***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 To assess a 2-year family-based behavioural intervention programme against  child obesity .  Design Single-group pre- and post-intervention feasibility study . Setting Swedish paediatric outpatient care . Participants 26 obese children aged 8.3–12.0 years and their parents who had consented to actively participate in a 2-year intervention . Interventions 25 paediatric outpatient group sessions  over a 2-year period with parallel groups for children and parents . The basis for the programme was a manual containing instructions for tutor-supervised group sessions with obese children and their parents . Primary and secondary outcome measures The primary outcome measure was change in st and ardised body mass index between baseline and after 36 months . The secondary outcome measures were change in the waist : height ratio , metabolic parameters and programme adherence . The participants were examined at baseline and after 3 , 12 and 24 months of therapy and at follow-up 12 months after completion of the programme . Results The primary outcome measure , st and ardised body mass index , declined from a mean of 3.3 ( 0.7 SD ) at baseline to 2.9 ( 0.7 SD ) ( p<0.001 ) at follow-up 12 months after completion of the programme . There was no change in the waist : height ratio . Biomedical markers of blood glucose metabolism and lipid status remained in the normal range . 96 % of the families completed the programme . Conclusions This feasibility study of a 2-year family-based behavioural intervention programme in paediatric outpatient care showed promising results with regard to further weight gain and programme adherence . These findings must be confirmed in a r and omised controlled trial with longer follow-up before the intervention programme can be implemented on a larger scale OBJECTIVE The objective was to compare targeting increased eating of healthy foods vs. reducing intake of high energy-dense foods within the context of a family-based behavioral weight control program . METHODS AND PROCEDURES Forty-one 8 - 12 year-old children > 85th BMI percentile were r and omly assigned to a 24-month family-based behavioral treatment that targeted increasing fruits and vegetables and low-fat dairy vs. reducing intake of high energy-dense foods . RESULTS Children in the increase healthy food group showed greater reduction in z BMI compared to children in the reduce high energy-dense food group at 12- ( -0.30 z BMI units vs. -0.15 z BMI units , P = 0.01 ) and 24- ( -0.36 z BMI units vs -0.13 z BMI units , P = 0.04 ) month follow-up . Parents in the increase healthy food group showed greater reductions in concern about child weight ( P = 0.007 ) , and these changes were associated with child z BMI change ( P = 0.008 ) . Children in the reduce high energy-dense group showed larger sustained reductions in high energy-dense foods ( P < 0.05 ) . Baseline levels of high energy-dense foods ( P < 0.05 ) , parent food restraint ( P = 0.01 ) , parent concern over parent weight ( P = 0.01 ) and parent acceptance of the child ( P < 0.05 ) moderated child z BMI change , with greater sustained reductions in z BMI for children in the increase healthy food group for each measure . Parent z BMI change followed the same pattern as child changes , and parent and child z BMI changes were correlated ( P < 0.001 ) . DISCUSSION Focusing on healthy food choices within an energy restricted diet may be useful in family-based weight control programs OBJECTIVE . The objective of this study was to determine whether a generalizable best- practice individualized behavioral intervention  reduced BMI z score relative to st and ard dietetic care among overweight children . METHODS . The design consisted of an assessor-blinded , r and omized , controlled trial involving 134 overweight children ( 59 boys , 75 girls ; BMI ≥ 98th centile relative to United Kingdom 1990 reference data for children aged 5–11 years ) who were r and omly assigned to a best- practice behavioral program ( intervention ) or st and ard care ( control ) .  The intervention used family-centered counseling and behavioral strategies to modify diet , physical activity , and sedentary behavior . BMI z score , weight , objective ly measured physical activity and sedentary behavior , fat distribution , quality of life , and height z score were recorded at baseline and at 6 and 12 months . RESULTS . The intervention had no significant effect relative to st and ard care on BMI z score from baseline to 6 months and 12 months . BMI z score decreased significantly in both groups from baseline to 6 and 12 months . For those who complied with treatment , there was a significantly smaller weight increase in those in the intervention group compared with control subjects from baseline to 6 months . There were significant between-group differences in favor of the intervention for changes in total physical activity , percentage of time spent in sedentary behavior , and light-intensity physical activity . CONCLUSIONS . A generalizable , best- practice individualized behavioral intervention had modest benefits on objective ly measured physical activity and sedentary behavior but no significant effect on BMI z score compared with st and ard care among overweight children . The modest magnitude of the benefits observed perhaps argues for a longer-term and more intense intervention , although such treatments may not be realistic for many health care systems Background In 2005 , we reported on the success of Comprehensive School Health ( CSH ) in improving diets , activity levels , and body weights . The successful program was recognized as a " best practice " and has inspired the development of the Alberta Project Promoting active Living and healthy Eating ( APPLE ) Schools . The project includes 10 schools , most of which are located in socioeconomically disadvantaged areas . The present study examines the effectiveness of a CSH program adopted from a " best practice " example in another setting by evaluating temporal changes in diets , activity levels and body weight . Methods In 2008 and 2010 , we surveyed grade 5 students from approximately 150 r and omly selected schools from the Canadian province of Alberta and students from 10 APPLE Schools . Students completed the Harvard Youth/Adolescent Food Frequency Question naire , questions on physical activity , and had their height and weight measured . Multilevel regression methods were used to analyze changes in diets , activity levels , and body weight between 2008 and 2010 . Results In 2010 relative to 2008 , students attending APPLE Schools were eating more fruits and vegetables , consuming fewer calories , were more physically active and were less likely obese . These changes contrasted changes observed among students elsewhere in the province . Conclusions These findings provide evidence on the effectiveness of CSH in improving health behaviors . They show that an example of " best practice " may lead to success in another setting . Herewith the study provides the evidence that investments for broader program implementation based on " best practice " are justified Background —The prevalence of obesity in both adults and children is increasing rapidly . Obesity in children is independently associated with arterial endothelial dysfunction and wall thickening , key early events in atherogenesis that precede plaque formation . Methods and Results —To evaluate the reversibility of obesity-related arterial dysfunction and carotid intima-media thickening by dietary and /or exercise intervention programs , 82 overweight children ( body mass index , 25±3 ) , 9 to 12 years of age , were r and omly assigned to dietary modification only or diet plus a supervised structured exercise program for 6 weeks and subsequently for 1 year . The prospect ively defined primary end points were ultrasound-derived arterial endothelial function ( endothelium-dependent dilation ) of the brachial artery and intima-media thickness of common carotid artery . At 6 weeks , both interventions were associated with decreased waist-hip ratio ( P < 0.02 ) and cholesterol level ( P < 0.05 ) as well as improved arterial endothelial function . Diet and exercise together were associated with a significantly greater improvement in endothelial function  than diet alone ( P = 0.01 ) . At 1 year , there was significantly less thickening of the carotid wall ( P < 0.001 ) as well as persistent improvements in body fat content and lipid profiles in the group continuing an exercise program . Vascular function was significantly better in those children continuing exercise ( n=22 ) compared with children who withdrew from the exercise program ( n=19 ) ( P < 0.05 ) . Conclusions —Obesity-related vascular dysfunction in otherwise healthy young children is partially reversible with diet alone or particularly diet combined with exercise training at 6 weeks , with sustained improvements at 1 year in those persisting with diet plus regular exercise Background : The program The combined DAK therapy for obesity in children and adolescents ’ funded and conducted by the Deutsche Angestellten-Krankenkasse ( DAK ) , a German health insurance company , commenced in 2003 . The treatment program lasts for 1 year and comprises of 2 phases : an initial inpatient therapy for 6 weeks followed by a home-based outpatient treatment of the overweight children , adolescents , and their families for 10.5 months . The therapy complies with the guidelines of the German Working Group of Obesity in Childhood and Adolescence ( AGA ) . Participants and Methods : In this study , 162 obese children and adolescents were compared with a control group of 75 obese subjects recruited from the waiting list for the program .  The aim was to analyze whether the changes in weight , eating behavior , and physical fitness during the therapy period are a result of the therapy itself or whether they are attributable to external effects . Body weight , height , and physical fitness were assessed through direct measurements while behavior and quality of life were assessed using self-report question naires . The development of body weight was evaluated using the BMI -SDS which is a measure of how many st and ard deviations an individual BMI is above or below the age- and gender-specific mean . Results : Within the observation period the BMI SDS decreased significantly by 0.36 ± 0.34 in the intervention group , whereas no changes of BMI -SDS were observed in the control group ( 0.04 ± 0.17 ) . The study revealed significant , positive treatment effects in exploratory analyses with regard to weight loss , behavior changes , physical fitness , and development of quality of life as a result of the therapy . These effects were not seen in the control group . Conclusion : We conclude that these positive developments are a result of the treatment program PURPOSE To determine the effect of increasing the aerobic component of the school 's physical activity program and improving the knowledge about weight control and blood pressure on the blood pressure and body fat of early adolescents . METHODS The subjects were 1140 youth aged 11 to 14 years ( 630 females , 510 males ; 64 % white , 24.4 % African-American , and 11.6 % " other " ) , who were r and omly assigned by school into four treatment groups : exercise only , education only , exercise and education combined , and control group . Heights , weights , and skinfold thicknesses were measured , and body mass index ( BMI ) was computed kg/m(2 ) . Blood pressure was obtained in duplicate using a r and om-zero mercury sphygmomanometer . Maximal oxygen uptake was predicted from a submaximal cycle ergometer test . Data were analyzed using analysis of covariance statistics , adjusting for gender , ethnicity , age , socioeconomic status , and initial baseline characteristics . RESULTS Systolic and diastolic blood pressures increased more in the control group than in the intervention groups ( p = .001 ) . The BMI did not change significantly ( p = .709 ) , but the sum of skinfolds increased less in subjects in the exercise intervention groups than the education only or control groups ( p = .0001 ) . The small increase in (p)VO(2)max of the combined exercise and education group was significantly greater than the education only group ( p = .0001 ) . CONCLUSION An exercise program for youth can have a positive effect on blood pressure independent of body weight loss Increasing fruits and vegetables ( FVs ) , a dietary recommendation for pediatric weight management , is theorized to reduce energy intake by reducing intake of more energy-dense foods , such as snack foods ( SFs ) . This study examined the relationship between changes in FV , SF , and energy intake in children enrolled in a 6-month , family-based behavioral pediatric weight management trial . Secondary data analyses examined dietary intake in 80 overweight ( ≥85th to < 95th percentile for body mass index [ BMI ] ) and obese ( ≥95th percentile for BMI ) children ( 7.2 ± 1.7 years ) with complete dietary records at 0 and 6 months . Participants were r and omized to one of three treatment conditions : ( 1 ) increased growth monitoring with feedback ; ( 2 ) decrease SFs and sugar sweetened beverages ; or ( 3 ) increase FVs and low-fat dairy . With treatment condition controlled in all analyses , FV intake significantly increased , while SF and energy intake decreased , but not significantly , from 0 to 6 months . Change in FV intake was not significantly associated with change in SF consumption . Additionally , change in FV intake was not significantly related to change in energy intake . However , reduction in SF intake was significantly related to reduction in energy intake . Changing only FVs , as compared to changing other dietary behaviors , during a pediatric obesity intervention may not assist with reducing energy intake 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 
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Results : Our findings propose that school-based programs can have long-term effects in a large target group .
They have remarkable consequences on health behaviors , but as there are some common limitations , their effects on anthropometric measures are not clear .
Due to the crucial role of parents in development of children 's behaviors , family-based interventions are reported to have successful effects in some aspects ; but selection bias and high dropout rate can confound their results .
Clinic-based interventions revealed favorable effects .
They include dietary or other lifestyle changes like increasing physical activity  or  behavior therapy .
It seems that a comprehensive intervention including diet and exercise are more practical .
When they have different design s , results are controversial .
Conclusion : We suggest that among different types of interventional programs , a multidisciplinary approach in schools in which children 's family are involved , can be the best and most sustainable approach for management of childhood obesity