Effectiveness of a multi-faceted, school-based health intervention program with 4th graders in Alabama

•Intervention children improved their nutritional knowledge, attitudes, and beliefs.•Intervention children were more likely to choose healthier foods after intervention.•More intervention children reported healthy weight loss attempts at posttest.•Fourth-graders find avatar manipulation useful for healthy body size consideration.•Females increased in size of desired/ideal body circumference measurements

Childhood obesity is considered one of the most prevalent, chronic disorders in the U.S. with Alabama among the states with the highest incidence. Schools have the opportunity to play a vital role in educating children about healthy nutritional, physical, and psychological choices. The purpose of this multi-faceted, school-based health intervention was to educate children about healthy nutrition, promote physical activity, and use avatars as an educational and motivational tool for understanding and developing healthy bodies. Six fourth-grade classrooms in rural Alabama participated. The intervention group consisted of 25 males and 26 females (43% African-American, 57% European-American; 26% obese, 14% overweight) who received a 10-week nutrition education program that incorporated classroom physical activity and exposure to avatars. The control group consisted of 30 males and 24 females (41% African-American, 59% European-American; 28% obese, 15% overweight) who received no intervention or initial avatar exposure. Repeated Measures Analysis of Variance determined that only intervention children significantly improved their healthy food choice intentions, ability to identify fatty foods, and general nutrition knowledge at posttest. Additionally, most intervention students reported that manipulating their avatar's body size helped them think about healthy weight (86%-helpful, 12%-somewhat helpful) and their own best, healthy body size (76%-yes, 22%-maybe). Intervention children picked healthier avatars as their ideal/desired body size at posttest. This intervention improved nutrition knowledge and attitudes and provided preliminary evidence that avatars can be a useful tool in childhood health interventions to help elementary school students think about healthy weight and body size.