Youth residing in rural Appalachia suffer from high rates of obesity and extreme obesity. This study compares the efficacy of a behavioral skills mentoring program (Mentored Planning to be Active [MBA]) to a teacher-led program (PBA) for increasing physical activity in Appalachian teens on health outcomes (weight loss, body mass index, and body fat).


Secondary analysis of a larger group-randomized controlled trial was conducted in 20 rural Appalachian schools. Descriptive, Pearson correlations and multivariate analyses with between-subject effects were conducted. Effect sizes (ES) using Cohen’s d and odds ratios (OR) with 95% confidence intervals were calculated.


The Obese MBA group lost 77.5% more weight by T3 compared to the PBA group; T2 was (F = 8.51, P = .000) and T3 was (F = 7.62, P = .000). ES was .34. The OR = 1.45 (95% CI [.558, 3.792]) at T2 and OR = 3.32 (95% [CI = 1.103, 9.978]) at T3. Extremely obese in the MBA group lost 80% more weight compared to the PBA group; T2 was (F = 5.23, P = .025) and at T3 (F = 6.33, P = .015) ES was .58. OR = 4.36, [95% CI .981, 19.34]. Extremely obese females lost more weight compared to males (F = 4.75, p = .034). BMI and body fat had similar results; youth in the MBA group had the more improvement in BMI and loss of body fat.


Rural Appalachian youth are disproportionately extremely obese. BMI does not capture adiposity or cardiovascular risk. BMI, BMI percentile, raw weight, fat mass, and percent body fat are more complete analyses of adiposity and cardiovascular risk.