A Middle School Intervention to Improve Health Behaviors and Reduce Cardiac Risk Factors

Study Questions:

What is the impact of Project Healthy Schools, a 10-week school-based multidisciplinary intervention program in which sixth-grade middle school students are exposed to healthful activity and nutrition habits through educational and environmental change?


This was a prospective study of sixth-grade students from 23 middle schools in 12 cities in southeast and mid-Michigan with varying populations. The students served as historical controls in this 10-week program. The educational component of the program was delivered through 10 interactive, 20-minute long learning modules addressing the following five goals: 1) increasing intake of fruits and vegetables, 2) decreasing intake of high-sugar beverages, 3) performing at least 150 minutes of exercise per week, 4) decreasing intake of fast and fatty food, and 5) decreasing “screen” time with television and computer/video games. Learning modules were taught by advisory (or “homeroom”) teachers or Health Ambassadors. Environmental change involved significant modifications in the school cafeteria (e.g., addition of a salad bar). Health behaviors were assessed before and after participation through responses on the modified School-Based Nutrition Monitoring behavioral questionnaire. The authors also collected physiologic data before the 10-week program and again 1-3 months after program completion, collected data included body mass index, systolic and diastolic blood pressures, cholesterol panel, and random blood glucose.


A total of 2,118 students consented to complete the surveys and physiologic screening. Following participation in Project Healthy Schools, self-reported participation in moderate and vigorous exercise activities and consumption of fruits and vegetables increased; self-reported “screen” time also showed small, statistically significant reductions (2.27 hours per day at baseline vs. 2.08 hours per day at follow-up, p < 0.001). Program participants also had statistically significant reductions in total cholesterol, low-density lipoprotein cholesterol, triglycerides, and blood pressure at follow-up.


Project Health Schools, a collaborative, customizable, and multidisciplinary middle-school intervention aimed at promoting healthy behaviors, led to significant reductions in cardiovascular risk factors.


Children with cardiovascular risk factors are at risk for becoming adults with cardiovascular disease. Accordingly, it is crucial to address obesity and risk factors at a young age. The authors presented promising results from a well-orchestrated school-based program that could be more broadly implemented to promote healthy habits among middle-school children.

Clinical Topics: Diabetes and Cardiometabolic Disease, Dyslipidemia, Prevention, Hypertriglyceridemia, Lipid Metabolism, Nonstatins, Exercise

Keywords: Students, Michigan, Cholesterol, LDL, Exercise, Beverages, Health Behavior, Goals, Television, Video Games, Cholesterol, Fruit, Body Mass Index, Vegetables, Blood Glucose, Schools, Obesity, Questionnaires, Triglycerides

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