An Analysis of Energy Balance Knowledge, Behaviors, and BMI among Adolescent SNAP-Ed Participants in The School District of Philadelphia

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Capstone Chair: Dr. Rickie Brawer, Jefferson School of Population Health, Thomas Jefferson University


Understanding the concept of energy balance (i.e., calories in = calories out) forms the basis of how to maintain a healthy weight through diet and physical activity. There is limited evidence that an energy balance-focused SNAP-Ed nutrition education program effectively impacts the energy balance knowledge (EBK) and behaviors of Philadelphia middle school students, and how those behaviors affect body mass index (BMI). This study aimed to further understand how low-income urban adolescents’ basic knowledge of metabolic energy balance is associated with their health behaviors, and how such behaviors are linked to weight status. A secondary data analysis was conducted using data from the School District of Philadelphia to examine relationships between students’ energy balance knowledge levels and energy balance behaviors, and their behaviors and BMI. Students’ baseline EBK level was negatively associated with SSB consumption (p<0.001). Baseline EBK and energy intake knowledge were significant predictors of SSB consumption. Baseline EBK was not associated with fruit and vegetable, milk or breakfast consumption, or with physical activity. EBK level was associated with, but not a significant predictor of breakfast, fruit and vegetable consumption, or physical activity among students who participated in the curriculum. Breakfast consumption was significantly linked to weight status; students who did not eat breakfast were about 2 times more likely to be overweight/obese than those who ate breakfast. The results showed that students lack basic understanding of metabolic energy balance, even after exposure to a nutrition education curriculum focused on the topic. Knowledge is necessary but not sufficient for behavior change to occur. Policy and system changes that address individual, social and environmental behavior influences, like structured recess, farm to school programs, and healthy eating policies in schools, could better improve adolescents' health behavior.

Presentation: 25 minutes