***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: 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 Summary Background Although childhood overweight and obesity prevalence has increased substantially worldwide in the past three decades , scarce evidence exists for effective preventive strategies . We aim ed to establish whether a school-based intervention for children aged 9–10 years would prevent excessive weight gain after 24 months . Methods This pragmatic cluster r and omised controlled trial of the Healthy Lifestyles Programme ( HeLP ) , a school-based obesity prevention intervention , was done in 32 schools in southwest Engl and . All state-run primary and junior schools in Devon and Plymouth ( UK ) with enough pupils for at least one year-5 class were eligible . Schools were assigned ( 1:1 ) using a computer-generated sequence to either intervention or control , stratified by the number of year-5 classes ( one vs more than one ) and the proportion of children eligible for free school meals ( < 19 % [ the national average ] vs ≥19 % ) . HeLP was delivered to year-5 children ( ages 9–10 years ) over 1 year , and included dynamic and interactive activities such as physical activity workshops , education sessions delivered by teachers with short homework tasks , drama sessions , and setting goals to modify behaviour ( with parental support and one-to-one discussion s with HeLP coordinators ) . The primary outcome was change in body-mass index ( BMI ) st and ard deviation score ( SDS ) between baseline and 24 months , analysed in children with BMI data available for both timepoints . This study is registered with the International St and ard R and omised Controlled Trial register , number IS RCT N15811706 , and the trial status is complete . Findings Between March 21 , 2012 , and Sept 30 , 2013 , 32 eligible schools with 1324 children were recruited , of which 16 schools ( 676 children ) were r and omly assigned to the HeLP intervention  and 16 schools ( 648 children ) to control . All schools that began the trial completed the intervention , and 1244 children ( 628 in intervention group and 616 in control group )  had BMI data at both baseline and 24 months for the primary outcome analysis . Mean BMI SDS was 0·32 ( SD 1·16 ) at baseline and 0·35 ( 1·25 ) at 24 months in the intervention group , and 0·18 ( 1·14 ) at baseline and 0·22 ( 1·22 ) at 24 months in the control group . With adjustment for school-level clustering , baseline BMI scores , sex , cohort , and number of year-5 classes and socioeconomic status of each school , the mean difference in BMI SDS score ( intervention – control ) at 24 months was −0·02 ( 95 % CI −0·09 to 0·05 ) , p=0·57 . One parent reported an adverse event related to their child 's eating and activity behaviours , but agreed for the child to continue trial participation after discussion with the chief investigator . Interpretation Despite a theoretically informed and extensively piloted intervention that achieved high levels of engagement , follow-up , and fidelity of delivery , we found no effect of the intervention on preventing overweight or obesity . Although schools are an ideal setting in which to deliver population -based interventions , school-based interventions might not be sufficiently intense to affect both the school and the family environment , and hence the weight status of children . Future research should focus on more upstream determinants of obesity and use whole-systems approaches . Funding UK National Institute for Health Research , Public Health Research Programme 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 Objective : To evaluate the effectiveness of the Shaping Healthy Choices Program ( SHCP ) . Design : A clustered , r and omized , controlled intervention lasting 1 school year . Setting : Schools in northern and central California . Participants : Fourth‐ grade rs ( aged 9–10 years ) at 2 control schools ( n = 179 ) and 2 intervention schools ( n = 230 ) . Intervention : Garden‐enhanced education , family , and community partnerships ; increased regionally procured produce in the lunchroom ; and school‐site wellness committees . Main Outcome Measures : Changes in body mass index ( BMI ) percentiles/Z‐scores ; nutrition knowledge , science process skills , and vegetable identification and preferences ; and reported fruit and vegetable intake . Analysis : Student t test , chi‐square , ANOVA of change , and multilevel regression mixed model to evaluate change in outcomes with school as a r and om effect to account for cluster design effects . Statistical significance was set at P < .05 . Results : There was a greater improvement in BMI percentile ( −6.08 ; P < 0.01 ) , BMI Z‐score ( −0.28 ; P < .001 ) , and waist‐to‐height ratio ( −0.02 ; P < .001 ) in the intervention compared with the control schools . Conclusions and Implication s : The SHCP result ed in improvements in nutrition knowledge , vegetable identification , and a significant decrease in BMI percentiles . This supports the concept that the SHCP can be used to improve the health of upper elementary school students The global rate of obesity in childhood is becoming an epidemic and many authors have established a significant association between childhood obesity and overweight in adulthood . It is therefore necessary to seek effective strategies to reduce these levels of obesity . The aim of this study was to evaluate the impact of the Healthy Habits Program ( HHP ) . The participants comprised 158 children from the fifth and sixth grade s ( intervention group , n = 82 ; control group , n = 76 ) . The HHP is a school-based physical activity program focusing on promoting a healthy lifestyle . It lasted for 8 months , and measurements were taken at the beginning and end of the program . Physiological variables ( total cholesterol , triglycerides , blood glucose , blood pressure , and maximal oxygen consumption ) , anthropometric variables ( body mass index ( BMI ) ) and behavioral variables ( breakfast , quality of diet , meal frequency , physical activity , sedentary behavior , sleep , and perceived health ) were evaluated . Repeated- measures ANOVA showed significant improvements ( p < 0.05 ) after the intervention for the intervention group in triglycerides , blood glucose and maximal oxygen consumption . Significant improvements were also observed in breakfast habits and quality of diet . Finally , a significant improvement in prevalence of normal levels was observed for total cholesterol , blood pressure , and BMI . It can therefore be stated that the HHP is an innovative and useful school-based program that can help to improve diet and health in childhood Background : To investigate whether changing the play environment in primary schools to one that includes greater risk and challenge increases physical activity and reduces body mass index ( BMI ) .Subjects/ Methods : A 2-year cluster r and omised controlled trial was undertaken in 16 New Zeal and schools ( years 1–8 ) . Intervention schools ( n=8 ) re design ed their play environments to encourage imaginative and independent free play by increasing opportunities for risk and challenge ( for example , rough- and -tumble play ) , reducing rules and adding new playground components ( for example , loose parts ) . Control schools ( n=8 ) were asked to not change their play environment . A qualified playworker rated all school play environments at baseline and 1 year . Primary outcomes were moderate-to-vigorous physical activity ( 7-day accelerometry ) and BMI z-score , collected in 840 children at baseline , 1 and 2 years . Data were analysed using generalised estimating equations . Results : Multiple changes were made to the school play environments result ing in a significant difference in overall play evaluation score between intervention and control schools of 4.50 ( 95 % confidence interval : 1.82 to 7.18 , P=0.005 ) , which represents a substantial improvement from baseline values of 19.0 ( s.d . 3.2 ) . Overall , schools liked the intervention and reported many benefits , including increased physical activity . However , these beliefs did not translate into significant differences in objective ly measured physical activity , either as counts per minute ( for example , 35 ( −51 to 120 ) during lunch break ) or as minutes of moderate-to-vigorous physical activity ( 0.4 , −1.1 to 2.0 ) . Similarly , no significant differences were observed for BMI , BMI z-score or waist circumference at 1 or 2 years ( all P>0.321 ) . Conclusions : Altering the school play environment to one that promoted greater risk and challenge for children did not increase physical activity , nor subsequently alter body weight . Although schools embraced the concept of adding risk and challenge in the playground , our findings suggest that children may have been involved in different , rather than additional activities 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 Background Adolescence is an established period of physical activity decline . Multi-component school-based interventions have the potential to slow the decline in adolescents ’ physical activity ; however , few interventions have been conducted in schools located in low-income or disadvantaged communities . This study aims to assess the effectiveness of a multi-component school-based intervention in reducing the decline in physical activity among students attending secondary schools located in disadvantaged communities . Methods / Design The cluster r and omised trial will be conducted with 10 secondary schools located in selected regions of New South Wales , Australia . The schools will be selected from areas that have a level of socio-economic status that is below the state average . Five schools will be allocated to receive an intervention based on the Health Promoting Schools framework , and will be supported by a part-time physical activity consultant placed in intervention schools who will implement a range of intervention adoption strategies . Study measures will be taken at baseline when students are in Year 7 ( 12–13 
    Output:
    
Conclusions School-based interventions are generally effective in reducing excessive weight gain of children .