Participation in a School-Based Wellness Initiative Associated With Improved K-12 Student Body Mass Index Trends

J Sch Health. 2023 Jul;93(7):547-556. doi: 10.1111/josh.13292. Epub 2022 Dec 27.


Background: Associations between school participation in an academic medical center-supported school-based wellness initiative and programmatic components implemented with change in average student body mass index (BMI) over time were examined.

Methods: This was an observational study of 103 K-12 South Carolina schools over school years 2014-2018, classified as participating (n = 87 schools, 27,855 students) or non-participating (n = 16 schools; 3608 students). Associations between students' BMI z-score (BMIz) and school participation were evaluated by linear multilevel mixed-effects modeling using data from FitnessGram and the School Wellness Checklist© (SWC), respectively.

Results: One-third of the students had a BMI percentile ≥85. Average student BMIz decreased in participating schools (p = .026) and increased in non-participating schools (p = .004) over time. For schools that participated two or more years, there was an inverse relationship between SWC score and student BMIz (p = .002) that did not differ by school type, rural/urban location, Title 1 status, or student sex. Physical activity and stress management interventions for students, as well as employee wellness and establishing a wellness committee at the school level were significantly associated with decreased average student BMIz (all p < .05).

Conclusion: Implementation of similar comprehensive school-based wellness programs focused on improving physical activity, stress management, and employee engagement may help prevent and reduce pediatric obesity in diverse communities.

Keywords: body mass index; health promotion; obesity; pediatrics; school-based wellness; students.

Publication types

  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Body Mass Index*
  • Child
  • Female
  • Health Promotion*
  • Humans
  • Male
  • Pediatric Obesity / prevention & control
  • Physical Fitness
  • Schools* / legislation & jurisprudence
  • South Carolina
  • Stress, Psychological / prevention & control