Original Article

Reducing High BMI in African American Preschoolers Effects of a Behavior-Based Physical Activity Intervention on Caloric Expenditure

Authors: James J. Annesi PhD, FAAHB, Alice E. Smith MS, MBA, Gisèle A. Tennant MSc


Objectives: Overweight and obesity in young children are increasing concerns for medical professionals. Lack of sufficient physical activity may be the primary cause; therefore, the development and testing of a theory-based intervention for preschoolers is a priority.

Methods: A 30-minutes/day preschool-based intervention (Start For Life), with a foundation in social cognitive theory that emphasizes the use of self-regulation skills and feelings of mastery (self-efficacy), was administered for 9 months to 4- and 5-year-old African American children.

Results: Findings indicated a significant increase in accelerometer-measured moderate-to-vigorous and vigorous physical activity during the 7-hour school day. Reductions in body mass index (BMI; kg/m2) were significant, with greater effects found in participants with an initially higher BMI. Further analyses indicated that the kilocalories expended through physical activity explained approximately 87% of the weight lost. Participants’ sex did not affect the identified changes in BMI.

Conclusions: A brief theory-based physical activity intervention (Start For Life) was associated with increased moderate-to-vigorous and vigorous physical activity and reduced overweight/obesity in 4- to 5-year-old preschoolers. Because of its practical format, opportunities for widespread dissemination may be possible.

This content is limited to qualifying members.

Existing members, please login first

If you have an existing account please login now to access this article or view purchase options.

Purchase only this article ($25)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.


1. Singh AS, Mulder C, Twisk JW, et al. Tracking of childhood overweight into adulthood: a systematic review of the literature. Obes Rev. 2008; 9: 474–488.
2. Kopelman P. Health risks associated with overweight and obesity. Obes Rev. 2007; 8: 13–17.
3. Ogden CL, Carroll MD, Curtin LR, et al. Prevalence of high body mass index in US children and adolescences. JAMA. 2010; 303: 242–249.
4. Must A, Tybor DJ. Physical activity and sedentary behavior: a review of longitudinal studies of weight and adiposity in youth. Int J Obes (Lond). 2005; 29: S84–S96.
5. Ward DS, Vaughn A, McWilliams C, et al. Physical activity at child care settings: review and research recommendations. Am J Lifestyle Med. 2009; 3: 474–488.
6. Hesketh KD, Campbell KJ. Interventions to prevent obesity in 0–5 year olds: an updated systematic review of the literature. Obesity (Silver Spring). 2010; 18: S27–S35.
7. Baranowski T, Lin LS, Wetter DW, et al. Theory as mediating variables: why aren’t community interventions working as desired? Ann Epidemiol. 1997; 7: S89–S95.
8. Bandura A . Social Foundations of Thought and Action: A Social Cognitive Theory. Englewood Cliffs, NJ: Prentice Hall; 1986.
9. Annesi JJ, Tennant G, Westcott WL, et al. Effects of the Youth Fit For Life protocol on physiological, psychological, and behavioral factors at YMCA Calgary after-school care sites. Psychol Rep. 2009; 104: 879–895.
10. US Department of Health and Human Services. 2000 CDC growth charts: United States. http://www.cdc.gov/growthcharts. Accessed June 5, 2013.
11. FY 2013 Office of Head Start Monitoring Protocol. Washington, DC: Administration for Children and Families, US Department of Health and Human Services; 2012.
12. Cole TJ, Faith MS, Pietrobelli A, et al. What is the best measure of adiposity change in growing children: BMI, BMI %, BMI z-score, or BMI centile? Eur J Clin Nutr. 2005; 59: 419–425.
13. American College of Sports Medicine. ACSM’s Guidelines for Exercise Testing and Prescription. 8th ed. New York: Lippincott Williams & Wilkins; 2010; .
14. Pate RR, Almeida MJ, McIver KL, et al. Validation and calibration of an accelerometer in preschool children. Obesity (Silver Spring). 2006; 14: 2000–2006.
15. Hall KD. What is the required energy deficit per unit weight loss? Int J Obes (Lond). 2008; 32: 573–576.