Date of Award


Document Type

Open Access Dissertation


College of Nursing


Nursing Practice

First Advisor

Stephanie Burgess


Obesity is a major chronic care condition proven to affect more than 12 million children and adolescents, age 2 to 19; categorizing approximately 17% of America’s youth as obese or overweight. As a result, Congress established federal mandates targeting obesity by enforcing nutritional policies for cafeteria and competitive foods to enhance learning environments. Establishing federal nutritional guidelines in education allows more than 31 million children to receive meals at a free or low cost in more than 96,000 public and nonprofit private schools. As such, the purpose of this quality improvement project is to compare individual food choices with the National School Lunch Program (NSLP) and physical activity following an educational program on food choices and physical activity to high school students.

The John Hopkins Nursing Evidence-Based (JHNEBP) 18-step research model is utilized to establish practice change, search evidence, and translate action plans in a NSLP environment. Opportunities to improve current student nutritional practices are established by recruiting Wellness Committee members to monitor and evaluate meal consumption and physical activity behaviors; while conducting an internal and external search for evidence

An extensive review of the literature is conducted to identify evidence-based practices that effect body mass index (BMI), dietary patterns and food choices, and physical activity levels to assist the researcher to establish strategies to improve nutrition and physical fitness. The intervention includes the implementation of an educational program; using the USDA SuperTracker, journaling, and accurate recording of nutrition logs; to determine adherence and identify barriers.

The 4-week cross-sectional study is comprised of sample data that reveals participant’s demographic information, BMI, food choices, physical activity level, and adherence to recording nutritional information during pre-and post-intervention. The sample population is assessed during the pre-and post-intervention phase of the study and included a total of 84 adolescents, age 14-17. The data shows 55.95 % of participants prefer to eat in the Cafeteria (n = 47) compared to 44.05% who like to eat in the Canteen (n = 37). There is no change in the pre-and post-intervention population and the dietary preferences remained the same. Comparable to the pre-intervention group, Week 4 data shows BMI and physical activity decreased 32% over time; totaling 27 participants not adhering to the recording requirements.


© 2018, Twanda D. Addison