Pathways: A school-based program for the primary prevention of obesity in American Indian children

Benjamin Caballero, Sally Davis, Clarence E. Davis, Becky Ethelbah, Marguerite Evans, Timothy Lohman, Larry Stephenson, Mary Story, Jean White

Research output: Contribution to journalArticlepeer-review

55 Scopus citations


This report describes the proposed intervention and outcome measurement procedures for the Pathways study. Pathways is a multicenter school-based study aimed at reducing the alarming increase in the prevalence of obesity in American Indian children. It is designed as a randomized clinical trial, involving approximately 2,000 third grade children in 40 schools in seven different American Indian communities. During a 3-year feasibility phase, which was just completed, the major components of the intervention (school food service, classroom curriculum, physical education program, and family involvement) were developed and pilot-tested. The measurement instruments for body composition; physical activity; dietary intake; and knowledge, attitudes, and behavior were also developed and validated. Comprehensive process evaluation procedures also were defined. As of this writing, the full-scale intervention program is being initiated and is scheduled to be completed in the spring of 2000. The primary aim of the Pathways intervention is to reduce average percent body fat in intervention-school children by at least 3% compared with control-school children by the end of the 3-year intervention. This goal is to be achieved primarily by an increase in physical activity and a reduction in the percent of dietary fat intake. The program does not seek to reduce dietary energy intake. Rather, it is based on the assumption that a healthier, lower-fat diet, combined with an increase in energy expenditure by increased physical activity, will result in fewer excess calories deposited as body fat. Copyright (C) 1998 Elsevier Science Inc.

Original languageEnglish (US)
Pages (from-to)535-543
Number of pages9
JournalJournal of Nutritional Biochemistry
Issue number9
StatePublished - Sep 1998

Bibliographical note

Funding Information:
Supported by grants U01-HL-50869, U01-HL-50867, U01-HL-50905, U01-HL-50907, and U01-HL-50885 from the National Heart, Lung, and Blood Institute, National Institutes of Health.

Funding Information:
This paper was delivered at the October 23–25, 1997, conference “The Determination, Treatment, and Prevention of Obesity,” which was sponsored by the Institute of Nutrition, University of North Carolina at Chapel Hill; Department of Nutrition, School of Public Health and School of Medicine, University of North Carolina at Chapel Hill; and School of Medicine, East Carolina University, in cooperation with the North American Association for the Study of Obesity, the National Institutes of Health, the American Cancer Society, and Eli Lilly & Company.


  • American Indians
  • Obesity
  • Prevention
  • Schoolchildren


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