Middle School Children Should Be Counseled About Healthful Behaviors

Gym stock
Gym stock
Children who exhibited at least 4 unhealthy behaviors were more likely to be obese and have unfavorable cholesterol levels.

In light of recent study results, researchers urged clinicians and schools should take a greater role in promoting healthful and non-sedentary lifestyles in middle school-aged children.

Investigators at the University of Michigan looked at 2667 students and found that 32.1% of students reported at least 4 unhealthy behaviors. They also found more cardiovascular (CV) risk factors in adolescents with less favorable health behaviors compared with students with healthier behaviors.

“We conducted this study because health risk indicators in children are not well known and are very important to prevent cardiovascular diseases (CVD) later in life. Therefore, we studied different behaviors in adolescents in order to see if participants with high-risk behaviors — 4 or more specified unhealthy behaviors — would be associated with CVD risk factors, such as increased LDL or decreased HDL,” said study principal investigator Rosa De Visser, MSc, a researcher at the University of Michigan in Ann Arbor.

This study is a wake-up call, noted De Visser, who presented the study findings at the American College of Cardiology’s (ACC) 65th Scientific Sessions. She underscored the need for urgent strategies to promote healthy behaviors in middle schoolers. Children’s ability to make healthy lifestyle choices should be incorporated into the school curriculum, and clinicians need to do more to educate families, she explained.

“If endocrinologists see patients in their practice, such as overweight or obese children or children with decreased HDL cholesterol levels, it is of great importance to target their behaviors as part of their treatment,” De Visser told Endocrinology Advisor.

In their study, she and her colleagues examined physical activity, sedentary behavior, and diet in association with CV risk factors among middle school students in Project Healthy Schools. 

A total of 855 students were categorized in the “Unhealthy Behavior” group because they exhibited at least 4 specific behaviors deemed to be unhealthy. These included less than 1 day a week of vigorous physical activity (20 minutes); less than 1 day a week of moderate physical activity (30 minutes); less than 1 day a week of physical education classes; less than 1 team sport participation per year; more than 2 hours a day of TV time; more than 2 hours a day of computer time; more than 2 hours a day playing video games; consuming less than 1 serving a day of a fruit or vegetables; no daily breakfast consumption; consuming more than 1 serving a day of sugary foods; and consuming more than 1 serving a day of sugary beverages.

A total of 1812 students who exhibited 1 or less unhealthy behavior comprised the reference group, or the “Healthy Behavior” group.

The researchers found that those students in the Unhealthy Behavior group, compared with the reference group, were positively associated with overweight and obesity (odds ratio [OR]=1.41) and negatively associated with HDL cholesterol (OR=0.79). There was also a trend towards increased LDL (OR=1.51).

“The results show that no matter which unhealthy behaviors you present as a child, if you have 4 or more unhealthy behaviors, you are associated with an increased risk of being overweight or obese, having lower HDL, and a trend towards higher LDL,” said De Visser. “The results are not that surprising, as we know that unhealthy behaviors in adults are associated with similar risk outcomes. Therefore, endocrinologists have the important task to examine and detect these behaviors at an early stage in life in order to prevent unhealthy behavioral routines and health problems.”

She said this study suggests that unhealthy behaviors can identify middle school students who may have an increased risk for CVD and educational wellness programs could be put in place. Early intervention can make a significant difference and could prevent many potential health problems, noted De Visser.

“I think there should be a major focus on behavioral change in clinical practice for prevention and treatment. Not only is this the healthiest way to cure it, it will have positive effects on many more aspects of health as well. To reach this goal of healthy behavioral change, we should make the healthy choice the easiest. The convenience of unhealthy foods and sedentary lifestyles at home and in school makes it difficult for many children and adults to live a healthy life,” said De Visser.


  1. De Visser R, Sylvester R, Jiang Q, et al. Health Behaviors Predicts Cardiovascular Risk Profile in Middle-School Children. Presented at: ACC 65th Scientific Sessions; April 2-4, 2016; Chicago, IL.