Assessment of a school-based intervention in eating habits and physical activity in school children: the AVall study The effect of a healthy lifestyle programme on 8–9 year olds from social disadvantage Successful overweight prevention in adolescents by increasing physical activity: a 4-year randomized controlled intervention Randomised controlled trial of primary school based intervention to reduce risk factors for obesity Promotion and Provision of Drinking Water in Schools for Overweight Prevention: Randomized, Controlled Cluster Trial Effect of four additional physical education lessons on body composition in children aged 8–13 years – a prospective study during two school years Evaluating Parents and Adult Caregivers as ‘Agents of Change’ for Treating Obese Children – Evidence for Parent Behavior Change Strategies and Research Gaps: A Scientific Statement from the American Heart Association Effect of a 6-month school-based physical activity program on body composition and physical fitness in lean and obese schoolchildren Evaluation of a computer-tailored physical activity intervention in adolescents in six European countries: the Activ-O-Meter in the HELENA intervention study. Dutch obesity intervention in teenagers: effectiveness of a school-based program on body composition and behavior. A 4-year, cluster-randomized, controlled childhood obesity prevention study: STOPP Intervention effects on physical activity: the HEIA study - a cluster randomized controlled trial A novel school-based intervention to improve nutrition knowledge in children: cluster randomised controlled trial Short-term effects of school-based weight gain prevention among adolescents. Overweight Prevention Implemented by Primary School Teachers: A Randomised Controlled Trial Effects of a physical education program on physical activity, fitness, and health in children: the JuvenTUM project. Krachtvoer: effect evaluation of a Dutch healthful diet promotion curriculum for lower vocational schools. Does school-based physical activity decrease overweight and obesity in children aged 6–9 years? A two-year non-randomized longitudinal intervention study in the Czech Republic A controlled trial of a school-based environmental intervention to improve physical activity in Dutch children: JUMP-in, kids in motion. The effects of a middle-school healthy eating intervention on adolescents' fat and fruit intake and soft drinks consumption. Assessment of a two-year school-based physical activity intervention among 7-9-year-old children Changes in BMI and blood pressure after a school based intervention: the CHILDREN study. Effect of school based physical activity programme (KISS) on fitness and adiposity in primary schoolchildren: cluster randomised controlled trial Limited effects of a 2-year school-based physical activity intervention on body composition and cardiorespiratory fitness in 7-year-old children. Body mass effects of a physical activity and healthy food intervention in middle schools. Evaluation of a nutrition intervention in adolescents of an urban area in Greece: short- and long-term effects of the VYRONAS study. Evaluation of the Web-based computer-tailored FATaintPHAT intervention to promote energy balance among adolescents: results from a school cluster randomized trial. Impact of an intervention through teachers to prevent consumption of low nutrition, energy-dense foods and beverages: a randomized trial. School-based randomized controlled trial of a physical activity intervention among adolescents. Effects of a 2-year school-based intervention of enhanced physical education in the primary school. A primary-school-based study to reduce the prevalence of childhood obesity – the EdAl (Educació en Alimentació) study: a randomized controlled trial Effectiveness of a primary school-based intervention to reduce overweight. Effects of a comprehensive fruit- and vegetable-promoting school-based intervention in three European countries: the Pro Children Study. Evaluation of a 2-year physical activity and healthy eating intervention in middle school children. Effects of A School-Based Intervention on BMI and Motor Abilities in Childhood.
Background Obesity has become a global public health problem , which also affects children . It has been proposed that the educational interventions during childhood could be a key strategy in the prevention of obesity . Objective To evaluate the efficacy of an intervention on food habits and physical activity in school children . Methods A 2-year cluster-r and omised prospect i ve study with two parallel arms was used to evaluate an intervention programme in children in their first year of primary schooling ( 5–6 years of age ) in schools in the city of Granollers . The intervention consisted of the promotion of healthy eating habits and physical activity by means of the educational methodology Investigation , Vision , Action and Change ( IVAC ) . At the beginning and at the end of the study ( 2006 and 2008 ) the weight and height of each child was measured in situ , while the families were given a self-report physical activity question naire and the Krece Plus quick test . Results Two years after the beginning of the study , the body mass index of the children in the control group was 0.89 kg/m2 higher than that of the intervention schools . The intervention reduced by 62 % the prevalence of overweight children . Similarly , the proportion of children that ate a second piece of fruit and took part in an after-school physical activity increased in the intervention group . In the control group , the weekly consumption of fish was reduced . Conclusions The educational intervention in healthy eating habits and physical activity in the school could contribute to lessen the current increase in child obesity Aims This study assessed the efficacy of a school-based healthy lifestyle intervention ( Sport for LIFE ) for increasing physical activity , decreasing sedentary behaviour , reducing screen time behaviour , encouraging healthy attitudes and behaviour to nutrition , and reducing body mass index ( BMI ) in 8–9-year-old primary school children from lower socioeconomic background s in Northern Irel and . Methods A non-r and omised controlled trial of 416 children from 24 schools took part . Schools were r and omly assigned to one of two groups , an intervention or control group with 12 schools in each group . The intervention group received a 12-week school-based programme based on social cognitive theory . At baseline and follow-up , groups completed question naires assessing physical activity , screen time behaviour and dietary patterns . On each occasion anthropometric assessment  s of height and weight were taken . Physical activity and sedentary behaviour were measured by accelerometry . Results Significant effects were observed for vigorous , moderate and light activity for the intervention group at follow-up . Sedentary behaviour was significantly reduced for the intervention group but not for the control group . No significant effects of the intervention on BMI , screen time behaviour or attitudes to nutrition , with the exception of non-core foods , were shown . Conclusions The programme was effective in increasing physical activity and reducing sedentary behaviour , however no significant changes in screen time behaviour and attitude to nutrition , with the exception of non-core foods , were observed . Future research ideas are offered for tackling low levels of physical activity in children Background : Population -based studies directed at promoting physical activity in youth have shown limited success in obesity prevention . Objective : To assess whether an intervention integrating environmental changes to induce sustained changes in physical activity , prevents overweight in adolescents . Design : Four-year r and omized trial started in 2002 in eight middle schools of Eastern France . The intervention , r and omized at school level , was design ed to promote physical activity by changing attitudes through debates and attractive activities , and by providing social support and environmental changes encouraging physical activity . Subjects : Nine hundred and fifty four 12-year-old six- grade rs . Measurements : Body mass index ( BMI ) , body composition , physical activity by question naire , plasma lipids and glucose , insulin resistance . Results : Intervention students had a lower increase in BMI ( P=0.01 ) and age- and gender-adjusted BMI ( P<0.02 ) over time than controls . The differences across groups of the age- and gender-adjusted BMI changes ( 95 % confidence interval ( CI ) ) were −0.29 ( −0.51 ; −0.07 ) kg/m2 at 3 years , −0.25 ( −0.51 ; 0.01 ) kg/m2 at 4 years . An interaction with baseline weight status was noted . The intervention had a significant effect throughout the study in initially non-overweight adolescents ( −0.36 ( −0.60;−0.11 ) kg/m2 for adjusted BMI at 4 years ) , corresponding to a lower increase in fat mass index ( P<0.001 ) . In initially overweight adolescents , the differences observed across groups at 2 years ( –0.40 ( −0.94 ; 0.13 ) kg/m2 for adjusted BMI ) did not persist over time . At 4 years , 4.2 % of the initially non-overweight adolescents were overweight in the intervention schools , 9.8 % in the controls ( odds ratio=0.41 ( 0.22 ; 0.75 ) ; P<0.01 ) . Independent of initial weight status , compared with controls , intervention adolescents had an increase in supervised physical activity ( P<0.0001 ) , a decrease of TV/video viewing ( P<0.01 ) and an increase of high-density cholesterol concentrations ( P<0.0001 ) . Conclusion : Enhancing physical activity with a multilevel program prevents excessive weight gain in non-overweight adolescents . Our study provides evidence that prevention of obesity in youth is feasible Abstract Objective : To assess if a school based intervention was effective in reducing risk factors for obesity . Design : Group r and omised controlled trial . Setting : 10 primary schools in Leeds . Participants : 634 children aged 7 - 11 years . Intervention : Teacher training , modification of school meals , and the development of school action plans targeting the curriculum , physical education , tuck shops , and playground activities . Main outcome measures : Body mass index , diet , physical activity , and psychological state . Results : Vegetable consumption by 24 hour recall was higher in children in the intervention group than the control group ( weighted mean difference 0.3 portions/day , 95 % confidence interval 0.2 to 0.4 ) , representing a difference equivalent to 50 % of baseline consumption . Fruit consumption was lower in obese children in the intervention group ( −1.0 , −1.8 to −0.2 ) than those in the control group . The three day diary showed higher consumption of high sugar foods ( 0.8 , 0.1 to 1.6 ) ) among overweight children in the intervention group than the control group . Sedentary behaviour was higher in overweight children in the intervention group ( 0.3 , 0.0 to 0.7 ) . Global self worth was higher in obese children in the intervention group ( 0.3 , 0.3 to 0.6 ) . There was no difference in body mass index , other psychological measures , or dieting behaviour between the groups . Focus groups indicated higher levels of self reported behaviour change , underst and ing , and knowledge among children who had received the intervention . Conclusion : Although it was successful in producing changes at school level , the programme had little effect on children 's behaviour other than a modest increase in consumption of vegetables . What is already known on this topic Obesity is increasing among school children and dem and s preventive strategies R and omised controlled trials of school based primary prevention programmes have all used a prescriptive approach What this study adds Behavioural changes were disappointing with this programme based on the health promoting schools philosophy , despite changes at school level The only positive outcome was a modest increase in vegetable consumption The discrepancy between changes achieved at the individual and school level raises issues regarding the problems inherent in such OBJECTIVE . The study tested whether a combined environmental and educational intervention solely promoting water consumption was effective in preventing overweight among children in elementary school . METHODS . The participants in this r and omized , controlled cluster trial were second- and third- grade rs from 32 elementary schools in socially deprived areas of 2 German cities .  Water fountains were installed and teachers presented 4 prepared classroom lessons in the intervention group schools ( N = 17 ) to promote water consumption .  Control group schools ( N = 15 ) did not receive any intervention . The prevalence of overweight ( defined according to the International Obesity Task Force criteria ) , BMI SD scores , and beverage consumption ( in glasses per day ; 1 glass was defined as 200 mL ) self-reported in 24-hour recall question naires , were determined before ( baseline ) and after the intervention . In addition , the water flow of the fountains was measured during the intervention period of 1 school year ( August 2006 to June 2007 ) . RESULTS . Data on 2950 children ( intervention group : N = 1641 ; control group : N = 1309 ; age , mean ± SD : 8.3 ± 0.7 years ) were analyzed . After the intervention , the risk of overweight was reduced by 31 % in the intervention group , compared with the control group , with adjustment for baseline prevalence of overweight and clustering according to school . Changes in BMI SD scores did not differ between the intervention group and the control group . Water consumption after the intervention was 1.1 glasses per day greater in the intervention group . No intervention effect on juice and soft drink consumption was found . Daily water flow of the fountains indicated lasting use during the entire intervention period , but to varying extent . CONCLUSION . Our environmental and educational , school-based intervention proved to be effective in the prevention of  overweight among children in elementary school , even in a population from socially deprived areas Background Strategies for combating increasing childhood obesity is called for . School setting s have been pointed out as potentially effective setting s for prevention . The objective of this paper was to evaluate the effect of four additional Physical Education ( PE ) lessons/week in primary schools on body composition and weight status  in children aged 8–13 . Methods Children attending 2nd to 4th grade ( n = 632 ) in 10 public schools , 6 intervention and 4 control schools , participated in this longitudinal study during 2 school years . Outcome measures : Primary : Body Mass Index ( BMI ) and Total Body Fat percentage ( TBF% ) derived from Dual Energy X ray Absorptiometry ( DXA ) . Secondary : the moderating effect of overweight/obesity ( OW/OB ) and adiposity based on TBF% cut offs for gender . Results Intervention effect on BMI and TBF% ( BMI : β -0.14 , 95 % CI : -0.33 ; 0.04 , TBF% : β -0.08 , 95 % CI:-0.65;0.49 ) was shown insignificant . However , we found significant beneficial intervention effect on prevalence of OW/OB based on BMI ( OR 0.29 , 95 % CI : 0.11;0.72 ) . The intervention effect on adiposity based on TBF% cut offs was borderline significant ( OR 0.64 , 95 % CI:0 . 39 ; 1.05 ) . Conclusion Four additional PE lessons/week at school can significantly improve the prevalence of OW/OB in primary schoolchildren . Mean BMI and TBF% improved in intervention schools , but the difference with controls was not significant . The intervention had a larger effect in children who were OW/OB or adipose at baseline This Scientific Statement addresses  Parents and Adult Caregivers ( PACs )  as ‘ agents of change ’ for obese children . Evidence is review ed to support the notion that PACs can leverage behavior change and reduce positive energy balance in obese youth , and research opportunities for the field are discussed . The Statement has three specific aims : First , the core behavior change strategies for PACs as used in family-based treatment programs are review ed . These strategies reduce childhood overweight compared to no treatment or nutrition education alone , although their limited potency is recognized . Second , the strength of evidence is evaluated for the hypothesis that greater parental ‘ involvement ’ in treatment is associated with greater reductions in child overweight . Drawing upon r and omized clinical trials that varied the degree/nature of parental involvement , and observational analyses that assessed parental adherence to behavioral strategies , we report limited and inconsistent support . For example , only 17 % of the intervention studies reported differential improvements in child overweight as function of parental involvement after treatment . On the other h and , greater parental adherence predicted better child weight outcomes after 2 and 5 years in certain studies . Third , research gaps identified throughout this review process are delineated and new opportunities for the field are proposed . For example , the assessment of refined parenting phenotypes , cultural tailoring of interventions , examination of family relationships , and incorporating new technologies in treatment represent topics needing further study . A conceptual model is proposed to guide research on underst and ing the determinants of parental feeding and physical-activity parenting practice s. The Statement strives to innovate the scope and potency of PAC treatments for childhood obesity Few studies have investigated the impact of school-based physical activity interventions on anthropometric characteristics concomitantly with aerobic and anaerobic capacities in young children . The present study aim ed to assess the effect of a 6-month physical activity program on body composition and physical fitness among primary schoolchildren . Four hundred fifty-seven children aged 6 to 10 years were r and omly assigned to the intervention group ( 229 children ) or observational group ( 228 children ) . Participants ’ height and weight were assessed , and obesity was determined using French reference curves for BMI . The sum of the four skinfolds and fat-free mass were determined . Ground tests were used to assess aerobic ( 20-m shuttle run test ) and anaerobic ( cycling peak power ) fitness before and after a 6-month physical activity intervention . The anthropometric modifications obtained over the 6 months can not be attributed to the intervention as the ANOVA revealed no group effect ( intervention vs. group ) . However , anaerobic and aerobic fitness were significantly improved , thanks to the program in both lean and obese children . A 6-month school-based physical activity intervention in 6- to 10-year-old children did not yield positive anthropometric improvements , but appears effective in terms of aerobic and anaerobic physical fitness . Two physical activity sessions per week in addition to st and ard physical education classes in primary schoolchildren bring effective results for the prevention of childhood obesity PURPOSE The present study investigates the effect of the Activ-O-Meter , an internet-based computer-tailored physical activity intervention in adolescents in six European centers involved in the HELENA study . METHODS Adolescents ( 12 - 17 years old ) from Vienna , Ghent , Heraklion , Dortmund , Athens , and Stockholm were r and omized into intervention and control schools . Participants in the intervention condition received the computer-tailored advice at baseline and after 1 month . Participants in the control condition received a generic st and ard advice . Effects were evaluated after 1 ( n = 675 ) and 3 months ( n = 494 ) using multi-level modeling . Physical activity levels were measured using the International Physical Activity Question naire for adolescents ( IPAQ-A ) . RESULTS After 1 month , the intervention group reported higher levels of moderate ( beta = -32.8 , 95 % CI ( confidence interval ) : -64.2 to -1.4 ) and vigorous ( beta = -28.0 , 95 % CI : -50.7 to -5.3 ) physical activity in leisure time , as well as higher levels of cycling for transport ( beta = -19.1 , 95 % CI : -34.4 to -7.6 ) compared to the control group . After 3 months , when the intervention group had received the tailored feedback twice , intervention effects were even stronger . Favorable changes in physical activity levels of all intensities and in different context s were found in the tailored group compared to the control group . Among adolescents not reaching the physical activity recommendations at baseline similar effects as in the total sample were found . CONCLUSIONS The data indicated that the computer-tailored physical activity intervention had positive effects on physical activity levels among the adolescents . However , the implementation of the computer-tailored intervention in the schools was not feasible in all countries OBJECTIVE To determine whether a multicomponent health promotion intervention for Dutch adolescents ( defined as persons between 12 and 14 years of age ) would be successful in influencing body composition and dietary and physical activity behavior in both the short and long terms . DESIGN R and omized controlled trial . SETTING Ten intervention and 8 control prevocational secondary schools . PARTICIPANTS A total of 1108 adolescents ( mean age , 12.7 years ) . Intervention An interdisciplinary program with an adapted curriculum for 11 lessons in biology and physical education and environmental change options . MAIN OUTCOME MEASURES Body height and weight , waist circumference , 4 skinfold thickness measurements , and dietary and physical activity behavior data . RESULTS Multilevel analyses showed that the intervention remained effective in preventing unfavorable increases in important measures of body composition after 20-month follow-up in girls ( biceps skinfold and sum of 4 skinfolds ) and boys ( triceps , biceps , and subscapular skinfolds ) . Consumption of sugar-containing beverages was significantly lower in intervention schools both after intervention ( boys : -287 mL/d ; 95 % confidence interval [ CI ] , -527 to -47 ; girls : -249 ; -400 to -98 ) and at 12-month follow-up ( boys : -233 ; -371 to -95 ; girls : -271 ; -390 to -153 ) . For boys , screen-viewing behavior was significantly lower in the intervention group after 20 months ( -25 min/d ; 95 % CI , -50 to -0.3 ) . No significant intervention effects on consumption of snacks or active commuting to school were found . CONCLUSION The Dutch Obesity Intervention in Teenagers program result ed in beneficial effects on the sum of skinfold thickness measurements in girls and consumption of sugar-containing beverages in both boys and girls in both the short and long terms Objective : To assess the efficacy of a school-based intervention programme to reduce the prevalence of overweight in 6 to 10-year-old children . Design : Cluster-r and omized , controlled study .Subjects : A total of 3135 boys and girls in grade s 1–4 were included in the study . Methods : Ten schools were selected in Stockholm county area and r and omized to intervention ( n=5 ) and control ( n=5 ) schools .  Low-fat dairy products and whole-grain bread were promoted and all sweets and sweetened drinks were eliminated in intervention schools .  Physical activity ( PA )  was aim ed to increase by 30 min day−1 during school time and sedentary behaviour restricted during after school care time . PA was measured by accelerometry .  Eating habits at home were assessed by parental report . Eating disorders were evaluated by self-report . Results : The prevalence of overweight and obesity decreased by 3.2 % ( from 20.3 to 17.1 ) in intervention schools compared with an increase of 2.8 % ( from 16.1 to 18.9 ) in control schools ( P<0.05 ) . The results showed no difference between intervention and controls , after cluster adjustment , in the longitudinal analysis of BMI sds changes . However , a larger proportion of the children who were initially overweight reached normal weight in the intervention group ( 14 % ) compared with the control group ( 7.5 % ) , P=0.017 . PA  did not differ between intervention and control schools after cluster adjustment . Eating habits at home were found to be healthier among families with children in intervention schools at the end of the intervention . There was no difference between children in intervention and control schools in self-reported eating disorders . Conclusions : A school-based intervention can reduce the prevalence of overweight and obesity in 6 to 10-year-old children and may affect eating habits at home . The effect of the intervention was possibly due to its effect on healthy eating habits at school and at home rather than on increased levels of PA Background Although school-based interventions to promote physical activity in adolescents have been suggested in several recent review s , questions have been raised regarding the effects of the strategies and the methodology applied and for whom the interventions are effective . The aim of the present study was to investigate effects of a school-based intervention program : the HEalth in Adolescents ( HEIA ) study , on change in physical activity , and furthermore , to explore whether potential effects varied by gender , weight status , initial physical activity level and parental education level . Methods This was a cluster r and omized controlled 20 month intervention study which included 700 11-year-olds . Main outcome -variable was mean count per minute ( cpm ) derived from ActiGraph accelerometers ( Model 7164/GT1 M ) . Weight and height were measured objective ly . Adolescents reported their pubertal status in a question naire and parents reported their education level on the consent form . Linear mixed models were used to test intervention effects and to account for the clustering effect of sampling by school . Results The present study showed an intervention effect on overall physical activity at the level of p = 0.05 with a net effect of 50 cpm increase from baseline to post intervention in favour of the intervention group ( 95 % CI −0.4 , 100 ) . Subgroup analyses showed that the effect appeared to be more profound among girls ( Est 65 cpm , CI 5 , 124 , p = 0.03 ) and among participants in the low-activity group ( Est 92 cpm , CI 41 , 142 , p < 0.001 ) , as compared to boys and participants in the high-activity group , respectively . Furthermore , the intervention affected physical activity among the normal weight group more positively than among the overweight , and participants with parents having 13–16 years of education more positively than participants with parents having either a lower or higher number of years of education . The intervention seemed to succeed in reducing time spent sedentary among girls but not among boys . Conclusions A comprehensive but feasible , multi-component school-based intervention can affect physical activity patterns  in adolescents by increasing overall physical activity . This intervention effect seemed to be more profound in girls than boys , low-active adolescents compared to high-active adolescents , participants with normal weight compared to the overweight , and for participants with parents of middle education level as opposed to those with high and low education levels , respectively . An implementation of the HEIA intervention components in the school system may have a beneficial effect on public health by increasing overall physical activity among adolescents and possibly among girls and low-active adolescents in particular Background Improving nutrition knowledge among children may help them to make healthier food choices . The aim of this study was to assess the effectiveness and acceptability of a novel educational intervention to increase nutrition knowledge among primary school children . Methods We developed a card game ' Top Grub ' and a ' healthy eating ' curriculum for use in primary schools . Thirty-eight state primary schools comprising 2519 children in years 5 and 6 ( aged 9 - 11 years ) were recruited in a pragmatic cluster r and omised controlled trial . The main outcome measures were change in nutrition knowledge scores , attitudes to healthy eating and acceptability of the intervention by children and teachers . Results Twelve intervention and 13 control schools ( comprising 1133 children ) completed the trial . The main reason for non-completion was time pressure of the school curriculum . Mean total nutrition knowledge score increased by 1.1 in intervention ( baseline to follow-up : 28.3 to 29.2 ) and 0.3 in control schools ( 27.3 to 27.6 ) . Total nutrition knowledge score at follow-up , adjusted for baseline score , deprivation , and school size , was higher in intervention than in control schools ( mean difference = 1.1 ; 95 % CI : 0.05 to 2.16 ; p = 0.042 ) . At follow-up , more children in the intervention schools said they ' are currently eating a healthy diet ' ( 39.6 % ) or ' would try to eat a healthy diet ' ( 35.7 % ) than in control schools ( 34.4 % and 31.7 % respectively ; chi-square test p < 0.001 ) . Most children ( 75.5 % ) enjoyed playing the game and teachers considered it a useful re source . Conclusions The ' Top Grub ' card game facilitated the enjoyable delivery of nutrition education in a sample of UK primary school age children . Further studies should determine whether improvements in nutrition knowledge are sustained and lead to changes in dietary behaviour OBJECTIVE To determine whether a multicomponent health promotion intervention for Dutch adolescents would be successful in influencing body composition and aerobic fitness . DESIGN R and omized controlled trial . SETTING Ten intervention and 8 control prevocational secondary schools . PARTICIPANTS A total of 978 adolescents ( mean age , 12.7 years ) . INTERVENTION An interdisciplinary multicomponent intervention program with an adapted curriculum for 11 biology and physical education lessons and environmental change options , including additional lessons on physical education and advice on the school canteen selection . MAIN OUTCOME MEASURES Body height and weight , hip and waist circumference , 4 skinfold thickness measurements , and aerobic fitness . RESULTS Multilevel analyses showed significant differences in changes after the 8-month intervention period in favor of the intervention group with regard to hip circumference ( mean difference , 0.53 cm ; 95 % confidence interval , 0.07 to 0.98 ) and sum of skinfolds among girls ( mean difference , -2.31 mm ; 95 % confidence interval , -4.34 to -0.28 ) . In boys , the intervention result ed in a significant difference in waist circumference ( mean difference , -0.57 cm ; 95 % confidence interval , -1.10 to -0.05 ) . No significant intervention effects were found related to aerobic fitness . CONCLUSIONS The multicomponent Dutch Obesity Intervention in Teenagers program positively influenced several measures of body composition among both girls and boys . Our results indicate that secondary prevocational school curriculum changes may contribute to excessive weight gain prevention among adolescents Objective : To describe the effects of URMEL-ICE , a German school-based intervention for overweight prevention , on children ’s BMI  and other measures of fat mass . Methods : A cluster-r and omised controlled design was used . The intervention which focused on physical activity , TV time and soft drink consumption was integrated into a second- grade curriculum and was implemented by classroom teachers themselves . It comprised 29 teaching lessons , 2 short exercise blocks per day and 6 family homework lessons .  BMI was assessed as primary outcome measure , waist circumference and skinfold thickness as secondary outcomes . Data of 945 children were analysed . Results : Multivariate analyses adjusted for baseline values showed no statistically significant effect of the intervention on BMI , but on waist circumference ( –0.85 ; 95 % confidence interval ( 95 % CI ) –1.59 to –0.12 ) and subscapular skinfold thickness ( –0.64 ; 95 % CI –1.25 to –0.02 ) . After additional adjustment for individual time lag between baseline and follow-up , these effects were reduced to –0.60 ( 95 % CI –1.25 to 0.05 ) and –0.61 ( 95 % CI –1.26 to 0.04 ) and lost their statistical significance . Conclusion : This study contributes to the field of r and omised school-based studies on overweight prevention and shows that within a 1-year , integrated intervention no effect on BMI , but a tendency towards effects on fat mass can be achieved The purpose of the study was to investigate the effects of a school-based prevention program on physical activity , fitness , and obesity . We performed a prospect i ve study in eight Bavarian primary schools ( n = 724 children , 8.4 ± 0.7 years ) r and omized one to one to either an  intervention school ( IS , n = 427 ) or a  control school ( CS , n = 297 ) . Children in IS attended 10 health-related lessons at school over a period of 1 year . Parents and teachers attended two and three educational health-related lessons , respectively , and also received 10 newsletters on health issues . Daily physical activity ( ≥ 60 min/day ) , physical fitness ( six-item test battery ) , and anthropometric data were obtained at baseline and after 1 year . Physical activity and physical fitness increased in IS , but it failed to reach significant intervention effects . Nevertheless , a reduction in waist circumference was observed for all children [ mean change 1.7 cm ; 95 % confidence interval ( CI ) 1.2 - 2.3 ; P < 0.001 ) . This effect was more pronounced in overweight children ( > 90th percentile , n = 99 , mean change 3.2 cm ; 95 % CI 1.5 - 4.8 ; P < 0.001 ) . This easily administered preventative program involving children , parents , and teachers revealed that a generalized approach increasing physical activity will even be favorable in a subgroup of obese children OBJECTIVE The aim of this study was to assess the behavioural effects of a school-based healthful diet promotion intervention implemented in lower vocational schools . DESIGN A cluster-r and omised pre-test-post-test experimental design was used , and data were collected by means of written question naires . SETTING Students of 18 Dutch lower vocational schools . SUBJECTS The final sample consisted of 10 experimental schools with 13 teachers , 37 classes and 879 students , and eight control schools with 10 teachers , 31 classes and 734 students ( total n = 1613 ) . RESULTS Fixed regression analyses revealed beneficial effects on the behavioural measures relating to fruit intake ( as assessed by a food frequency measure and fruit consumption during the previous day ) , and most behavioural measures related to high-fat snack intake ( food frequency measure , and number of snacks and total fat intake from snacks during the previous day ) . The behavioural effects relating to breakfast habits were limited . Some positive behavioural effects occurred in the total target population , others mainly or only among students with more unfavourable intakes at baseline . Mixed regression analysis found comparable regression coefficients for the behavioural outcomes , but the effects related to fruit intake were no longer statistically significant . CONCLUSIONS Although we did not find the expected effects on all outcome indicators , the total pattern of results suggest that Krachtvoer offered a surplus value over existing curricula . However , some programme elements need to be revised to improve effectiveness and prevent negative effects , and more information is needed about the long-term effects of the programme Background Globally , efforts aim ed at the prevention of childhood obesity have led to the implementation of a range of school-based interventions . This study assessed whether augmenting physical activity ( PA ) within the school setting result ed in increased daily PA and decreased overweight/obesity levels in 6 - 9-year-old children . Methods Across the first to third primary school years , PA of 84 girls and 92 boys was objective ly monitored five times ( each for seven successive days ) using Yamax pedometer ( step counts ) and Caltrac accelerometer ( activity energy expenditure AEE - kcal/kg per day ) . Four schools were selected to participate in the research ( 2 intervention , 2 controls ) , comprising intervention ( 43 girls , 45 boys ) and control children ( 41 girls , 47 boys ) . The study was non-r and omized and the intervention schools were selected on the basis of existing PA-conducive environment . Analyses of variance ( ANOVA ) for repeated measures examined the PA programme and gender effects on the step counts and AEE . Logistic regression ( Enter method ) determined the obesity and overweight occurrence prospect over the course of implementation of the PA intervention . Results There was a significant increase of school-based PA during schooldays in intervention children ( from ≈ 1718 to ≈ 3247 steps per day ; and from 2.1 to ≈ 3.6 Kcal/Kg per day ) in comparison with the control children .  Increased school-based PA  of intervention children during schooldays contributed to them achieving > 10,500 steps and > 10.5 Kcal/Kg per school day across the 2 years of the study , and result ed in a stop of the decline in PA levels that is known to be associated with the increasing age of children .  Increased school-based PA  had also positive impact on leisure time PA of schooldays and on PA at weekends of intervention children . One year after the start of the PA intervention , the odds of being overweight or obese in the intervention children was almost three times lower than that of control children ( p < 0.005 ) , and these odds steadily decreased with the duration of the intervention . Conclusions The findings suggest that school-based PA ( Physical Education lessons , PA during short breaks and longer recesses , PA at after-school nursery ) in compatible active environments ( child-friendly gym and school playground , corridors with movement and playing around corners and for games ) has a vital role in obesity and overweight reduction among younger pupils Interventions to promote physical activity are important in preventing children from becoming overweight . Many projects have been developed but only a few showed ( moderate ) effects . JUMP-in is a systematic ally developed primary -school-based intervention that focuses on the use of theory , environmental changes , parental influences and cooperation with multi-level parties in intervention development . The effects of JUMP-in were evaluated with a quasi-experimental pre-test/post-test research design . In total , 510 children from Grade s 4 , 5 and 6 of four intervention schools and two control schools in Amsterdam were followed for an intervention period of one school year . Changes in physical activity as well as in the social cognitive determinants were assessed using self-reports . In addition , a process evaluation has been executed . The results show that JUMP-in was effective in influencing physical activity , especially among children from Grade 6 . Children in the control group decreased their level of physical activity considerably , while activity levels in intervention children from Grade 6 remained stable . The intervention effects could not be explained by changes in the measured social cognitive determinants . In contrast , process information illuminated differences in intervention effects between the participating schools . The results from the JUMP-in study show the importance of intervention design s that focus on a theory-based mix of relevant environmental and social cognitive factors OBJECTIVES To evaluate the effects of a  middle-school healthy eating promotion intervention combining environmental changes and computer-tailored feedback , with and without an explicit parent involvement component . DESIGN Clustered r and omised controlled trial . SETTING Fifteen West-Flemish ( Belgian ) middle schools . SUBJECTS A r and om sample of 15 schools with 2991 pupils in 7th and 8th grade s was r and omly assigned to an intervention group with parental support ( n = 5 ) , an intervention group without parental support ( n = 5 ) and a control group ( n = 5 ) . In these 15 schools an intervention combining environmental changes with computer-tailored feedback was implemented . Fat and fruit intake , water and soft drinks consumption were measured with food-frequency question naires in the total sample of children . RESULTS In girls , fat intake and percentage of energy from fat decreased significantly more in the intervention group with parental support , compared with the intervention alone group ( all F>3.9 , P < 0.05 ) and the control group ( all F>16.7 , P < 0.001 ) . In boys , there were no significant decreases in fat intake ( F = 1.4 , not significant ( NS ) ) or percentage of energy from fat ( F = 0.7 , NS ) as a result of the intervention . No intervention effects were found in boys or in girls for fruit ( F = 0.5 , NS ) , soft drinks ( F = 2.6 , NS ) and water consumption ( F = 0.3 , NS ) . CONCLUSIONS Combining physical and social environmental changes with computer-tailored feedback in girls and their parents can induce lower fat intake in middle-school girls . However , to have an impact on the consumption of soft drinks and water , governmental laws that restrict the at-school availability of low-nutritive products may be necessary Background  Physical activity ( PA )  in children has declined in recent decades , highlighting the need for effective intervention programs for school-aged children . The main objective of this study was to assess to what extent PA during and after school hours changed among children who received a progressive two-year long intervention vs. that of children who only received general curriculum-based PA .  Methods A cluster r and omized intervention study was conducted and six elementary schools r and omly assigned to serve as control- or intervention schools . All children attending second grade ( mean age = 7.4 years - born in 1999 ) were invited to participate in the fall of 2006 ( N = 320 , 82 % participated ) , again in 2007 ( midpoint ) and 2008 ( end of intervention ) . The intervention consisted of multi-component PA-intervention during school hours and was conducted by teachers at each intervention school . PA  was assessed by means of accelerometers and subjectively at the intervention schools via teachers ' PA log-books . Results There was no difference in PA intensity ( minutes of moderate-to-vigorous physical activity - min of MVPA ) between the two study groups at baseline , but children in the intervention schools were more physically active at moderate-to-vigorous intensity compared to those in control schools after one year of intervention ( mean difference of MVPAlog-minutes : 0.61 , 95%CI : 0.02 , 1.20 , p = 0.04 ) . Moreover , the model for minutes of MVPA during school hours , showed a significant three-way interaction between time at mid-point , group and gender ( mean difference of MVPAlog-minutes : 1.06 , 95%CI : 0.15 , 1.97 , p = .02 ) , indicating a significantly greater increase among the boys in the intervention schools compared to girls . No difference in PA was detected between the study groups at the end of the study period after two years of intervention . Conclusions The results suggest that the objective of increasing PA at school was met after one year of intervention , and it was more pronounced among boys . The lack of increase at the end of the study period suggested that any increase in  PA  during school may highly depend on both motivation and training of general teachers . Boys may respond better to PA interventions such as the one described in this study BACKGROUND Identification of the behavioural , normative and control beliefs influencing children 's behaviour is an important prerequisite in design ing effective interventions . The current study aims to evaluate the effectiveness of an intervention program , based on the Theory of Planned Behaviour ( TPB ) , on  obesity indices and blood pressure ( BP ) in Ioannina , Greece . METHODS Participants were 646 fifth grade pupils ( 360 girls and 286 boys ) . The intervention group ( IG ) consisted of 321 children in 13 r and omly selected schools while the rest ( n = 325 children ) served as the  control group ( CG ) . Based on the outcome of the TPB question naire , the intervention focused on overcoming the barriers in accessing physical activity areas , increasing the availability of fruits and vegetables and increasing parental support . General linear mixed model and mediating variable analysis were used to evaluate the differences between the two groups and to test whether changes in certain dietary , physical activity and anthropometrical indices mediated the effect of the intervention on BP . RESULTS IG had higher consumption of fruits and lower consumption of fats/oils and sweets/beverages compared with the CG . Intervention 's effect on BMI could be explained by the changes in fruit and fats/oils intake whereas the reduction of systolic and diastolic BP could be explained by the reduction of BMI . CONCLUSIONS The findings indicate favourable changes in BP and obesity indices after the implementation of a 1-year school-based intervention program based on the TPB . These results highlight the importance of developing a social and physical environment that promotes balanced eating behaviours and extra-curricular access to physical activity venues Objective To assess the effectiveness of a school based physical activity programme during one school year on physical and psychological health in young schoolchildren . Design Cluster r and omised controlled trial . Setting 28 classes from 15 elementary schools in Switzerl and r and omly selected and assigned in a 4:3 ratio to an intervention ( n=16 ) or control arm ( n=12 ) after stratification for grade ( first and fifth grade ) , from August 2005 to June 2006 . Participants 540 children , of whom 502 consented and presented at baseline . Intervention Children in the intervention arm ( n=297 ) received a multi-component physical activity programme that included structuring the three existing physical education lessons each week and adding two additional lessons a week , daily short activity breaks , and physical activity homework . Children ( n=205 ) and parents in the control group were not informed of an intervention group . For most outcome measures , the assessors were blinded . Main outcome measures Primary outcome measures included body fat ( sum of four skinfolds ) , aerobic fitness ( shuttle run test ) , physical activity ( accelerometry ) , and quality of life ( question naires ) . Secondary outcome measures included body mass index and cardiovascular risk score ( average z score of waist circumference , mean blood pressure , blood glucose , inverted high density lipoprotein cholesterol , and triglycerides ) . Results 498 children completed the baseline and follow-up assessment s ( mean age 6.9 ( SD 0.3 ) years for first grade , 11.1 ( 0.5 ) years for fifth grade ) . After adjustment for grade , sex , baseline values , and clustering within classes , children in the intervention arm compared with controls showed more negative changes in the z score of the sum of four skinfolds ( −0.12 , 95 % confidence interval −0.21 to −0.03 ; P=0.009 ) . Likewise , their z scores for aerobic fitness increased more favourably ( 0.17 , 0.01 to 0.32 ; P=0.04 ) , as did those for moderate-vigorous physical activity in school ( 1.19 , 0.78 to 1.60 ; P<0.001 ) , all day moderate-vigorous physical activity ( 0.44 , 0.05 to 0.82 ; P=0.03 ) , and total physical activity in school ( 0.92 , 0.35 to 1.50 ; P=0.003 ) . Z scores for overall daily physical activity ( 0.21 , −0.21 to 0.63 ) and physical quality of life ( 0.42 , −1.23 to 2.06 ) as well as psychological quality of life ( 0.59 , −0.85 to 2.03 ) did not change significantly . Conclusions A school based multi-component physical activity intervention including compulsory elements improved physical activity and fitness and reduced adiposity in children . Trial registration Current Controlled Trials IS RCT N15360785 The aim of this study was to assess the effects of a 2-year cluster-r and omized physical activity and dietary intervention program among 7-year-old ( at baseline ) elementary school participants on body composition and objective ly measured cardiorespiratory fitness .  Three pairs of schools were selected and matched , then r and omly selected as either an  intervention ( n = 151 ) or  control school ( n = 170 ) . None of the effect sizes of body composition were statistically significant . Children in the intervention group increased their fitness by an average of 0.37 z score units more than the controls ( 95 % CI:-0.27 to 1.01 , P = 0.18 ) , representing an improvement of 0.286 W/kg . Boys had higher fitness ( mean(diff ) = 0.35 z scores , 95 % CI : 0.13 - 0.58 , P = 0.001 ) than girls , independent of study group , fitness z score at baseline and body mass index . Post hoc analysis showed that the intervention school with the highest fitness z score change was significantly different from two of the lowest control schools ( mean(diff ) = 0.83 z scores , 95 % CI : 0.44 - 1.21 , P < 0.0001 and mean(diff ) = 0.70 z scores , 95 % CI : 0.29 - 1.10 , P = 0.01 ) , but it was also significantly different from the lowest intervention school ( mean(diff ) = 0.59 z scores , 95 % CI : 0.19 - 0.99 , P = 0.05 ) . The results of this intervention are inconclusive as regards to the effects on fitness , but the intervention did not have any statistically significant effect on body composition OBJECTIVE To evaluate the effects of a 2-year middle school  physical activity and healthy food intervention , including an environmental and computer-tailored component on  BMI and BMI z-score in boys and girls . RESEARCH METHODS AND PROCEDURES A r and om sample of 15 schools with seventh and eighth grade rs was r and omly assigned to three conditions : an intervention with parental support group , an intervention-alone group , and a control group . Weight and height were measured at the beginning and end of each school year to assess BMI and BMI z-score . A physical activity and healthy food program was implemented over 2 school years . RESULTS In girls , BMI and BMI z-score increased significantly less in the intervention with parental support group compared with the control group ( p < 0.05 ) or the intervention-alone group ( p = 0.05 ) . In boys , no significant positive intervention effects were found . DISCUSSION This was the first study evaluating the effectiveness of an intervention combining environmental changes with personal computer-tailored feedback on BMI and BMI z-score  in middle school children . After 2 school years , BMI and BMI z-score changed in a more positive direction in girls as a result of the intervention with parental support OBJECTIVE To assess the short-term ( 15-d ) and long-term ( 12-month ) effects of a school-based health and nutrition education intervention on diet , nutrition intake and BMI . DESIGN The 12-week teacher-implemented intervention in combination with seminars organized for parents was aim ed at improving children 's diet and nutrition knowledge . The intervention took place between September 2007 and January 2008 . The participants were r and omized to two study groups , the intervention group ( IG ) and control group ( CG ) , and were examined prior to the intervention on a variety of health knowledge , dietary , behavioural and anthropometric indices . The same measurements were collected 15 d and 1 year after the intervention . SETTING All high schools in Vyronas , a densely populated district of Athens , Greece . SUBJECTS The sample consisted of 191 students aged 12 - 13 years . RESULTS Twelve months after the intervention , the programme was effective in reducing various indices in the IG compared with baseline findings ( BMI : 23.3 ( sd 2.8 ) v. 24.0 ( sd 3.1 ) kg/m2 , P < 0.001 ; daily energy intake : 8112.4 ( sd 1412.4 ) v. 8503.3 ( sd 1419.3 ) kJ/d , P < 0.001 ; total fat intake : 31.3 ( sd 4.4 ) v. 35.4 ( sd 4.7 ) % of daily energy , P < 0.001 ) . Except for BMI , decreases in the aforementioned indices were also observed 15 d after the intervention . In addition , students of the IG reduced their weekly consumption of red meat and non-home-made meals and increased their frequency of fruit and breakfast cereal consumption . CONCLUSIONS The beneficial effects of this nutrition education intervention among adolescents may highlight the potential of such programmes in the prevention of obesity OBJECTIVE To evaluate the short- and long-term results of FATaintPHAT , a Web-based computer-tailored intervention aim ing to increase physical activity , decrease sedentary behavior , and promote healthy eating to contribute to the prevention of excessive weight gain  among adolescents . DESIGN Cluster r and omized trial with an intervention group and a no-intervention control group . SETTING Twenty schools in the Netherl and s. PARTICIPANTS A total of 883 students ( aged 12 - 13 years ) . INTERVENTION The FATaintPHAT ( VETisnietVET in Dutch ) Web-based computer-tailored intervention . OUTCOME MEASURES Self-reported behaviors ( diet , physical activity , sedentary behavior ) and pedometer counts were measured at baseline and at 4-month and 2-year follow-up ; body mass index ( BMI ) , waist circumference , and fitness were measured at baseline and at 2-year follow-up . Descriptive and multilevel regression analyses were conducted among the total study population and among students not meeting behavioral recommendations at baseline ( students at risk ) . RESULTS The complete case analyses showed that FATaintPHAT had no effect on BMI and waist circumference . However , the intervention was associated with lower odds ( 0.54 ) of drinking more than 400 mL of sugar-sweetened beverages per day and with lower snack intake ( β = -0.81 snacks/d ) and higher vegetable intake ( β = 19.3 g/d ) but also with a lower step count ( β = -10 856 steps/wk ) at 4-month follow-up . In addition , among students at risk , FATaintPHAT had a positive effect on fruit consumption ( β = 0.39 g/d ) at 4-month follow-up and on step count ( β = 14 228 steps/wk ) at 2-year follow-up but an inverse effect on the odds of sports participation ( odds ratio , 0.45 ) at 4-month follow-up . No effects were found for sedentary behavior . CONCLUSION The FATaintPHAT intervention was associated with positive short-term effects on diet but with no effects or unfavorable effects on physical activity and sedentary behavior OBJECTIVE To examine the effects of an intervention program held by teachers previously trained in nutrition , on the consumption of low nutrient , energy-dense ( LNED ) foods , of children attending elementary schools . METHOD 464 children ( 239 female , 6 to 12 years ) from seven elementary Portuguese schools participated in this r and omized trial . Three schools were allocated to the intervention , and four to the control group . The intervention program was based on the Health Promotion Model and social cognitive theory . Teachers previously trained by research ers in nutrition and healthy eating implemented the intervention in the classroom from November 2008 to March 2009 . Sociodemographic , anthropometric , physical activity , and dietary assessment s were performed before ( 2007/2008 ) and at the end of the intervention ( 2009 ) . Dietary intake was gathered by a 24-hour dietary recall and two groups of LNED foods were defined , namely SSBs and solid LNED foods . RESULTS Children from intervention group reported a reduction whereas the control group reported an increase in solid LNED foods consumption . The odds of increasing solid LNED foods consumption was 0.48 , 95%CI ( 0.24 , 0.95 ) in the intervention schools . CONCLUSION Our study provides further support for the success of intervention programs aim ed at limiting the consumption of solid LNED foods in children PURPOSE To evaluate the effects of a  middle school physical activity intervention , new in combining an environmental and computer tailored component ; and to evaluate the effects of parental involvement . METHODS A clustered r and omized controlled design was used . A r and om sample of 15 schools with 7th and 8th grade rs was r and omly assigned to one of three conditions : ( a ) intervention with parental support , ( b ) intervention alone , and ( c ) control group . The intervention was new in combining environmental strategies with computer-tailored feedback to increase levels of moderate to vigorous physical activity .  The intervention was implemented by the school staff . Physical activity was measured through a question naire in the total sample and with accelerometers in a sub sample of adolescents . RESULTS The intervention with parental support led to an increase in self-reported school-related physical activity of , on average , 6.4 minutes per day ( p < or = .05 , d = .40 ) . Physical activity of light intensity measured with accelerometers decreased with , on average , 36 minutes per day as a result of the intervention with parental support ( p < or = .05 , d = .54 ) . Physical activity of moderate to vigorous intensity measured with accelerometers significantly increased with on average 4 minutes per day in the intervention group with parental support , while it decreased with almost 7 minutes per day in the control group ( p < or = .05 , d = .46 ) . CONCLUSIONS The physical activity intervention , implemented by the school staff , result ed in enhanced physical activity behaviors in both middle school boys and girls . The combination of environmental approaches with computer-tailored interventions seemed promising BACKGROUND This study aim ed to assess whether a school-based physical education intervention was effective in improving physical abilities and influencing daily physical activity habits in primary school children . The possible effect on body mass index ( BMI ) was also considered . METHODS Twenty-six 3rd- grade classes were r and omly selected stratifying by geographic location ( city , plain , hills ) and were assigned either to an  intervention ( 127 boys ; 120 girls ) or to a traditional ( 129 boys ; 121 girls ) physical education program . At baseline ( age : 8 - 9 years ) and after a 2-year follow-up ( age : 10 - 11 years ) , information was collected about sport participation and daily activity habits using a self-administered question naire . Height , weight , and BMI were measured and physical performance was assessed by means of st and ardized tests . RESULTS The enhanced program of physical education was effective in improving physical abilities of children and determining a decrease ( boys : 10 % ; girls : 12 % ) in daily sedentary activities ( preintervention versus postintervention , p < .05 ; intervention versus control group , p < .01 ) . The percentages of overweight and obese children did not vary significantly , but the experimental group showed a significantly lower rise in BMI compared to the control group ( p < .001 ) . CONCLUSION The school proved to be an ideal setting for promoting physical activity and achieving the required daily activity levels Background Obesity is one of the main determinants of avoidable disease burden . To implement a program by university students acting as “ health promoting agents ” ( HPAs ) and to evaluate the effects on obesity prevalence of the  primary -school-based program that promotes healthy lifestyle , including dietary and physical activity recommendations over 28 months . Methods Two school clusters were r and omly assigned to intervention ( 24 schools , 1,222 pupils ) or control ( 14 schools , 717 pupils ) ; 78 % of pupils were Western European . Mean age ( ±SD ) was 8.4 ± 0.6 years ( 49.9 % females ) at baseline . Generalized linear mixed models were used to analyze differences in primary outcome between both groups . Data collected included body mass index ( BMI ) every year . Dietary habits and lifestyle question naires were filled in by the parents at baseline and at the end of the study . The interventions focused on eight lifestyle topics covered in 12 activities ( 1 hour/activity/session ) implemented by HPAs over 3 school academic years . Results At 28 months , obesity prevalence in boys was decreased −2.36 % in the intervention group ( from 9.59 % to 7.23 % ) and increased 2.03 % ( from 7.40 % to 9.43 % ) in the control group ; the difference was 4.39 % ( 95 % CI 3.48 to 5.30 ; P = 0.01 ) . The boys in the intervention group had an effective reduction of −0.24 units in the change of BMI z-score ( from 0.01 to −0.04 ) , compared to control ( from −0.10 to 0.09 ) ; 5.1 % more intervention pupils undertook physical activity > 5 hours/week than control pupils ( P =  0.02).Fish  consumption was a protector ( odds ratio 0.39 ; 95 % CI 0.23 to 0.67 ) while “ fast-food ” consumption was a risk factor for childhood obesity ( odds ratio : 2.27 ; 95 % CI 1.08 to 4.77 ) . Conclusions Our school-based program , conducted by HPA students , successfully reduced childhood obesity  prevalence in boys . Trial registration International St and ard R and omized Controlled Trial Number : IS RCT N29247645 OBJECTIVES The purpose of this study was to evaluate the effect of a school-based intervention program to reduce overweight and improve fitness in primary school children . METHODS A cluster r and omized controlled design was used over one school year with schools as unit of r and omization . In total 20 schools and 2,622 children aged 6 - 12 years ( grade s 3 - 8 ) from multi-ethnic , low income inner-city neighbourhoods in Rotterdam , Netherl and s , participated . The intervention , named Lekker Fit ! ( Enjoy being fit ! ) was a multi-component intervention based on behavioural and ecological models . Main components of the intervention are the implementation of three physical education ( PE ) sessions a week by a professional PE teacher , additional sport and play activities outside school hours and an educational program . Main primary outcome measures were weight status , body mass index ( BMI ) , waist circumference and fitness ( 20 m shuttle run ) . RESULTS Significant positive intervention effects were found for percentage overweight children ( OR 0.53 ; 95 % CI 0.36 - 0.78 ) , waist circumference ( -1.29 cm ; 95 % CI -2.16 to -0.42 cm ) and 20 m shuttle run ( 0.57 laps ; 95 % CI 0.13 - 1.01 laps ) among pupils of grade s 3 - 5 ( 6 - 9-year olds ) . The prevalence of overweight in grade s 3 - 5 increased by 4.3 % in the control group and by 1.3 % in the intervention group . No significant effects were found for BMI or for grade s 6 - 8 ( 9 - 12-year olds ) . CONCLUSIONS Our results provide evidence for the effectiveness of the multi-component intervention Lekker Fit ! among pupils of grade s 3 - 5 and adds to the growing body of evidence that school-based programs with a focus on PA are most effective in reducing childhood obesity . [ IS RCT N84383524 ] The objective of the present study was to evaluate the effects of the Pro Children intervention on schoolchildren 's fruit and vegetable ( FV ) intake after 1 and 2 years of follow-up . The intervention combined a FV curriculum with efforts to improve FV availability at schools and at home . Effects were examined in a group-r and omised trial among 1,472 10 - 11-year-old children from sixty-two schools in Norway , the Netherl and s and Spain .  FV intake was assessed by means of vali date d self-administered question naires completed before the intervention ( September 2003 ) , immediately after the first year of the intervention ( May 2004 ) and 1 year later ( May 2005 ) . Data were analysed using multilevel linear regression analyses with age and sex as covariates . Significant intervention effects for FV intake were found at first follow-up in the total sample . The adjusted FV intake reported by the children from intervention schools was 20 % higher than FV intake reported by children from control schools . At 1 year later , a significant impact was only observed in Norway . Positive intervention effects on FV intake occurred both at school and outside school . We conclude that the Pro Children intervention is a promising means to promote European schoolchildren 's FV intakes , but mainly fruit intake , in the short term . As shown in Norway , where the intervention was best implemented , the intervention might also result in longer-term effects . Further strategies need to be developed that can improve implementation , have an impact on vegetable intake and can secure sustained effects The aim of the present study was to evaluate the effects of a  middle school physical activity and healthy eating intervention , including an environmental and computer-tailored component , and to investigate the effects of parental involvement . A r and om sample of 15 schools with seventh and eight grade rs was r and omly assigned to one of three conditions : ( i ) intervention with parental involvement , ( ii ) intervention alone and ( iii ) control group . In 10 schools , an intervention , combining environmental changes with computer-tailored feedback , was implemented over 2 school years . In five intervention schools , increased parental support was added . Physical activity was measured with question naires in the total sample and with accelerometers in a sub- sample of children . Fat intake , fruit , water and soft drink consumption were measured using food-frequency question naires . Results showed significant positive intervention effects on physical activity in both genders and on fat intake in girls . Parental involvement did not increase intervention effects . It can be concluded that physical activity and eating behaviours of middle school children can be improved by school-based strategies combining environmental and personal interventions . The use of personalized computer-tailored interventions seems to be a promising tool for targeting adolescents but needs to be further explored Obesity in childhood is increasing worldwide . To combat overweight and obesity in childhood , the school-based Children 's Health InterventionaL Trial ( CHILT ) project combines health education and physical activity . This paper examines the effect of intervention on the body mass index ( BMI ) and motor abilities after 20.8 ± 1.0 months in 12 r and omly selected primary schools compared with 5 r and omly selected control schools .  The anthropometric data were assessed , BMI was calculated . Coordination was determined by lateral jumping and endurance performance by a 6-minute run . No difference in the prevalence of overweight and obesity was found between the intervention ( IS ) and control schools ( CS ) either at baseline or following intervention ( each p > 0.05 ) . The increase in the number of lateral jumps was significantly higher in the IS than in the CS ( p < 0.001 ) . For the 6-minute run the increase in distance run was significantly improved in IS ( p = 0.020 ) . All variables were controlled for gender and age . Overweight and obese children in both IS and CS produced significantly lower scores in coordination and endurance tasks than normal and underweight children during both examinations ( each p ≤ 0.001 ) , adjusted for gender and age . Preventive intervention in primary schools offers an effective means to improve motor skills in childhood and to break through the vicious circle of physical inactivity - motor deficits - frustration - increasing inactivity possibly combined with an excess energy intake and weight gain . To prevent overweight and obesity these measures have to be intensified . Key PointsSchool-based prevention improves motor abilities in primary school children . The incidence of obesity is not influenced by school-based intervention . To prevent obesity in early childhood the measures have to be intensified and parents should be included
Context : The use of social marketing to modify lifestyle choices could be helpful in reducing  youth obesity .
Some or all of the 8 domains of the National Social Marketing Centre ’s social marketing benchmark criteria ( SMBC ) are often used but not always defined in intervention studies .
Objective : The aim of this review is to assess the effectiveness of European school-based interventions to prevent obesity relative to the inclusion of SMBC domains in the intervention .