Small dietary changes might not seem important, but they can go a long way toward helping children achieve a healthy weight, according to an evaluation of childhood obesity projects conducted statewide.

East Carolina University (ECU) researchers reviewed the results of 19 childhood obesity projects funded by the N.C. Health and Wellness Trust Fund that aimed to help North Carolina children achieve a healthy weight.

ECU researchers looked at 1,346 children from 4 to 18 years old who were grouped into one of four categories when the projects began: underweight, healthy weight, overweight and obese. Forty-four percent were overweight or obese when the projects began. These children were followed for three years.

Using approaches such as nutrition lessons that encourage less sweet beverage consumption and more fruit and vegetable consumption, 90 percent of the children stayed in their weight category or improved. Most of the 19 projects focused on nutrition education, such as a cooking class for children, and physical activity.

During the projects, the percentage of children who chose fruits over traditional snack foods climbed from 13.3 to 17.5 percent. Physical activity, however, did not change much overall, researchers said.

"These projects have demonstrated that even small dietary changes can make a difference," said lead researcher Dr. Lauren Whetstone, a clinical associate professor of family medicine at the Brody School of Medicine at ECU. "While physical activity may well have played a role, outcomes were largely achieved by the dietary changes that took place, at least in this study."

Among overweight and obese children in the study, 51 percent improved their weight category. For some, improving their weight category meant they actually lost weight. For others, it meant they grew taller while maintaining their weight. Some did both.

"These projects were developed and implemented at the local level with a small amount of resources," said Dr. Kathryn Kolasa, a nutritionist and professor of family medicine and pediatrics at ECU. "The positive results show these projects deserve to be sustained and expanded throughout North Carolina."

According to the advocacy group Trust for America's Health, more than 16 percent of North Carolina children ages 10 to 17 are overweight.

Most of the projects were conducted by local health departments, school systems, after-school programs or community-based organizations. For example, Pitt County Schools received $449,000 to fund several projects that encouraged students to make healthy food choices and be more active, said Alice Keene, special projects coordinator for Pitt County Community Schools and Recreation. She said long-term behavioral change is needed to help children achieve healthy weights.

"We are extremely pleased with the positive outcomes of our project and are committed to trying to find ways to sustain our programs and interventions over time," Keene said. "We are making progress; therefore, we must stay the course."

The projects were part of the Health and Wellness Trust Fund's childhood obesity grant program, which aims to reduce obesity and encourage healthful lifestyles in the state. Projects across the state each received approximately $300,000 to $400,000 over three years. The full report is available online at www.healthwellnc.com/hwtfc/htmfiles/fundprty_obesity-grants.htm.

The N.C. Health and Wellness Trust Fund funds programs that promote preventive health. Created by the General Assembly in 2000 to allocate a portion of North Carolina's share of the national tobacco settlement, the fund has invested $143 million to support preventive health projects and $102 million to fund prescription drug assistance programs.

For more information on N.C. Health and Wellness, visit www.healthwellnc.com.