)
(2.76)
Height (cm)
M (SD)
Weight (lb)
M (SD)
BMI (kg/m2)
M (SD)
One-mile run/walk (min)
M (SD)
F
df
Sig. (2-tailed)
Effect Size (Partial Eta2)
46.14
1,87
<.001
.374
25.95
1,87
<.001
.230
3.80
1,87
.054
.042
22.00
1,87
<.001
.202
5.82
1,87
<.05
.063
66.10
1,85
<.001
.473
Note. Small effect (.10–<0.30); medium effect (0.30–<0.50); large effect (0.5).
Body Fat and Fitness Improvements
have expected a 0.6 %BF change in the control group.
Furthermore, our overall 2.49% BF reduction is consistent
with other studies that reported a 2–3%BF reduction as a
result of PA intervention (Gately et al., 2005; Janssen et al.,
2002; Weiss et al., 2004; Yusuf et al., 2004).
Results from this study also showed a statistically significant reduction in WC (5.27 cm). This finding is consistent with a summer intervention that reported a 6-cm
change in WC (Gately et al., 2005). The focus on reducing
WC is critical because recent studies have reported that
WC was a better determinant of cardiovascular disease
than BMI (Biggard et al., 2004; Gutin, 2011). WC has
been associated with metabolic syndrome (Gutin et al.,
2008), type 2 diabetes, hypertension, and cholesterol
(Gutin et al., 2002). To our knowledge, our findings contributed greatly to the literature regarding the impact of PA
on abdominal fat during a summer intervention because
limited research has examined such impact in minority
girls (Janssen et al., 2002; Olvera et al., 2010; Weiss
et al., 2004; Yusuf et al., 2004).
Changes in BMI as a result of the BOUNCE interventions were also explored, even though BMI was not the
focus of the study. In the current study, an average reduction in BMI of 0.410 kg/m2 was observed. This finding
effect size was small, but was congruent with the expert
committee recommendations of a gradual weight loss of 1
pound per month for 6–11- year-old children who are overweight and no more than an average of 2 pounds per week
for children aged 12–18 years (Barlow, 2007). Compared
with other studies, our finding regarding the reduction of
BMI was small (Gately, Cooke, Butterly, Mackreth, &
Carroll, 2000; Gately et al., 2005). Gately et al. (2000)
noted a significant decrease of 3.8 kg/m2 in BMI of 11–
16-year-old children who had participated in an 8-week
summer camp, which included five 1.5-hour exercise sessions per day. In another study, Gately et al. (2005) observed decreases of 2.4 kg/m2 in BMI and 3% in BF in
white children aged 9-18 years who attended camp for
an average of 29 days (included six 1-hour PA sessions
and dietary restriction). This study also revealed an increase in MVPA minutes and a decrease in 1-mile run/
walk minutes. A high percentage of girls in this study
achieved 60 min or more of MVPA per day. These findings
are relevant, given that a large number of minority children
are not meeting PA guidelines (Butte et al., 2007; CDC,
2006; Singh et al., 2008), particularly overweight Hispanic
girls (Butte et al., 2007). The use of accelerometers to
assess PA during the intervention represented an additional
strength to this study. Although the increase in PA during
the combined BOUNCE interventions was noteworthy,
there is no follow-up information regarding PA engagement
during evenings, weekends, and after the conclusion of the
4-week intervention. Future PA interventions should
include follow-up data to determine sustainability of
intervention effectiveness.
From a programmatic perspective, a major strength of
this study is its high attendance rate (89% minority girls).
This finding is consistent with that reported by Baranowski
et al. (2003), who found a 95.5% attendance rate in a
sample of African American girls who participated in
summer intervention. Although maternal weekly attendance was acceptable, it was more challenging primarily
due to lack of transportation and childcare and conflict
with work schedule. Overall, the high attendance rate suggests that summer intervention is a promising avenue for
promoting health behavior change in minority children.
The pediatric psychologist has an important role as a
member of an interdisciplinary team, with the unique ability to address behavioral and psychological issues related to
weight control. The pediatric psychologist is uniquely prepared to participate in this type of therapeutic intervention
due to his or her training in cognitive behavioral treatments
and motivational interviewing. Not only can pediatric psychologists function as direct interventionists with children,
but they can also work as advocates across systems. Having
skills that allow for work across the systems can lead to
improved intervention efforts that link family, medical, and
school systems to provide a comprehensive approach to
obesity.
Limitations of this study included the participants’
self-selection into the study and the absence of a true control or comparison group precluded the ability to control
for extraneous variables that can reduce internal validity.
The inclusion of a control or comparison group was not
possible, given the financial constraints of the intervention.
Future studies should include research designs that are
increasingly more complex, particularly in relation to adiposity outcomes. The use of a randomized controlled trial
design would strengthen the scientific design of replicating
efforts. Another limitation of this study was the lack of
dietary monitoring components to gauge daily nutritional
intake. Although participants ate healthy lunches and
snacks each day of the summer interventions, there was
no measurement of food intake at home or on weekends
recorded. The lack of follow-up PA data outside of the
intervention is another limitation. Furthermore, no cost
analysis (including elements e.g., number of children,
food expenses, and staff/child ratio) was conducted to determine the feasibility of dissemination of the intervention.
It is also important to recognize that other factors such as
parental support and involvement could have contributed
to the health changes. Despite the limitations to the
993
994
Olvera, Leung, Kellam, and Liu
current study, findings from BOUNCE notably contribute
to our understandings about the impact of summer interventions in reducing adiposity and increasing aerobic
endurance in high-risk populations for obesity.
Funding
This study was funded by a grant #66345 from the Robert
Wood Johnson Foundation Salud America! Program.
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