Skip to main content

A conative educational model for an intervention program in obese youth



Obesity in children has increased in recent years throughout the world and is associated with adverse health consequences. Early interventions, including appropriate pedagogy strategies, are important for a successful intervention program. The aim of this study was to assess changes in body mass index, the ability to perform sport activities, behavior in the classroom and academic performance following one year of a health-wellness intervention program in obese youth.


The CEMHaVi program included 37 obese children (19 girls and 18 boys). Participants received an intervention program consisting of physical activity and health education. Assessment included body mass index, academic performance, classroom performance and ability to perform sport activities. Paired t tests were used to assess the effects of intervention, and chi square was used to assess inter-action between measures.


Findings of the study suggest significant decrease in Z scores of Body Mass Index and an improvement of academic performance, classroom behavior and the ability to perform sport activities (p < 0.05). Chi square testing showed significant positive inter-actions between body mass index, classroom behavior and academic performance.


Results following year one of CEMHaVi showed that a program of physical activity and health education had positive effects on obesity, behavior in the classroom and the ability to perform sport activities in obese adolescents. Significant inter-action in changes between variables was observed. Findings are important for designing intervention models to improve health in obese youth.

Peer Review reports


Early prevention programs are effective in treating obesity [14]. Adolescence, in particular, represents a period during which multiple physiological and psychological changes occur that affect dietary and physical activity habits [5]. Approximately 50% of obese adolescents with body mass index equal to or greater than the 95th percentile become obese adults with serious diseases [6]. Consequences of early obesity include: poor quality of life [7], onset of risk factors that can lead to early pathology [8, 9], frequent persistence into adulthood that can lead to increased morbidity of type 2 diabetes, cardiovascular diseases and cancer, and increased early mortality [10, 11].

In addition to physical consequences, obesity in youth is also associated with cognitive and psycho-social maladaptive behaviors. Li et al. showed an association between overweight and decreased cognitive function among children and adolescents that leads to poor quality of life, increased illness, incompetence, and low self esteem [12]. Low self-esteem is also associated with a poor academic performance. Obese youth are less able to perform sport activities compared to their lean counterparts further contributing to low self esteem.

Early interventions, including appropriate pedagogy strategies, are important for a successful program. Exercise is one of the factors which contributes to long term weight maintenance [13]. Physical activity, particularly aerobic training, improves lipid oxidation and may be take account in reducing cardiovascular diseases risk factors [14]. Caloric restriction is not recommended in children and adolescents. Children are still growing, diet restriction is not compatible with long term nutrition habits, and dietary restraint for youth as for adults can lead to greater food consumption later [15].

Few studies of diet restriction have been undertaken in children. Protein-sparing and hypo caloric balanced diets have been evaluated for safety and effectiveness for children in outpatient weight reduction [16]. Data suggest that hypo caloric diets are safe and effective in short-term management of pediatric obesity, but should only be undertaken with close medical supervision [16]. Long term effectiveness is uncertain.

Combining diet and physical activity has not been recommended because of the consequences of decreased energy intake with increased energy expenditure. Ebbeling & Rodriguez suggest that exercise offers metabolic benefits for obese children during diet-induced weight loss [17]. Longitudinal studies to assess long term health outcomes are recommended. In our study, we developed a program of physical activity using the Conative Educational Model, i.e. that each subject has an adapted program according to individual competences [18, 19]. The principal aim of the Conative Educational Model is to provide a variety of games specifically selected to be enjoyable, maintain interest, and motivate subjects to adhere. The model assures that the child is never in a failure situation which might lead to decreased activity. The child is positioned in an evolutionary dynamics to a particular moment, raising in the same time of his singularity and responsibility, he is an actor of his own construction and management. Each child has an individualized program. This is differentiation pedagogy.

The aim of the present study was to assess changes in ability to perform sport activity, classroom behavior and academic performance following one year of a health-wellness intervention using the Conative Educational Model in obese youth.


Thirty-seven subjects, 19 girls and 18 boys from Dunkerque, France participated in the study. Selected physical characteristics are presented in Table 1. Subjects were referred by two pediatricians from the medical community of Dunkerque. Eligibility criteria included: Body Mass Index (BMI) > 97th percentile, 7 to 17 years of age, non-genetic obesity, and a normal clinical examination including normal growth and psychomotor development. Aims and objectives were carefully explained to each subject prior to intervention. Written informed consent was obtained from subjects and parents. The study was approved by the Lille University Research Ethics Committee (Comité de Protection des Personnes, Lille, France). All procedures were performed in accordance with ethical standards of the Helsinki Declaration of 1975, as revised in 2008, and the European Good Clinical Practices. Data were collected at baseline and at the end of year one.

Table 1 Physical characteristics of subjects ( n= 37)

CEMHaVi intervention

CEMHaVi is a unique program of exercise and health education developed by Applied Physiology Laboratory of University of Littoral Cote d’Opale (France, Nord) and Dunkerque medical community.CEMHaVi consisted of one hour every three months for health education and two hours per week of physical activity in the university gymnasium using the Conative Educational Model [18, 19].

Health education

Health education was adopted from PATH (Physical Activity Teenage Health) translated into French [1, 20]. A manual consisting of written and oral exercises on the following topics was provided to all subjects: 1. Function of the heart, cardiovascular anatomy and physiology, cardiovascular risk factors, and the effects of obesity, 2. Physical activity, prescribing exercise, exercise training and the benefits of physical activity, 3. Proper nutrition, macro-and micro nutrients, the importance of water, saturated fat and cholesterol, food guide pyramids, and the importance of eating breakfast, 4. How to deal with stress, explaining stress and stressors, identifying positive and negative stress, stress management techniques, and the effects of relaxation and physical exercise on stress, and, 5. Sleep and the consequences of sleep deprivation with obesity.

Conative educational approach

The conative educational approach is based on the idea of conative curriculum which models a sense given by to one’s actions [19]. Identifies five impetus which lead one’s actions. This model allows the resarcher to identify conative stages through observation of child’s practice, and to assess progress or evolution in the three components (structural, functional and technical) forming the model. The summation of these three components is called “guiding principle” which organize five conative stages, from novice (1) to expert (5) [19]. Subjects identify their stage and observe their progress in the practice of sport. Progress of the intervention program is associated with a teaching activity adapted to the stage that best encourages acquiring of new skills and progressing from one stage to the next. Subjects were evaluated individually and the activity program was adapted for each subject at the stage that met the subject’s ability.


Anthropometric measures

Body mass was measured without shoes and heavy outer garments to the nearest 0.1 kg using an electronic scale (Oregon Scientific®, GA 101, USA). Height was measured without shoes to the nearest 0.1 cm using a standard physician’s scale. Body Mass Index (BMI) was calculated by Weight (kg)/Height (m²), and was converted to Z-score of BMI.

Ability to perform sport activities (conative curriculum)

Ability to perform sport activities was assessed by only a CEMHaVi researcher with scales for team sports, e.g. soccer, handball, basketball, etc. and net sports, e.g. tennis, badminton, volleyball. The five levels in conative curriculum are described in Table 2.

Table 2 Description of conative curriculum criteria for each sport topic

Academic performance and classroom behavior traits

Academic performance was assessed by questionnaire interview between a researcher from CEMHaVi and the teacher. The questionnaire was comprised of two components: 1) notation and, 2) life in the classroom. The notation score was calculated from the formula: general mean of pupil/general mean of classroom × 100. The individual pupil mean of note includes different disciplines, e.g. mathematics, physiology, French, etc. Each pupil has a note score in each discipline between 0 and 20. In the end, the teacher sums the note of each discipline and calculated the general mean of pupil. According to the general mean of class, the pupil has a score class ranking. Classroom performance consisted of measures of self-esteem, self evaluation of academic performance, and ability to work alone. Interviews were scheduled with the teacher at baseline and following year one for each subject.

Statistical analysis

Data were analyzed using the Statistical Package for the Social Sciences, Windows 11.5 (SPSS Inc., Chicago, IL, USA), Excel 2003 (Microsoft Inc., Redmond, WA, USA) and Sphinx (Chavanod, France). Means were calculated at baseline and following intervention and were compared by paired t tests to assess the effects of the intervention program. Measures included academic performance, Z-score of BMI, and the stage of conative curriculum. The chi square test was used to assess the interactions between these three variables during the intervention program. A p values < 0.05 were taken to be significant with a 95% confidence interval.


Significant improvements were observed in Z score of BMI and ability to perform team and net sports (Table 3), and behavior traits in the classroom, i.e. self-esteem, self evaluation of academic performance, and ability to work alone (Table 4). A non-significant increase was observed in academic performance based on class rank.

Table 3 Pre and Post intervention mean differences in Z score of BMI and the stage obtained in conative curriculum (n = 37)
Table 4 Pre and Post intervention mean differences in academic performance and the classroom behavior (n = 37)

Significant chi square findings suggest an interaction between decreased Z-score of BMI and improvement in classroom behavior traits (2 = 57.14, df = 2, p < 0.001), increased ability to perform sports and improvement of academic performance, (2 = 62.65, df = 2, p < 0.001), and increased academic performance and improved classroom behavior traits (2 = 10.34, df = 2, p < 0.001). Finally, a strong interaction was found between decreased Z-score of BMI and increased in sport activity (2 = 18.40, df = 2, p < 0.001).


To the best of our knowledge, the present study is the first to assess changes in academic performance, classroom behavior and ability to perform sport activities following a one year health-wellness program in obese youth using the Conative Educational Model. Results of the present study suggest that the conative model had a positive impact and that a strong inter-action exists in changes among measures.

Significant decrease in Z score of BMI was important because of the association between obesity and cardiovascular disease, metabolic syndrome or type 2 diabetes [21]. Several studies of intervention programs treating obesity in youth have been undertaken [2226]. Although the studies have dissimilar methodologies most showed decrease in BMI. A limitation of these interventions was the short duration of programs. CEMHaVi was planned for 12 months to allow for a greater impact on healthy lifestyle than reported previously.

Krukowski et al. suggest that psychosocial variables, such as weight-based teasing, be considered in future research examining the impact of childhood obesity on school performance and the effect of health intervention studies [27]. Increased body weight is independently associated with decreased visuospatial organization and general mental ability among children [12]. Obesity in adolescence is also linked with poor physical quality of life [7]. Another goal of CEMHaVi was to assess psycho-social issues because of their relationship to feeling ill, incompetence, and a low self esteem. Hillman et al. suggested that fitness may be related to better cognitive functioning in preadolescents and may have implications for increasing cognitive health in children and adults [28]. The present study confirms the findings of Hillman demonstrating a strong inter-action between a decreased Z score of BMI and improved of classroom behavior, and increased academic performance (changes in class standing). Decreased BMI also had a favorable impact on self-esteem and the self-assurance. The present study demonstrates the inter-actions of physical and psycho-social measures and the contribution of physical activity to their improvement.

To reinforce self esteem and classroom performance, the CEMHaVi program used the Conative Educational Model [18]. Exercises during physical activity sessions were programmed as a function of subjects individual abilities, i.e. stage obtained in the conative curriculum. In the conative model, obese youth are never in a situation of failure prior to the activity, but rather value activity in relation into their effort and ability. Findings of CEMHaVi showed that the decreased BMI is associated with improved of ability to perform sport activity. Increased ability to perform, in turns, is associated with improved academic performance. Obese youth feel better during exercise sessions. As a consequence subjects are motivated to do more physical activity and to increase the cognitive function [28].

One of the limitations of the present study is the absence of a control group. Because of time limitations and financial constraints a randomized control group was not possible. However, the study has pre-test/post-test design and the group participants act as their own control subjects. Nevertheless, it would be preferable to develop this program with a control group in order to have more rigorous methodology, and to increase the number of participants for statistical power. Therefore, the present study is a pilot and its findings are preliminary, but encouraging.


Results following year one of CEMHaVi showed a close relationship between BMI, academic performance and ability to perform sport activity. Of greatest importance is that Z-score of BMI decreases proportionally to improved behavior and quality of life in classroom and ability to work alone. Results also showed a positive inter-action between academic performance and the ability to perform sport activities. Finally, the positive effect of academic performance on behavior traits in the classroom demonstrates in obese youth that increased academic performance results in better integration into classroom. These results are particularly favorable for obese youth to improve their general health state, both physical and mental.


There are no funding sources for the work.


  1. Bayne-Smith M, Fardy PS, Azzollini A, Magel J, Schmitz KH, Agin D: Improvements in heart health behaviors and reduction in coronary artery disease risk factors in urban teenaged girls through a school-based intervention: the PATH program. Am J Public Health. 2004, 94: 1538-43. 10.2105/AJPH.94.9.1538.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Reilly JJ, Kelly L, Montgomery C, Williamson A, Fisher A, McColl JH, Lo Conte R, Paton JY, Grant S: Physical activity to prevent obesity in young children: cluster randomised controlled trial. BMJ. 2006, 18: 1041-

    Article  Google Scholar 

  3. James J, Thomas P, Cavan D, Kerr D: Preventing childhood obesity by reducing consumption of carbonated drinks: cluster randomised controlled trial. BMJ. 2004, 22: 1237-

    Article  Google Scholar 

  4. Müller MJ, Asbeck I, Mast M, Langnäse K, Grund A: Prevention of obesity--more than an intention. Concept and first results of the Kiel Obesity Prevention Study (KOPS). Int J Obes Relat Metab Disord. 2001, 25: S66-74.

    Article  PubMed  Google Scholar 

  5. Moreno LA, Gonzalez-Gross MM, Kersting M, Molnár D, de Henauw S, Beghin L, et al: Assessing, understanding and modifying nutritional status, eating habits and physical activity in European adolescents. The HELENA Study. Publ Health Nutr. 2008, 11: 288-299.

    Article  CAS  Google Scholar 

  6. Dietz WH: Childhood weight affects adult morbidity and mortality. J Nutr. 1998, 128: 411-414.

    Google Scholar 

  7. Swallen KC, Reither EN, Haas SA, Mejer AM: Overweight, obesity, and health-related quality of life among adolescents: the National Longitudinal Study of Adolescent Health. Pediatrics. 2005, 115: 340-7. 10.1542/peds.2004-0678.

    Article  PubMed  Google Scholar 

  8. Higgins PB, Gower BA, Hunter GR, Goran MI: Defining health-related obesity in prepubertal children. Obes Res. 2001, 9: 233-40. 10.1038/oby.2001.27.

    Article  CAS  PubMed  Google Scholar 

  9. Wabitsch M, Hauner H, Heinze E, Muche R, Böckmann A, Parthon W, Mayer H, Teller W: Body-fat distribution and changes in the atherogenic risk-factor profile in obese adolescent girls during weight reduction. Am J Clin Nutr. 1994, 60: 54-60.

    CAS  PubMed  Google Scholar 

  10. Berenson G, Srinivasan S, Bao W, Newman WP, Tracy RE, Wattigney WA: Association between multiple cardiovascular risk factors and athersclerosis in children and young adults. N Engl J Med. 1998, 338: 1650-1656. 10.1056/NEJM199806043382302.

    Article  CAS  PubMed  Google Scholar 

  11. Fair AM, Montgomery K: Energy balance, physical activity, and cancer risk. Methods Mol Biol. 2009, 472: 57-88. 10.1007/978-1-60327-492-0_3.

    Article  PubMed  Google Scholar 

  12. Li Y, Dai Q, Jackson JC, Zang J: Overweight is associated with decreased cognitive functioning among school-age children and adolescents. Obesity. 2008, 16: 1809-15. 10.1038/oby.2008.296.

    Article  PubMed  Google Scholar 

  13. Van Dale D, Saris WH, Ten Hoor F: Weight maintenance and resting metabolic rate 18–40 months after a diet/exercise treatment. Int J Obes. 1990, 14: 347-59.

    CAS  PubMed  Google Scholar 

  14. Dumortier M, Brandou F, Perez-Martin A, Fedou C, Mercier J, Brun JF: Low intensity endurance exercise targeted for lipid oxidation improves body composition and insulin sensitivity in patients with the metabolic syndrome. Diabetes Metab. 2003, 29: 509-18. 10.1016/S1262-3636(07)70065-4.

    Article  CAS  PubMed  Google Scholar 

  15. Rotenberg KJ, Flood D: Dietary restraint, attributional styles for eating, and preloading effects. Eat Behav. 2000, 1: 63-78. 10.1016/S1471-0153(00)00005-2.

    Article  CAS  PubMed  Google Scholar 

  16. Figueroa-Colon R, Von Almen TK, Franklin FA, Schuftan C, Suskind RM: Comparison of two hypocaloric diets in obese children. Am J Dis Child. 1993, 147: 160-6.

    CAS  PubMed  Google Scholar 

  17. Ebbeling CB, Rodriguez NR: Effects of exercise combined with diet therapy on protein utilization in obese children. Med Sci Sports Exerc. 1999, 31: 378-85. 10.1097/00005768-199903000-00005.

    Article  CAS  PubMed  Google Scholar 

  18. Mikulovic J, Bui-Xuân G, Marcellini A: Social and professional reintegration of the long-term unemployed disabled. Intervention on the body through adapted physical activities, conative teaching skills and social re-energization. Int J Rehabil Res. 2002, 25: 47-50.

    Article  CAS  PubMed  Google Scholar 

  19. Bui-Xuan G: Teaching Physical Education. Modeling process teaching. Volume 1. Edited by: Bui-xuan G, Gleyse J. 1999, Clermont Ferrand, , 62-83.

    Google Scholar 

  20. Fardy PS, White RE, Haltiwanger-Schmitz K, Magel JR, McDermott KJ, Clark LT, Hurster MM: Coronary disease risk factor reduction and behavior modification in minority adolescents: the PATH program. J Adolesc Health. 1996, 18: 247-53. 10.1016/1054-139X(95)00283-X.

    Article  CAS  PubMed  Google Scholar 

  21. Ginsberg HN, MacCallum PR: The obesity, metabolic syndrome, and type 2 diabetes mellitus pandemic: Part I. Increased cardiovascular disease risk and the importance of atherogenic dyslipidemia in persons with the metabolic syndrome and type 2 diabetes mellitus. J Cardiometab Syndr. 2009, 4: 113-9. 10.1111/j.1559-4572.2008.00044.x.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Emes C, Velde B, Moreau M, Murdoch DD, Trussell R: An activity based weight control program. Adapt Phys Act Quart. 1990, 7: 314-324.

    Google Scholar 

  23. Gutin B, Owens S, Slavens G, Riggs S, Treiber F: Effect of physical training on heart-period variability in obese children. J Pediatr. 1997, 130: 938-943. 10.1016/S0022-3476(97)70280-4.

    Article  CAS  PubMed  Google Scholar 

  24. Schwingshandl J, Sudi K, Eibl B, Wallner S, Borkenstein M: Effect of an individualised training programme during weight reduction on body composition: a randomised trial. Arch Dis Child. 1999, 81: 426-428. 10.1136/adc.81.5.426.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Faith MS, Berman N, Heo M, Pietrobelli A, Gallagher D, Epstein LH, Eiden MT, Allison DB: Effects of contingent television on physical activity and television viewing in obese children. Pediatrics. 2001, 107: 1043-1048. 10.1542/peds.107.5.1043.

    Article  CAS  PubMed  Google Scholar 

  26. Woo KS, Chook P, Yu CW, Sung RY, Qiao M, Leung SS, Lam CW, Metreweli C, Celermajer DS: Effects of diet and exercise on obesity-related vascular dysfunction in children. Circulation. 2004, 109: 1981-1986. 10.1161/01.CIR.0000126599.47470.BE.

    Article  PubMed  Google Scholar 

  27. Krukowski RA, Smith West D, Philyaw Perez A, Bursac Z, Phillips MM, Raczynski JM: Overweight children, weight-based teasing and academic performance. Int J Pediatr Obes. 2009, 4: 274-80. 10.3109/17477160902846203.

    Article  PubMed  Google Scholar 

  28. Hillman CH, Castelli DM, Buck SM: Aerobic fitness and neurocognitive function in healthy preadolescent children. Med Sci Sports Exerc. 2005, 37: 1967-74. 10.1249/01.mss.0000176680.79702.ce.

    Article  PubMed  Google Scholar 

Pre-publication history

Download references


The authors thank the children and their parents for taking part in the study.

Author information

Authors and Affiliations


Corresponding author

Correspondence to Jérémy Vanhelst.

Additional information

Competing Interests

The authors declare that they have no competing interests.

Author contributions

J. Mikulovic, L Béghin, J. Vanhelst conceived the idea. J. Vanhelst and P Fardy wrote the first and subsequent drafts. G. Bui-Xuan helped developed the ideas. All authors read and approved the final manuscript.

Rights and permissions

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Reprints and Permissions

About this article

Cite this article

Vanhelst, J., Béghin, L., Fardy, P.S. et al. A conative educational model for an intervention program in obese youth. BMC Public Health 12, 416 (2012).

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI:


  • Obesity
  • Physical activity
  • Intervention strategy