# Effect of the healthy school recognized campus initiative on metabolic syndrome among adolescents in texas: a pilot randomized factorial trial study

## TL;DR

This study tested a school-based health initiative in Texas to see if it could improve metabolic health and reduce obesity risk factors in adolescents.

## Contribution

The study introduces a bundled school-based health program and evaluates its components using a factorial trial design.

## Key findings

- The program reduced BMI z-scores but increased glucose levels and total MetS factors.
- The mentoring program lowered systolic blood pressure and increased dermal carotenoids.
- The STHS intervention increased waist circumference, suggesting complex effects in bundled programs.

## Abstract

School-based interventions are effective in improving physical activity and healthy eating in adolescents. However, there has been limited research into how bundled school-based programs, and their components, may improve adolescents’ metabolic health. The purpose of this study is to evaluate the effectiveness of the Healthy School Recognized Campus (HSRC) – a bundled school-based health initiative – and two HSRC components on metabolic syndrome (MetS) and other obesity-related risk factors.

A 2 × 2 cluster randomized factorial trial was conducted in eight HSRC middle schools (n = 107 students) to pilot test a novel program’s (Strong Teens for Healthy Schools [STHS]) and implementation strategy’s (mentoring program) preliminary effects on MetS z-scores, obesity-related risk factors (e.g., BMI z-scores), and behavioral risk factors (e.g., physical activity, healthy eating). General linear model frameworks were used to estimate the main and interaction effects on outcomes. Additionally, bivariate tests were run to determine if students had a significant change in outcomes over the year-long HSRC intervention.

Across all schools, students involved in the HSRC program decreased BMI z-scores (mean difference [MD]=-0.12 ± 0.33, p=.003); whereas students increased glucose levels (MD = 6.29 ± 18.34, p=.003), total MetS factors (MD = 0.23 ± 0.83, p=.015), and fruit and vegetable consumption (MD = 34.47 ± 92.33, p = < 0.001). The STHS intervention was associated with an increase in waist circumference (β = 5.55, 95%CI: 0.14, 10.96, p=.044). The mentoring program was associated with a reduction in systolic blood pressure (β=-6.32, 95%CI: -12.13, -0.51, p=.033) and increase in dermal carotenoids (β = 65.50, 95%CI: 18.11, 112.89, p=.007).

HSRC improved some obesity-related risk factors, but not MetS severity. The STHS intervention independently increased waist circumference, and the mentoring program independently improved dermal carotenoid levels and systolic blood pressure. Results suggest that complex interaction effects exist in bundled interventions within school settings; however, bundled EBPs may be effective in reducing some obesity-related outcomes (e.g., BMI z-scores) over a one-year duration for adolescents in East Texas.

The online version contains supplementary material available at 10.1186/s41043-026-01261-6.