***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: This study reports the effect of the Fruits and Vegetables Make the Marks intervention , a school-based fruit and vegetable intervention consisting of a home economics classroom component and parental involvement and encouraged participation in the Norwegian School Fruit Programme , all delivered during the school year of 2001 - 02 . Nine r and omly chosen schools received the intervention and 10 schools served as control schools . Participating pupils completed question naires at baseline ( September 2001 ) , at Follow-up 1 ( May-June 2002 ) and at Follow-up 2 ( May 2003 ) . A total of 369 pupils ( 69 % ; mean age , 11.3 years at baseline ) participated in all three surveys . No effect of the intervention was found for intake of fruit and vegetables eaten at school or all day , neither at Follow-up 1 nor at Follow-up 2 . On analysing the effects on potential mediators , significant differences between intervention and control groups were found for Awareness of the five-a-day recommendations only . The intervention programme was rated as very good by the teachers , and the pupils reported that they enjoyed it . However , the intervention failed to change fruit and vegetable intake , probably because it did not succeed in changing the pupils ' preferences for or the accessibility of fruit and vegetables -- the two strongest correlates of children 's fruit and vegetable intake BACKGROUND AND OBJECTIVES With prevalence of childhood obesity increasing rapidly , developing of effective and sustainable intervention strategies is becoming more and more important for the prevention of childhood obesity in China . A trial was developed to evaluate the effect of comprehensive school-based intervention on  childhood obesity  . METHODS AND STUDY DESIGN A multi-center cluster r and omized controlled trial was conducted among urban children ( n=9,867 ) aged 6 - 13 years in 38 primary schools from six large cities .  Comprehensive intervention , nutrition education and physical activity interventions were carried out among children . Nutrition education was also targeted towards teachers , parents and health workers in intervention schools . The program was implemented for 2 semesters from May 2009 to May 2010 . RESULTS The combined prevalence of overweight and obesity increased by 1.5 percent ( 22.7 % vs 24.2 % , p<0.001 ) in control group while 0.2 percent in comprehensive intervention group ( 23.6 % vs 23.8 % , p=0.954 ) after intervention ( p=0.067 ) . The effect was significantly stronger among girls than boys ( -1.4 % vs -0.9 % , p=0.028 ) . A significant intervention effect was found on BMI for -0.3 kg/m2 ( 95 % confidence interval ( CI ) : -0.4 , -0.2 ; p<0.001 ) , BMI z scores for -0.14 ( 95 % CI : -0.18 , -0.11 ; p<0.001)，body fat for -0.8 percent ( 95 % CI : -0.9 , -0.6 ; p<0.001 ) , waist circumference for -0.5 cm ( 95 % CI : -0.6 , -0.3 ; p<0.001 ) , blood serum glucose for -0.20 mmol/L ( 95 % CI : -0.24 , -0.16 ; p<0.001 ) and cholesterol for -0.32 mmol/L ( 95 % CI : -0.34 , -0.30 ; p<0.001 ) . CONCLUSIONS We observed moderately significant effects on combined prevalence of overweight and obesity , BMI , BMI z scores , waist circumference , percentage body fat , glucose and lipid for a comprehensive school-based intervention of childhood obesity in China Background Childhood obesity has been increasing rapidly worldwide . There is limited evidence for effective lifestyle interventions to prevent childhood obesity worldwide , especially in developing countries like China . The objective of this study was to assess the effectiveness of a school-based multi-component lifestyle childhood obesity prevention program ( the CLICK-Obesity study ) in Mainl and China . Methods A cluster r and omized controlled trial was developed among grade 4 students from 8 urban primary schools ( 638 students in intervention , 544 as control ) in Nanjing City , China . Students were r and omly allocated to the control or intervention group at school-level . A one-year multi-component intervention program ( classroom curriculum , school environment support , family involvement and fun programs/events ) together with routine health education was provided to the intervention group , while the control group received routine health education only . The main outcome variables assessed were changes in body mass index , obesity occurrence , obesity-related lifestyle behaviors and knowledge . Results Overall , 1108 ( 93.7 % ) of the 1182 enrolled students completed the intervention study . The intervention group had a larger marginal reduction than did the control group in overall mean BMI value ( -0.32±1.36 vs. -0.29±1.40 , p = 0.09 ) , although this was not significant . Compared with the control group , the intervention group was more likely to decrease their BMI ( OR = 1.44 , 95%CI = 1.10 , 1.87 ) by 0.5 kg/m2 or above , increase the frequency of jogging/running ( OR = 1.55 , 95%CI = 1.18 , 2.02 ) , decrease the frequency of TV/computer use ( OR = 1.41 , 95%CI = 1.09 , 1.84 ) and of red meat consumption ( OR = 1.50 , 95%CI = 1.15 , 1.95 ) , change commuting mode to/from school from sedentary to active mode ( OR = 2.24 , 95%CI = 1.47 , 3.40 ) , and be aware of the harm of selected obesity risk factors . Conclusions The school-based lifestyle intervention program was practical and effective in improving health behaviors and obesity-related knowledge for children in China . This study provides important policy implication s on school-based intervention programs for modifications of obesity-related lifestyles . Trial Registration Chinese Clinical Trial Registry Background Multi-level , longer-term obesity prevention interventions that focus on inequalities are scarce . Fun ‘ n healthy in Morel and ! aim ed to improve child adiposity , school policies and environments , parent engagement , health behaviours and child wellbeing . Methods All children from primary schools in an inner urban , culturally diverse and economically disadvantaged area in Victoria , Australia were eligible for participation . The intervention , fun ‘ n healthy in Morel and ! , used a Health Promoting Schools Framework and provided schools with evidence , school research data and part time support from a Community Development Worker to develop health promoting strategies . Comparison schools continued as normal . Participants were not blinded to intervention status . The primary outcome was change in adiposity . Repeated cross-sectional design with nested longitudinal sub sample . Results Students from twenty-four primary schools ( clusters ) were r and omised ( aged 5–12 years at baseline ) . 1426 students from 12 intervention schools and 1539 students from 10 comparison schools consented to follow up measurements . Despite increased prevalence of healthy weight across all schools , after 3.5 years of intervention there was no statistically significant difference between trial arms in BMI z score post-intervention ( Mean ( sd ) : Intervention 0.68(1.16 ) ; Comparison : 0.72(1.12 ) ; Adjusted mean difference ( AMD ) : -0.05 , CI : -0.19 to 0.08 , p = 0.44 ) . Children from intervention schools consumed more daily fruit serves ( AMD : 0.19 , CI:0.00 to 0.37 , p = 0.10 ) , were more likely to have water ( AOR : 1.71 , CI:1.05 to 2.78 , p = 0.03 ) and vegetables ( AOR : 1.23 , CI : 0.99 to 1.55 , p = 0.07 ) , and less likely to have fruit juice/cordial ( AOR : 0.58 , CI:0.36 to 0.93 , p = 0.02 ) in school lunch compared to children in comparison schools . More intervention schools ( 8/11 ) had healthy eating and physical activity policies compared with comparison schools ( 2/9 ) . Principals and schools highly valued the approach as a catalyst for broader positive school changes . The cost of the intervention per child was $ 65 per year . Conclusion The fun n healthy in Morel and ! intervention did not result in statistically significant differences in BMI z score across trial arms but did result in greater policy implementation , increased parent engagement and re sources , improved child self-rated health , increased fruit , vegetable and water consumption , and reduction in sweet drinks . A longer-term follow up evaluation may be needed to demonstrate whether these changes are sustainable and impact on childhood overweight and obesity . Clinical trial registration ACTRN12607000385448 ( Date su bmi tted 31/05/2007 ; Date registered 23/07/2007 ; Date last up date d 15/12/2009 ) Background Childhood obesity has been a serious public health problem . An effective school-based physical activity ( PA ) intervention is still lacking in China . This study aim ed to assess the effectiveness of a school-based physical activity intervention during 12 weeks on obesity and related health outcomes  in school children . Methods It was a non-r and omized controlled trial . Altogether 921 children aged 7 to 15 years were recruited at baseline survey . Children in the intervention group ( n = 388 ) participated in a multi-component physical activity intervention during 12 weeks that included improvement of physical education , extracurricular physical activities for overweight/obese students , physical activities at home , and health education lectures for students and parents . Children ( n = 533 ) in the control group participated in usual practice .  Results Participants had mean age of 10.4 years , mean body mass index ( BMI ) of 19.59 kg/m2 , and 36.8 % of them were overweight or obese at baseline survey . The change in BMI in intervention group ( −0.02 ± 0.06 kg/m2 ) was significantly different from that in control group ( 0.41 ± 0.08 kg/m2 ) . The adjusted mean difference was −0.43 kg/m2 ( 95 % CI : −0.63 to −0.23 kg/m2 , P < 0.001 ) . The effects on triceps , subscapular , abdominal skinfold thickness and fasting glucose were also significant in intervention group compared with control group ( all P < 0.05 ) . The change in duration of moderate to vigorous physical activity ( MVPA ) in intervention group ( 8.9 ± 4.3 min/day ) was significantly different from that in control group ( −13.8 ± 3.3 min/day ) . The adjusted mean difference was 22.7 min/day ( 95 % CI : 12.2 to 33.2 min/day , P < 0.001 ) . Conclusions The school-based , multi-component physical activity intervention was effective to decreasing levels of BMI , skinfold thickness , fasting glucose and increasing duration of MVPA . These findings provided evidence for the development of effective and feasible school-based obesity interventions .Trial registration Clinical trials.gov Identifier : NCT02074332 ( 2014 - 02 - 26 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 BACKGROUND The objective of this study , focused on parents and children to reduce sedentary behavior , consumption of soft drinks and high-fat and salt containing snacks , and increase the consumption of fruits and vegetables , was to assess the effect of a six month intervention and an 18 month follow-up intervention on the body mass index , food consumption and physical activity of 2nd and 3rd grade elementary school children . METHODS This was a r and omized cluster controlled trial . School children were selected from 2nd and 3rd ( n = 532 ) grade . MEASUREMENTS BMI z 
    Output:
    
No consistent pattern was found between either type of environment targeted , number of type of environment targeted , or the child 's targeted socio-cognitive determinants and intervention effectiveness .
DISCUSSION School-based interventions with direct parental involvement have the potential to improve children 's weight status , physical activity and sedentary behavior .