***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: 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 Whether large portion sizes affect children 's eating behavior has rarely been studied . OBJECTIVES Our objectives were 1 ) to determine the effects of repeated exposure to a large portion of an entrée on preschool-aged children 's awareness of portion size , self-selected portion size , and food intake and 2 ) to evaluate associations of children 's responsiveness to portion size with weight status and overeating . DESIGN Energy intake , bite size , and comments about portion size were evaluated among 30 children at 2 series of lunches in which either an age-appropriate portion or a large portion of an entrée was served . On separate occasions , the children 's self-served portions , weight , height , and tendency to overeat were assessed . RESULTS Doubling an age-appropriate portion of an entrée increased entrée and total energy intakes at lunch by 25 % and 15 % , respectively . Changes were attributable to increases in the average size of the children 's bites of the entrée without compensatory decreases in the intake of other foods served at the meal . These increases were seen even though observational data indicated that the children were largely unaware of changes in portion size . Greater responsiveness to portion size was associated with higher levels of overeating . The children consumed 25 % less of the entrée when allowed to serve themselves than when served a large entrée portion . CONCLUSIONS Large entrée portions may constitute an " obesigenic " environmental influence for preschool-aged children by producing excessive intake at meals . Children with satiety deficits may be most susceptible to large portions . Allowing children to select their own portion size may circumvent the effects of exposure to large portions on children 's eating 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 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 Abstract Objective To identify risk factors in early life ( up to 3 years of age ) for obesity in children in the United Kingdom . Design Prospect i ve cohort study . Setting Avon longitudinal study of parents and children , United Kingdom . Participants 8234 children in cohort aged 7 years and a sub sample of 909 children ( children in focus ) with data on additional early growth related risk factors for obesity . Main outcome measures Obesity at age 7 years , defined as a body mass index 3 95th centile relative to reference data for the UK population in 1990 . Results Eight of 25 putative risk factors were associated with a risk of obesity in the final models : parental obesity ( both parents : adjusted odds ratio , 10.44 , 95 % confidence interval 5.11 to 21.32 ) , very early ( by 43 months ) body mass index or adiposity rebound ( 15.00 , 5.32 to 42.30 ) , more than eight hours spent watching television per week at age 3 years ( 1.55 , 1.13 to 2.12 ) , catch-up growth ( 2.60 , 1.09 to 6.16 ) , st and ard deviation score for weight at age 8 months ( 3.13 , 1.43 to 6.85 ) and 18 months ( 2.65 , 1.25 to 5.59 ) ; weight gain in first year ( 1.06 , 1.02 to 1.10 per 100 g increase ) ; birth weight , per 100 g ( 1.05 , 1.03 to 1.07 ) ; and short ( < 10.5 hours ) sleep duration at age 3 years ( 1.45 , 1.10 to 1.89 ) . Conclusion Eight factors in early life are associated with an increased risk of obesity in childhood OBJECTIVE To examine whether televised food commercials influence preschool children 's food preferences .  DESIGN In this r and omized , controlled trial , preschool children viewed a videotape of a popular children 's cartoon either with or without embedded commercials . Children were then asked to identify their preferences from pairs of similar products , one of which was advertised in the videotape with embedded commercials .  Preschoolers ' parents were interviewed to determine children 's demographic characteristics and media use patterns . SUBJECTS Forty-six 2- to 6-year-olds from a Head Start program in northern California . STATISTICAL ANALYSES For demographic and media use characteristics , univariate data were examined and Student t and chi 2 tests were used to test for differences between the control and treatment groups . We calculated the Cochran Q statistic to assess whether the proportion of those choosing advertised food items was significantly higher in the treatment group than in the control group . RESULTS Children exposed to the videotape with embedded commercials were significantly more likely to choose the advertised items than children who saw the same videotape without commercials ( Qdiff = 8.13 , df = 1 , P < .01 ) . CONCLUSIONS /APPLICATIONS Even brief exposures to televised food commercials can influence preschool children 's  food preferences . Nutritionists and health educators should advise parents to limit their preschooler 's exposure to television advertisements . Furthermore , advocates should raise the public policy issue of advertising and young children , especially given the recent epidemic of childhood obesity and the ever-changing media environment BACKGROUND . The prevalence and seriousness of childhood obesity has prompted calls for broad public health solutions that reach beyond clinic setting s. Schools are ideal setting s for population -based interventions to address obesity . OBJECTIVE . The purpose of this work was to examine the effects of a multicomponent , School Nutrition Policy Initiative on the prevention of overweight ( 85.0th to 94.9th percentile ) and obesity ( > 95.0th percentile ) among children in grade s 4 through 6 over a 2-year period . METHODS . Participants were 1349 students in grade s 4 through 6 from 10 schools in a US city in the Mid-Atlantic region with ≥50 % of students eligible for free or reduced-price meals .  Schools were matched on school size and type of food service and r and omly assigned to intervention or control . Students were assessed at baseline and again after 2 years . The School Nutrition Policy Initiative included the following components : school self- assessment , nutrition education , nutrition policy , social marketing , and parent outreach . RESULTS . The incidences of overweight and obesity after 2 years were primary outcomes . The prevalence and remission of overweight and obesity , BMI z score , total energy and fat intake , fruit and vegetable consumption , body dissatisfaction , and hours of activity and inactivity were secondary outcomes . The intervention result ed in a 50 % reduction in the incidence of overweight . Significantly fewer children in the intervention schools ( 7.5 % ) than in the control schools ( 14.9 % ) became overweight after 2 years . The prevalence of overweight was lower in the intervention schools . No differences were observed in the incidence or prevalence of obesity or in the remission of overweight or obesity at 2 years . CONCLUSION . A multicomponent school-based intervention can be effective in preventing the development of overweight among children in grade s 4 through 6 in urban public schools with a high proportion of children eligible for free and reduced-priced school meals BACKGROUND & AIMS To assess the effects of a low cost behavioral prevention program in a preschool setting . METHODS 64 Kindergartens in 4 Bavarian regions were r and omly assigned as intervention or controls in a 2:1 ratio . Sample s of 1318 and 1340 children examined in the school entrance health examination at 5.7+/-2.6 and 17.6+/-2.3 months ( mean+/-st and ard deviation for first and second sample ) after the start of the program were analysed . MEASUREMENTS Main outcome measures were the prevalence of high fruit and vegetable consumption , low consumption of high caloric drinks assessed in parental question naires , overweight and obesity , and secondary , further dietary habits and results of motoric testing . RESULTS The program led to an increased proportion of children with high fruit and vegetable consumption already after 6 months , which was sustainable with adjusted odds ratios of 1.59 ( 1.26 : 2.01 ) and 1.48 ( 1.08 : 2.03 ) after 18 months . Subgroup analyses by gender , overweight and parent 
    Output:
    
There was moderately strong evidence to support interventions on  food promotion  , large portion sizes and sugar-sweetened soft drinks .
Conclusions Reducing food promotion to young children , increasing the availability of smaller portions and providing alternatives to sugar-sweetened soft drinks should be considered in obesity prevention programmes aim ed at younger children .
These environment-level interventions would support individual and family-level behaviour change