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Peer-reviewedCC BY 4.0JAMA Network Open

A Community-Based Behavioral Intervention and Body Mass Index in School-Aged Children

  • Monica L. Wang1,2
  • Selenne Alatorre1
  • Aviva G. Schwarz1,3
  • Janice Weinberg4
  • Linda Sprague Martinez5
  • Jennifer Aldworth6
  • Rabindra Kadel7
  • Milagros C. Rosal8
  • Stephenie C. Lemon8
8 affiliations
  1. 1Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts
  2. 2Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
  3. 3Department of Psychiatry, Boston Medical Center, Boston, Massachusetts
  4. 4Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
  5. 5Department of Medicine, University of Connecticut School of Social Work, Hartford
  6. 6Massachusetts Alliance of Boys & Girls Clubs, Ludlow
  7. 7Center for Health Data Science, Boston University School of Public Health, Boston, Massachusetts
  8. 8Department of Population and Quantitative Health Sciences, University of Massachusetts T.H. Chan School of Medicine, Worcester
Open at sourceDOICite

Abstract

Importance: Childhood obesity remains a major concern in the US, with increases in body mass index (BMI) observed during and after the COVID-19 pandemic. Scalable behavioral interventions are needed to support obesity prevention in community settings.

Objective: To evaluate the efficacy of a community-based behavioral intervention (H ₂ GO!) on BMI z scores ( z BMIs) among school-aged children.

Design, Setting, and Participants: This cluster randomized clinical trial was conducted from September 2020 to June 2025 across 11 Boys & Girls Club sites in Massachusetts. Sites were pair-matched and randomized to intervention or usual care condition. Participants included children aged 8 to 13 years and their parents or caregivers.

Intervention: Twelve group-based sessions delivered in person over 6 weeks by trained Boys & Girls Club staff using behavioral strategies to reduce sugar-sweetened beverage intake and increase water consumption through health sessions, youth-created narratives, and parent-child activities. Comparison sites received usual programming.

Main Outcomes and Measures: Outcomes were assessed at baseline and at 2, 6, and 12 months using intention-to-treat analyses. The primary outcome was 12-month change from baseline in child z BMI, derived from staff-measured height and weight using standardized protocols. Secondary outcomes included child sugar-sweetened beverage and water intake measured using a validated questionnaire.

Results: Among 437 child participants (mean [SD] age, 10.1 [1.2] years; 219 girls [50.1%]), 0.2% were American Indian or Alaska Native, 1.8% were Asian, 15.8% were Black or African American, 42.6% were Hispanic or Latino, and 29.5% were White; 297 (68%) were eligible for free or reduced-price lunch. At baseline, 74 children (16.9%) had overweight, and 161 (36.8%) had obesity. From baseline to 12 months, the mean z BMI did not statistically significantly decrease (−0.11 [95% CI, –0.25 to 0.02]) in the intervention group and did not statistically significantly increase (0.08 [95% CI, –0.04 to 0.20]) in the comparison group; however, the estimated between-group difference in the adjusted mean z BMI change from baseline was statistically significant: −0.19 (95% CI, −0.38 to −0.01; P = .04). Between-group differences in sugar-sweetened beverage and water intake were not significant.

Conclusions and Relevance: In this cluster randomized clinical trial, a community-based behavioral intervention was associated with a statistically significant between-group difference in z BMI change among school-aged children. Findings support the potential of community-based behavioral interventions in obesity prevention.

Trial Registration: ClinicalTrials.gov Identifier: NCT04265794

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Cite

BibTeXRIS
BibTeX
@article{wang2026communitybased,
  title = {{A Community-Based Behavioral Intervention and Body Mass Index in School-Aged Children}},
  author = {Monica L. Wang and Selenne Alatorre and Aviva G. Schwarz and Janice Weinberg and Linda Sprague Martinez and Jennifer Aldworth and Rabindra Kadel and Milagros C. Rosal and Stephenie C. Lemon},
  journal = {JAMA Network Open},
  year = {2026},
  month = oct,
  doi = {10.1001/jamanetworkopen.2026.38188},
  url = {https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2855120},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - A Community-Based Behavioral Intervention and Body Mass Index in School-Aged Children
AU  - Monica L. Wang
AU  - Selenne Alatorre
AU  - Aviva G. Schwarz
AU  - Janice Weinberg
AU  - Linda Sprague Martinez
AU  - Jennifer Aldworth
AU  - Rabindra Kadel
AU  - Milagros C. Rosal
AU  - Stephenie C. Lemon
PY  - 2026
DA  - 2026/10/09
JO  - JAMA Network Open
DO  - 10.1001/jamanetworkopen.2026.38188
UR  - https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2855120
AB  - Importance: Childhood obesity remains a major concern in the US, with increases in body mass index (BMI) observed during and after the COVID-19 pandemic. Scalable behavioral interventions are needed to support obesity prevention in community settings.  Objective: To evaluate the efficacy of a community-based behavioral intervention (H ₂ GO!) on BMI z scores ( z BMIs) among school-aged children.  Design, Setting, and Participants: This cluster randomized clinical trial was conducted from September 2020 to June 2025 across 11 Boys & Girls Club sites in Massachusetts. Sites were pair-matched and randomized to intervention or usual care condition. Participants included children aged 8 to 13 years and their parents or caregivers.  Intervention: Twelve group-based sessions delivered in person over 6 weeks by trained Boys & Girls Club staff using behavioral strategies to reduce sugar-sweetened beverage intake and increase water consumption through health sessions, youth-created narratives, and parent-child activities. Comparison sites received usual programming.  Main Outcomes and Measures: Outcomes were assessed at baseline and at 2, 6, and 12 months using intention-to-treat analyses. The primary outcome was 12-month change from baseline in child z BMI, derived from staff-measured height and weight using standardized protocols. Secondary outcomes included child sugar-sweetened beverage and water intake measured using a validated questionnaire.  Results: Among 437 child participants (mean [SD] age, 10.1 [1.2] years; 219 girls [50.1%]), 0.2% were American Indian or Alaska Native, 1.8% were Asian, 15.8% were Black or African American, 42.6% were Hispanic or Latino, and 29.5% were White; 297 (68%) were eligible for free or reduced-price lunch. At baseline, 74 children (16.9%) had overweight, and 161 (36.8%) had obesity. From baseline to 12 months, the mean z BMI did not statistically significantly decrease (−0.11 [95% CI, –0.25 to 0.02]) in the intervention group and did not statistically significantly increase (0.08 [95% CI, –0.04 to 0.20]) in the comparison group; however, the estimated between-group difference in the adjusted mean z BMI change from baseline was statistically significant: −0.19 (95% CI, −0.38 to −0.01; P = .04). Between-group differences in sugar-sweetened beverage and water intake were not significant.  Conclusions and Relevance: In this cluster randomized clinical trial, a community-based behavioral intervention was associated with a statistically significant between-group difference in z BMI change among school-aged children. Findings support the potential of community-based behavioral interventions in obesity prevention.  Trial Registration: ClinicalTrials.gov Identifier: NCT04265794
SN  - 2574-3805
ER  -