Lifestyle prescriptions - you should eat a balanced diet - are notoriously difficult to stick with. But these limits were impossible to avoid.
"Instead of selling candy for a fund-raiser, they were selling carnations. And those are the sort of things that made it holistic across the environment," said Wayne Grasela, senior vice president for food services in the Philadelphia School District, where six middle schools took part in the three-year national program.
The plan was to intervene early, before diabetes develops - and at a young enough age to learn new habits that could prevent or reduce obesity, a major risk factor for the disease. Numerous physicians helped craft the program, but all the action took place in the schools.
"They are already there. They already take physical education and they already eat lunch in the school," explained Barbara Linder, who oversaw the study for the National Institutes of Health.
So researchers set about changing the school.
In gym, for example, "instead of doing layups, with most kids standing in line, we had things set up so balls were being passed back and forth while they waited," said Gary D. Foster, director of Temple University's Center for Obesity Research and Education, who chaired the national study.
Dumbbells, jump ropes, and medicine balls were distributed to groups, with rotations every 45 to 90 seconds to keep everyone moving. Pop music was played so that gyms were seen as "fun places to be with cool things to do," Foster said.
