***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: OBJECTIVES Motivating adolescents to adopt proper nutrition and physical activity behaviors is important in this nation 's fight to prevent obesity and chronic diseases . This study was conducted to determine which health education delivery method would elicit a greater behavior change . METHOD The intervention was conducted in three schools ( control , computer-based , and traditional education ) .  RESULTS Students who received the computer-based intervention showed increased knowledge ( p<0.001 ) , physical activity ( p=0.001 ) , self-efficacy ( p<0.001 ) , and social support ( p<0.001 ) , and decreased meals skipped ( p<0.001 ) . CONCLUSION The computer-based group showed more positive behavior changes . However , future programs may be enhanced by including group discussion and individual feedback Background Age‐related endothelial dysfunction and vascular stiffening are associated with increased cardiovascular ( CV ) risk . Many groups have encouraged goals of ≥10 000 steps/day or ≥30 min/day of moderate intensity physical activity ( MPA ) to reduce age‐related CV risk . The impact of MPA on the vasculature of older adults remains unclear . Methods and Results We r and omized 114 sedentary older adults ages ≥50 to 12 weeks of either no intervention ( group 1 ) , a pedometer‐only intervention ( group 2 ) , or a pedometer with an interactive website employing strategies to increase the adoption of habitual physical activity ( PA , group 3 ) . Endothelial function by brachial flow‐mediated dilation ( FMD% ) , vascular stiffness by tonometry , step‐count by pedometer , and PA intensity/distribution by accelerometer were measured . Step‐count increased in groups 2 ( 5136±1554 to 9596±3907 , P<0.001 ) and 3 ( 5474±1512 to 8167±3111 , P<0.001 ) but not in group 1 ( 4931±1667 to 5410±2410 ) . Both groups 2 and 3 increased MPA ≥30 min/day . Only group 3 increased MPA in continuous bouts of ≥10 minutes ( P<0.001 ) and improved FMD% ( P=0.001 ) . Neither achievement of ≥10 000 steps/day nor ≥30 min/day of MPA result ed in improved FMD% . However , achieving ≥20 min/day in MPA bouts result ed in improved FMD% . No changes in vascular stiffness were observed . Conclusions MPA reverses age‐related endothelial dysfunction , but may require MPA to be performed in bouts of ≥10 minutes duration for ≥20 min/day to be effective . Commonly encouraged PA goals do not guarantee improved endothelial function and may not be as effective in reducing CV risk . Clinical Trial Registration URL : Clinical trials.gov . Unique identifier : NCT‐01212978 BACKGROUND Web-based interventions for weight control could promote more-widespread dissemination of weight-loss opportunities ; however , they remain limited in effectiveness . Incorporating weight-control practice s used by individuals with long-term weight-loss success ( " positive deviants " ) may improve the efficacy of web-based weight control interventions . PURPOSE To evaluate the efficacy of AchieveTogether , a web-based weight-loss intervention for adults based on user-generated weight-loss strategies from successful weight losers . DESIGN In 2009 - 2010 , participants were r and omized to either a 12-week  web-based intervention , AchieveTogether , or a wait-list control condition . SETTING / PARTICIPANTS 100 overweight or obese adults participated in the study . INTERVENTION AchieveTogether was design ed to help individuals implement weight control practice s used by others who successfully lost and maintained weight . MAIN OUTCOME MEASURES The primary outcome was change in weight . Secondary outcomes included blood pressure , daily caloric intake , quality of life , and use of weight control practice s. ANCOVA , with adjustment for baseline values on outcome measures , was used to assess differences between groups in primary and secondary outcomes . Statistical analyses were conducted in 2010 - 2011 . RESULTS Most participants were women ( 69.7 % ) and white ( 90.8 % ) , with a mean age of 50.3 years and baseline BMI of 33.2 ; 88 % completed post-program assessment s.  Mean weight loss among intervention participants was -1.4 kg ( 95 % CI= -2.2 , -0.5 ) , compared with a mean weight gain of 0.6 kg ( 95 % CI= -0.3 , 1.4 ) in control participants ( p<0.01 ) . CONCLUSIONS User-generated weight-loss practice s from " positive deviants " could promote weight control in web-based interventions ; however , further research is needed to improve program efficacy . TRIAL REGISTRATION This study is registered at Clinical Trials.govNCT00709501 BACKGROUND Given the dramatic increase in adolescent overweight and obesity , models are needed for implementing weight management treatment through readily accessible venues . We evaluated the acceptability and efficacy of a school-based intervention consisting of school nurse-delivered counseling and an afterschool exercise program in improving diet , activity , and body mass index ( BMI ) among overweight and obese adolescents . METHODS A pair-matched cluster-r and omized controlled school-based trial was conducted in which 8 public high schools were r and omized to either a  12-session school nurse-delivered cognitive-behavioral counseling intervention plus school-based after school exercise program , or 12-session nurse contact with weight management information ( control ) .  Overweight or obese adolescents ( N = 126 ) completed anthropometric and behavioral assessment s at baseline and 8-month follow-up . Main outcome measures included diet , activity , and BMI . Mixed effects regression models were conducted to examine differences at follow-up . RESULTS At follow-up , students in intervention compared with control schools were not different in BMI , percent body fat , and waist circumference . Students reported eating breakfast ( adjusted mean difference 0.81 days ; 95 % confidence interval [ CI ] 0.11 - 1.52 ) on more days/week ; there were no differences in other behaviors targeted by the intervention . CONCLUSIONS While a school-based intervention including counseling and access to an after-school exercise program is theoretically promising with public health potential , it was not effective in reducing BMI or key obesogenic behaviors . Our findings are important in highlighting that interventions targeted at the individual level are not likely to be sufficient in addressing the adolescent obesity epidemic without changes in social norms and the environment Background : Theory-based interventions accessible to large groups of people are needed to induce favorable shifts in health behaviors and body weight . Purpose : The aim was to assess nutrition ; physical activity ; and , secondarily , body weight in the tailored , social cognitive Guide to Health ( GTH ) Internet intervention delivered in churches . Methods : Participants ( N=1,071 ; 33 % male , 23 % African American , 57 % with body mass index ≥25 , 60 % sedentary , Mdn age=53 years ) within 14 Baptist or United Method ist churches were r and omized to the GTH intervention only ( GTH-Only ; 5 churches ) , with church-based supports ( GTH-Plus ; 5 churches ) , or to a waitlist ( control ; 4 churches ) . Verified pedometer step counts , measured body weight , fat , fiber , and fruit and vegetable ( F&V ) servings from food frequency and supermarket receipts were collected at pretest , posttest ( 7 months after pretest ) , and follow-up ( 16 months after pretest ) . Results : Participants in GTH-Only  increased F&V at post ( ∼1.50 servings ) compared to control ( ∼0.50 servings ; p=.005 ) and at follow-up ( ∼1.20 vs. ∼0.50 servings ; p=.038 ) and increased fiber at post ( ∼3.00 g ) compared to control ( ∼1.5 g ; p=.006 ) and follow-up ( ∼3.00 g vs. ∼2.00 g ; p=.040 ) . GTH-Plus participants compared to control increased steps at post ( ∼1,500 steps/day vs. ∼400 steps/day ; p=.050 ) and follow-up ( ∼1,000 steps/day vs. ∼−50 steps/day ; p=.010 ) , increased F&V at post ( ∼1.5 servings ; p=.007 ) and follow-up ( ∼1.3 servings ; p=.014 ) , increased fiber at post ( ∼3.00 g ; p=.013 ) , and follow-up ( ∼3.00 ; p=.050 ) and decreased weight at post ( ∼−0.30 kg vs. ∼+0.60 kg ; p=.030 ) . Conclusions : Compared to control , both GTH treatments improved nutrition at posttest , but church supports improved physical activity and nutrition at posttest and follow-up , suggesting environmental supports may improve Internet-based interventions Context : Menopausal-related weight gain and increased waist circumference have major cardiovascular health implication s for older women . The efficacy of a dietary and physical activity lifestyle intervention to prevent weight gain and elevations in cardiovascular disease ( CVD ) risk factors from the peri- to postmenopause is unknown . Objective : To report the 54-month results of a lifestyle dietary and physical activity program on weight , body composition , physical activity , diet , and other CVD risk factors . Design : Data are from a 5-year r and omized clinical trial known as the Women ’s Healthy Lifestyle Project , conducted from 1992 to 1999 . Participants : 535 healthy , premenopausal women ages 44 to 50 at study entry enrolled into the trial . Intervention : Participants were r and omly assigned to either a lifestyle intervention group receiving a 5-year behavioral dietary and physical activity program or to an assessment -only control group . The lifestyle intervention group was given modest weight loss goals ( 5–15 lb , or approximately 2.3–6.8 kg ) to prevent subsequent gain above baseline weight by the end of the trial . To achieve weight loss and lower low-density lipoprotein cholesterol levels , intervention participants followed an eating pattern consisting of 1,300 kcal/day ( 25 % total fat , 7 % saturated fat , 100 mg of dietary cholesterol ) and increased their physical activity expenditure ( 1,000–1,500 kcal/week).Main Outcome Measures : Regarding weight gain prevention , 55 % ( 136/246 ) of intervention participants were at or below baseline weight compared with 26 % ( 68/261 ) of controls after 4.5 years , χ(2 , N = 507 ) = 45.0 , p < .001 . The mean weight change in the intervention group was 0.1 kg below baseline ( SD = 5.2 kg ) compared with an average gain of 2.4 kg ( SD = 4.9 kg ) observed in the control group . Waist circumference also significantly decreased more in the intervention group compared with controls ( M = −2.9 cm , SD = 5.3 vs. M = −0.5 cm , SD = 5.6 , p < .001 ) . Moreover , participants in the lifestyle intervention group were consistently more physically active and reported eating fewer calories and less fat than controls . Long-term adherence to physical activity and a low-fat eating pattern was associated with better weight maintenance . Conclusions : In healthy women , weight gain and increased waist circumference during the peri- to postmenopause can be prevented with a long-term lifestyle dietary and physical activity intervention BACKGROUND Childhood obesity is a major public health problem in the United States , particularly among American Indian communities . OBJECTIVE The objective was to evaluate the effectiveness of a school-based , multicomponent intervention for reducing percentage body fat in American Indian schoolchildren . DESIGN This study was a r and omized , controlled , school-based trial involving 1704 children in 41 schools and was conducted over 3 consecutive years , from 3rd to 5th grade s , in schools serving American Indian communities in Arizona , New Mexico , and South Dakota . The intervention had 4 components : 1 ) change in dietary intake , 2 ) increase in physical activity , 3 ) a classroom curriculum focused on healthy eating and lifestyle , and 4 ) a family-involvement program . The main outcome was percentage body fat ; other outcomes included dietary intake , physical activity , and knowledge , attitudes , and behaviors . RESULTS The intervention result ed in no significant reduction in percentage body fat . However , a significant reduction in the percentage of energy from fat was observed in the intervention schools . Total energy intake ( by 24-h dietary recall ) was significantly reduced in the intervention schools but energy intake ( by direct observation ) was not . Motion sensor data showed similar activity levels in both the intervention and control schools . Several components of knowledge , attitudes , and behaviors were also positively and significantly changed by the intervention . CONCLUSIONS These results document the feasibility of implementing a multicomponent program for obesity prevention in elementary schools serving American Indian communities . The program produced significant positive changes in fat intake and in food- and health-related knowledge and behaviors . More intense or longer interventions may be needed to significantly reduce adiposity in this population Importance Strategies to improve the nutritional status of those participating in the Supplemental Nutrition Assistance Program 
    Output:
    
Few areas demonstrated statistically significant effects across studies ; school‐based approaches and health care initiatives  reduced energy consumed , education reduced energy consumed and increased energy expended , and social‐group approaches increased energy expenditure .
Conclusions Despite the amount of research on obesity prevention interventions , very few studies have provided relevant information on energy intake and expenditure , two factors determining weight gain .