A Cascade Model for School Wellness Programming: A Feasibility Case Study

Objective: In this paper, we report on the Wellness Cascade process for engaging stakeholders in population-level school-based obesity preventive/treatment programming. Methods: We implemented the 5-step process to improve body mass index (BMI) >85^th percentile (elevated BMI) or participation in less than 7 hours a week of moderately vigorous physical activity (inadequate MVPA) by defining numerators and denominators, identifying potential data sources, considering data source issues, and compiling and analyzing data. Results: We collected and compiled data on 239 youth (ages 11-14 years) during the 2016-2017 and 2017-2018 school years. Participant attainment of Wellness Cascade step milestones included Step 1 (Assessment) where 56% and 84% of those assessed had elevated BMI and inadequate MVPA, respectively; Step 2 (Enrollment) where 39% and 40% of participants with elevated BMI and inadequate MVPA, respectively, enrolled in preventive/treatment programming; Step 3 (Engagement) where 38% and 39%, respectively, engaged in programming; Step 4 (Completion) where 33% and 34%, respectively, completed programming; and Step 5 (Outcomes) where 16% with elevated BMI improved their BMI and 19% with inadequate MVPA increased hours spent in MVPA and attained expected outcomes. Conclusion: Stakeholder Wellness Cascade adoption can facilitate monitoring via attainment of step milestones which identify gaps in obesity prevention and treatment.