title: Decreasing sedentary behaviors in treating pediatric obesity. Evaluation of a multiple ecological level child obesity prevention program: Switch® what you Do, View, and Chew Reducing obesity via a school-based interdisciplinary intervention among youth: Planet Health. A randomized controlled trial of culturally tailored dance and reducing screen time to prevent weight gain in low-income African American girls: Stanford GEMS. A 4-year, cluster-randomized, controlled childhood obesity prevention study: STOPP Reducing children's television viewing to prevent obesity: a randomized controlled trial. The Fun Families Study: intervention to reduce children's TV viewing. Effects of Open-Loop Feedback on Physical Activity and Television Viewing in Overweight and Obese Children: A Randomized, Controlled Trial Behavioural and weight status outcomes from an exploratory trial of the Healthy Lifestyles Programme (HeLP): a novel school-based obesity prevention programme Effect of multidimensional lifestyle intervention on fitness and adiposity in predominantly migrant preschool children (Ballabeina): cluster randomised controlled trial Multiple behavior changes in diet and activity: a randomized controlled trial using mobile technology. Office-Based Randomized Controlled Trial to Reduce Screen Time in Preschool Children Feasibility trial evaluation of a physical activity and screen-viewing course for parents of 6 to 8 year-old children: Teamplay Use of an open-loop system to increase physical activity. A Parent-Focused Intervention to Reduce Infant Obesity Risk Behaviors: A Randomized Trial Impact of a school-based interdisciplinary intervention on diet and physical activity among urban primary school children: eat well and keep moving. Household obesity prevention: Take Action--a group-randomized trial. Feasibility of an obesity intervention for paediatric primary care targeting parenting and children: Helping HAND. Influence of a health education intervention on physical activity and screen time in primary school children: 'Switch Off--Get Active'. A randomized trial of the effects of reducing television viewing and computer use on body mass index in young children. Evaluation of the Web-based computer-tailored FATaintPHAT intervention to promote energy balance among adolescents: results from a school cluster randomized trial. A translational research intervention to reduce screen behaviours and promote physical activity among children: Switch-2-Activity. Primary care interventions to reduce television viewing in African-American children. Evaluation of a pilot school programme aimed at the prevention of obesity in children. Open-loop feedback increases physical activity of youth. A WIC-based intervention to prevent early childhood overweight. Effects of decreasing sedentary behavior and increasing activity on weight change in obese children. An intervention to reduce television viewing by preschool children. Effect of electronic time monitors on children's television watching: pilot trial of a home-based intervention. Randomized controlled trial of a primary care and home-based intervention for physical activity and nutrition behaviors: PACE+ for adolescents. Effects of television viewing reduction on energy intake and expenditure in overweight and obese adults: a randomized controlled trial. Outcomes of a group-randomized trial to prevent excess weight gain, reduce screen behaviours and promote physical activity in 10-year-old children: Switch-Play Randomized controlled trial to improve primary care to prevent and manage childhood obesity: the High Five for Kids study. Prevention of overweight in preschool children: results of kindergarten-based interventions Use of text messaging for monitoring sugar-sweetened beverages, physical activity, and screen time in children: a pilot study.
abstract: BACKGROUND Epidemiological studies have shown television watching to be a risk factor for the development of obesity in children . The effect of reducing television watching and other sedentary behaviors as a component of a comprehensive obesity treatment program has not been thoroughly tested . OBJECTIVE To compare the influence of targeting decreases in sedentary behavior vs. increases in physical activity in the comprehensive treatment of obesity in 8- to 12-year-old children . DESIGN R and omized , controlled outcome study . SETTING Childhood obesity research clinic . DESIGN Ninety families with obese 8- to 12-year-old children were r and omly assigned to groups that were provided a comprehensive family-based behavioral weight control program that included dietary , and behavior change information but differed in whether sedentary or physically active behaviors were targeted and the degree of behavior change required . RESULTS Results during 2 years showed that targeting either decreased sedentary behaviors or increased physical activity was associated with significant decreases in percent overweight and body fat and improved aerobic fitness . Self-reported activity minutes increased and targeted sedentary time decreased during treatment . Children substituted nontargeted sedentary behaviors for some of their targeted sedentary behaviors . CONCLUSION These results support reducing sedentary behaviors as an adjunct in the treatment of pediatric obesity Background Schools are the most frequent target for intervention programs aim ed at preventing child obesity ; however , the overall effectiveness of these programs has been limited . It has therefore been recommended that interventions target multiple ecological levels ( community , family , school and individual ) to have greater success in changing risk behaviors for obesity . This study examined the immediate and short-term , sustained effects of the Switch program , which targeted three behaviors ( decreasing children 's screen time , increasing fruit and vegetable consumption , and increasing physical activity ) at three ecological levels ( the family , school , and community ) . Methods Participants were 1,323 children and their parents from 10 schools in two states . Schools were matched and r and omly assigned to treatment and control . Measures of the key behaviors and body mass index were collected at baseline , immediately post-intervention , and 6 months post-intervention . Results The effect sizes of the differences between treatment and control groups ranged between small ( Cohen 's d = 0.15 for body mass index at 6 months post-intervention ) to large ( 1.38 ; parent report of screen time at 6 months post-intervention ) , controlling for baseline levels . There was a significant difference in parent-reported screen time at post-intervention in the experimental group , and this effect was maintained at 6 months post-intervention ( a difference of about 2 hours/week ) . The experimental group also showed a significant increase in parent-reported fruit and vegetable consumption while child-reported fruit and vegetable consumption was marginally significant . At the 6-month follow-up , parent-reported screen time was significantly lower , and parent and child-reported fruit and vegetable consumption was significantly increased . There were no significant effects on pedometer measures of physical activity or body mass index in the experimental group . The intervention effects were moderated by child sex ( for fruit and vegetable consumption , physical activity , and weight status ) , family involvement ( for fruit and vegetable consumption ) , and child body mass index ( for screen time ) . The perception of change among the experimental group was generally positive with 23 % to 62 % indicating positive changes in behaviors . Conclusion The results indicate that the Switch program yielded small-to-modest treatment effects for promoting children 's fruit and vegetable consumption and minimizing screen time . The Switch program offers promise for use in youth obesity prevention OBJECTIVE To evaluate the impact of a school-based health behavior intervention known as Planet Health on obesity among boys and girls in grade s 6 to 8 . DESIGN R and omized , controlled field trial with 5 intervention and 5 control schools . Outcomes were assessed using preintervention ( fall 1995 ) and follow-up measures ( spring 1997 ) , including prevalence , incidence , and remission of obesity . PARTICIPANTS A group of 1295 ethnically diverse grade 6 and 7 students from public schools in 4 Massachusetts communities . INTERVENTION Students participated in a school-based interdisciplinary intervention over 2 school years . Planet Health sessions were included within existing curricula using classroom teachers in 4 major subjects and physical education . Sessions focused on decreasing television viewing , decreasing consumption of high-fat foods , increasing fruit and vegetable intake , and increasing moderate and vigorous physical activity . MAIN OUTCOME MEASURES Obesity was defined as a composite indicator based on both a body mass index and a triceps skinfold value greater than or equal to age- and sex-specific 85th percentiles . Because schools were r and omized , rather than students , the generalized estimating equation method was used to adjust for individual-level covariates under cluster r and omization . RESULTS The prevalence of obesity among girls in intervention schools was reduced compared with controls , controlling for baseline obesity ( odds ratio , 0.47 ; 95 % confidence interval , 0.24 - 0.93 ; P = .03 ) , with no differences found among boys . There was greater remission of obesity among intervention girls vs. control girls ( odds ratio , 2.16 ; 95 % confidence interval , 1.07 - 4.35 ; P = .04 ) . The intervention reduced television hours among both girls and boys , and increased fruit and vegetable consumption and result ed in a smaller increment in total energy intake among girls . Reductions in television viewing predicted obesity change and mediated the intervention effect . Among girls , each hour of reduction in television viewing predicted reduced obesity prevalence ( odds ratio , 0.85 ; 95 % confidence interval , 0.75 - 0.97 ; P = .02 ) . CONCLUSION Planet Health decreased obesity among female students , indicating a promising school-based approach to reducing obesity among youth OBJECTIVE To test a 2-year community- and family-based obesity prevention program for low-income African American girls : Stanford GEMS ( Girls ' health Enrichment Multi-site Studies ) . DESIGN R and omized controlled trial with follow-up measures scheduled at 6 , 12 , 18 , and 24 months . SETTING Low-income areas of Oakl and , California . PARTICIPANTS African American girls aged 8 to 10 years ( N=261 ) and their parents or guardians . INTERVENTIONS Families were r and omized to one of two 2-year , culturally tailored interventions : ( 1 ) after-school hip-hop , African , and step dance classes and a home/family-based intervention to reduce screen media use or ( 2 ) information-based health education . MAIN OUTCOME MEASURE Changes in body mass index ( BMI ) . RESULTS Changes in BMI did not differ between groups ( adjusted mean difference [ 95 % confidence interval ] = 0.04 [ -0.18 to 0.27 ] per year ) . Among secondary outcomes , fasting total cholesterol level ( adjusted mean difference , -3.49 [ 95 % confidence interval , -5.28 to -1.70 ] mg/dL per year ) , low-density lipoprotein cholesterol level ( -3.02 [ -4.74 to -1.31 ] mg/dL per year ) , incidence of hyperinsulinemia ( relative risk , 0.35 [ 0.13 to 0.93 ] ) , and depressive symptoms ( -0.21 [ -0.42 to -0.001 ] per year ) decreased more among girls in the dance and screen time reduction intervention . In exploratory moderator analysis , the dance and screen time reduction intervention slowed BMI gain more than health education among girls who watched more television at baseline ( P = .02 ) and /or those whose parents or guardians were unmarried ( P = .01 ) . CONCLUSIONS A culturally tailored after-school dance and screen time reduction intervention for low-income , preadolescent African American girls did not significantly reduce BMI gain compared with health education but did produce potentially clinical ly important reductions in lipid levels , hyperinsulinemia , and depressive symptoms . There was also evidence for greater effectiveness in high-risk subgroups of girls 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 CONTEXT Some observational studies have found an association between television viewing and child and adolescent adiposity .  OBJECTIVE To assess the effects of reducing television , videotape , and video game use on changes in adiposity , physical activity , and dietary intake . DESIGN R and omized controlled school-based trial conducted from September 1996 to April 1997 . SETTING Two sociodemographically and scholastically matched public elementary schools in San Jose , Calif. PARTICIPANTS Of 198 third- and fourth- grade students , who were given parental consent to participate , 192 students ( mean age , 8.9 years ) completed the study . INTERVENTION Children in 1 elementary school received an 18-lesson , 6-month classroom curriculum to reduce television , videotape , and video game use . MAIN OUTCOME MEASURES Changes in measures of height , weight , triceps skinfold thickness , waist and hip circumferences , and cardiorespiratory fitness ; self-reported media use , physical activity , and dietary behaviors ; and parental report of child and family behaviors . The primary outcome measure was body mass index , calculated as weight in kilograms divided by the square of height in meters . RESULTS Compared with controls , children in the intervention group had statistically significant relative decreases in body mass index ( intervention vs control change : 18.38 to 18.67 kg/m2 vs 18.10 to 18.81 kg/m2 , respectively ; adjusted difference -0.45 kg/m2 [ 95 % confidence interval [ CI ] , -0.73 to -0.17 ] ; P = .002 ) , triceps skinfold thickness ( intervention vs control change : 14.55 to 15.47 mm vs 13.97 to 16.46 mm , respectively ; adjusted difference , -1.47 mm [ 95 % CI , -2.41 to -0.54 ] ; P=.002 ) , waist circumference ( intervention vs control change : 60.48 to 63.57 cm vs 59.51 to 64.73 cm , respectively ; adjusted difference , -2.30 cm [ 95 % CI , -3.27 to -1.33 ] ; P<.001 ) , and waist-to-hip ratio ( intervention vs control change : 0.83 to 0.83 vs 0.82 to 0.84 , respectively ; adjusted difference , -0.02 [ 95 % CI , -0.03 to -0.01 ] ; P<.001 ) . Relative to controls , intervention group changes were accompanied by statistically significant decreases in children 's reported television viewing and meals eaten in front of the television . There were no statistically significant differences between groups for changes in high-fat food intake , moderate-to-vigorous physical activity , and cardiorespiratory fitness . CONCLUSIONS Reducing television , videotape , and video game use may be a promising , population -based approach to prevent childhood obesity Media consumption may contribute to  childhood obesity . This study developed and evaluated a theory-based , parent-focused intervention to reduce television and other media consumption to prevent and reduce childhood obesity .  Families ( n = 202 ) with children ages 6 - 9 were recruited from a large , urban multiethnic population into a r and omized controlled trial ( 101 families into the intervention group and 101 into the  control group ) , and were followed for 6 months . The intervention consisted of a 2-hour workshop and six bimonthly newsletters . Behavioral objectives included : ( i ) reduce TV watching ; ( ii ) turn off TV when nobody is watching ; ( iii ) no TV with meals ;  ( iv ) no TV in the child 's bedroom ; and ( v ) engage in fun non-media related activities .  Parents were 89 % female , 44 % white , 28 % African American , 17 % Latino , and 11 % Asian , mean age 40 years ( s.d . = 7.5 ) ; 72 % were married . Children were 49 % female , mean age 8 years ( s.d . = 0.95 ) . Sixty-five percent of households had three or more TVs and video game players ; 37 % had at least one h and held video game , and 53 % had three or more computers . Average children 's weekday media exposure was 6.1 hours . At 6 months follow-up , the intervention group was less likely to report the TV being on when nobody was watching ( adjusted odds ratio ( AOR ) = 0.23 , P < 0.05 ) , less likely to report eating snacks while watching TV ( AOR = 0.47 , P < 0.05 ) , and less likely to have a TV in the child 's bedroom ( AOR = 0.23 , P < 0.01 ) . There was a trend toward reducing actual media consumption but these outcomes did not reach statistical significance . Effective strategies to reduce children 's TV viewing were identified OBJECTIVES . Television viewing and physical inactivity increase the risk of obesity in youth . Thus , identifying new interventions that increase physical activity and reduce television viewing would be helpful in the prevention and treatment of pediatric obesity . This study evaluated the effects of open-loop feedback plus reinforcement versus open-loop feedback alone on  physical activity , targeted sedentary behavior , body composition , and energy intake in youth . METHODS . Thirty overweight or obese 8- to 12-year-old children were r and omly assigned to an  intervention ( n = 14 ) or control group ( n = 16 ) . Participants wore accelerometers every day for 8 weeks and attended biweekly meetings to download the activity monitors . For children in the open-loop feedback plus reinforcement ( intervention ) group , accumulating 400 counts of physical activity on pedometers earned 1 hour of television/VCR/DVD time , which was controlled by a Token TV electronic device . Open-loop feedback control subjects wore activity monitors but had free access to targeted sedentary behavior . RESULTS . Compared with controls , the open-loop feedback plus reinforcement group demonstrated significantly greater increases in daily physical activity counts ( + 65 % vs + 16 % ) and minutes per day of moderate-to-vigorous physical activity ( + 9.4 vs + 0.3 ) and greater reductions in minutes per day spent in television viewing ( −116.1 vs + 14.3 ) . The intervention group also showed more favorable changes in body composition , dietary fat intake , and energy intake from snacks compared with controls . Reductions in sedentary behavior were directly related to reductions in BMI , fat intake , snack intake , and snack intake while watching television . CONCLUSIONS . Providing feedback of physical activity in combination with reinforcing physical activity with sedentary behavior is a simple method of modifying the home environment that may play an important role in treating and preventing child obesity Objectives To assess the behavioural and weight status outcomes in English children in a feasibility study of a novel primary school-based obesity prevention programme . Design Exploratory cluster r and omised controlled trial of the Healthy Lifestyles Programme . Setting Four city primary schools ( two control and two intervention ) in the South West of Engl and . Participants 202 children aged 9–10 years , of whom 193 and 188 were followed up at 18 and 24 months , respectively . No child was excluded from the study ; however , to be eligible , schools were required to have at least one single Year 5 class . Intervention Four-phase multicomponent programme using a range of school-based activities including lessons , assemblies , parents ' evenings , interactive drama workshops and goal setting to engage and support schools , children and their families in healthy lifestyle behaviours . It runs over the spring and summer term of Year 5 and the autumn term of Year 6 . Primary and secondary outcomes Weight status outcomes were body mass index , waist circumference and body fat st and ard deviation scores ( SDS ) at 18 and 24 months , and behavioural outcomes were physical activity , television ( TV ) viewing/screen time and food intake at 18 months . Results At 18 months of follow-up , intervention children consumed less energy-dense snacks and more healthy snacks ; had less ‘ negative food markers ’ , more ‘ positive food markers ’ , lower mean TV/screen time and spent more time doing moderate-vigorous physical activity each day than those in the control schools . Intervention children had lower anthropometric measures at 18 and 24 months than control children , with larger differences at 24 months than at 18 months for nearly all measures . Conclusions Results from this exploratory trial show consistent positive changes in favour of the intervention across all targeted behaviours , which , in turn , appear to affect weight status and body shape . A definitive trial is now justified Objective To test the effect of a multidimensional lifestyle intervention on aerobic fitness and adiposity in predominantly migrant preschool children . Design Cluster r and omised controlled single blinded trial ( Ballabeina study ) over one school year ; r and omisation was performed after stratification for linguistic region . Setting 40 preschool classes in areas with a high migrant population in the German and French speaking regions of Switzerl and . Participants 652 of the 727 preschool children had informed consent and were present for baseline measures ( mean age 5.1 years ( SD 0.7 ) , 72 % migrants of multicultural origins ) . No children withdrew , but 26 moved away . Intervention The multidimensional culturally tailored lifestyle intervention included a physical activity programme , lessons on nutrition , media use ( use of television and computers ) , and sleep and adaptation of the built environment of the preschool class . It lasted from August 2008 to June 2009 . Main outcome measures Primary outcomes were aerobic fitness ( 20 m shuttle run test ) and body mass index ( BMI ) . Secondary outcomes included motor agility , balance , percentage body fat , waist circumference , physical activity , eating habits , media use , sleep , psychological health , and cognitive abilities . Results Compared with controls , children in the intervention group had an increase in aerobic fitness at the end of the intervention ( adjusted mean difference : 0.32 stages ( 95 % confidence interval 0.07 to 0.57 ; P=0.01 ) but no difference in BMI ( −0.07 kg/m2 , −0.19 to 0.06 ; P=0.31 ) . Relative to controls , children in the intervention group had beneficial effects in motor agility ( −0.54 s , −0.90 to −0.17 ; P=0.004 ) , percentage body fat ( −1.1 % , −2.0 to −0.2 ; P=0.02 ) , and waist circumference ( −1.0 cm , −1.6 to −0.4 ; P=0.001 ) . There were also significant benefits in the intervention group in reported physical activity , media use , and eating habits , but not in the remaining secondary outcomes . Conclusions A multidimensional intervention increased aerobic fitness and reduced body fat but not BMI in predominantly migrant preschool children . Trial registration Clinical Trials NCT00674544 BACKGROUND Many patients exhibit multiple chronic disease risk behaviors . Research provides little information about advice that can maximize simultaneous health behavior changes . METHODS To test which combination of diet and activity advice maximizes healthy change , we r and omized 204 adults with elevated saturated fat and low fruit and vegetable intake , high sedentary leisure time , and low physical activity to 1 of 4 treatments :  increase fruit/vegetable intake and physical activity , decrease fat and sedentary leisure , decrease fat and increase physical activity , and increase fruit/vegetable intake and decrease sedentary leisure .  Treatments provided 3 weeks of remote coaching supported by mobile decision support technology and financial incentives . During treatment , incentives were contingent on using the mobile device to self-monitor and attain behavioral targets ; during follow-up , incentives were contingent only on recording . The outcome was st and ardized , composite improvement on the 4 diet and activity behaviors at the end of treatment and at 5-month follow-up . RESULTS Of the 204 individuals r and omized , 200 ( 98.0 % ) completed follow-up . The increase fruits/vegetables and decrease sedentary leisure treatments improved more than the other 3 treatments ( P < .001 ) . Specifically , daily fruit/vegetable intake increased from 1.2 servings to 5.5 servings , sedentary leisure decreased from 219.2 minutes to 89.3 minutes , and saturated fat decreased from 12.0 % to 9.5 % of calories consumed . Differences between treatment groups were maintained through follow-up . Traditional dieting ( decrease fat and increase physical activity ) improved less than the other 3 treatments ( P < .001 ) . CONCLUSIONS Remote coaching supported by mobile technology and financial incentives holds promise to improve diet and activity . Targeting fruits/vegetables and sedentary leisure together maximizes overall adoption and maintenance of multiple healthy behavior changes OBJECTIVE : To determine if an intervention for preschool-aged children in primary care is effective in reducing screen time , meals in front of the television , and BMI . METHODS : A r and omized controlled trial was conducted at a primary care pediatric group practice in Toronto , Canada . Three-year-old children and their parents were r and omly assigned to receive a short behavioral counseling intervention on strategies to decrease screen time .  The primary outcome 1 year later was parent reported screen time . Secondary outcomes included television in the child ’s bedroom , number of meals in front of the television , and BMI . RESULTS : In the intention-to-treat analysis at 1 year , there were no significant differences in mean total weekday minutes of screen time ( 60 , interquartile range [ IQR ] : 35–120 vs 65 , IQR : 35–120 ; P = .68 ) or mean total weekend day minutes of screen time ( 80 , IQR : 45–130 vs 90 , IQR : 60–120 ; P = .33 ) between the intervention and control group . Adjusting for baseline BMI , there was a reduction in the number of weekday meals in front of the television ( 1.6 ± 1.0 vs 1.9 ± 1.2 ; P = .03 ) but no differences in BMI or number of televisions in the bedroom . CONCLUSIONS : This pragmatic trial was not effective in reducing screen time or BMI but was effective in reducing meals in front of the screen . Short interventions focused solely on reducing screen time implemented in the primary care practice setting may not be effective in this age group Background Many children spend too much time screen-viewing ( watching TV , surfing the internet and playing video games ) and do not meet physical activity ( PA ) guidelines . Parents are important influences on children ’s PA and screen-viewing ( SV ) . There is a shortage of parent-focused interventions to change children ’s PA and SV . Methods Teamplay was a two arm individualized r and omized controlled feasibility trial . Participants were parents of 6–8 year old children . Intervention participants were invited to attend an eight week parenting program with each session lasting 2 hours . Children and parents wore an accelerometer for seven days and minutes of moderate-to-vigorous intensity PA ( MVPA )  were derived . Parents were also asked to report the average number of hours per day that both they and the target child spent watching TV . Measures were assessed at baseline ( time 0 ) at the end of the intervention ( week 8) and 2 months after the intervention had ended ( week 16 ) . Results There were 75 participants who provided consent and were r and omized but 27 participants withdrew post-r and omization . Children in the intervention group engaged in 2.6 fewer minutes of weekday MVPA  at Time 1 but engaged in 11 more minutes of weekend MVPA . At Time 1 the intervention parents engaged in 9 more minutes of  weekday MVPA  and 13 more minutes of weekend MVPA  . The proportion of children in the intervention group watching ≥ 2 hours per day of TV on weekend days decreased after the intervention ( time 0 = 76 % , time 1 = 39 % , time 2 = 50 % ) , while the control group proportion increased slightly ( 79 % , 86 % and 87 % ) . Parental weekday TV watching decreased in both groups . In post- study interviews many mothers reported problems associated with wearing the accelerometers . In terms of a future full-scale trial , a sample of between 80 and 340 families would be needed to detect a mean difference of 10-minutes of weekend MVPA . Conclusions Teamplay is a promising parenting program in an under- research ed area . The intervention was acceptable to parents , and all elements of the study protocol were successfully completed . Simple changes to the trial protocol could result in more complete data collection and study engagement This study evaluated the effectiveness of an open-loop system that reinforces physical activity with TV watching to increase  children 's physical activity .  Nonoverweight , sedentary boys and girls ( 8 - 12 y ) were r and omized to a group that received feedback of activity counts + reinforcement for physical activity by providing access to television ( F+R , n = 20 ) ; or to feedback , no reinforcement ( Feedback , n = 20 ) or no feedback , no reinforcement control ( Control , n = 21 ) groups . Children wore an  accelerometer with a count display  for 4-months with a 1-year follow-up . F+R reduced TV by 68 min/day and TV time was lower than the Feedback ( p < .005 ) and Control ( p < .002 ) groups . TV time of F+R remained 31 min lower ( p < .02 ) than baseline at 1-year . F+R had a 44 % increase in physical activity , which was greater than the feedback ( p < .04 ) and control ( p < .01 ) groups . An open-loop system decreases TV viewing and increases physical activity of children for 4-months . TV of the F+R group remained lower at 12 months , suggesting a reduction in screen-time habits OBJECTIVE : To assess the effectiveness of a  parent-focused intervention on  infants ’ obesity-risk behaviors and BMI . METHODS : This cluster r and omized controlled trial recruited 542 parents and their infants ( mean age 3.8 months at baseline ) from 62 first-time parent groups . Parents were offered six 2-hour dietitian-delivered sessions over 15 months focusing on parental knowledge , skills , and social support around infant feeding , diet , physical activity , and television viewing . Control group parents received 6 newsletters on nonobesity-focused themes ; all parents received usual care from child health nurses . The primary outcomes of interest were child diet ( 3 × 24-hour diet recalls ) , child physical activity ( accelerometry ) , and child TV viewing ( parent report ) . Secondary outcomes included BMI z-scores ( measured ) . Data were collected when children were 4 , 9 , and 20 months of age . RESULTS : Unadjusted analyses showed that , compared with controls , intervention group children consumed fewer grams of noncore drinks ( mean difference = –4.45 ; 95 % confidence interval [ CI ] : –7.92 to –0.99 ; P = .01 ) and were less likely to consume any noncore drinks ( odds ratio = 0.48 ; 95 % CI : 0.24 to 0.95 ; P = .034 ) midintervention ( mean age 9 months ) . At intervention conclusion ( mean age 19.8 months ) , intervention group children consumed fewer grams of sweet snacks ( mean difference = –3.69 ; 95 % CI : –6.41 to –0.96 ; P = .008 ) and viewed fewer daily minutes of television ( mean difference = –15.97 : 95 % CI : –25.97 to –5.96 ; P = .002 ) . There was little statistical evidence of differences in fruit , vegetable , savory snack , or water consumption or in BMI z-scores or physical activity . CONCLUSIONS : This intervention result ed in reductions in sweet snack consumption and television viewing in 20-month-old children OBJECTIVE To evaluate the impact of a school-based interdisciplinary health behavior intervention on  diet  and  physical activity  among children in grade s 4 and 5 . DESIGN A quasiexperimental field trial with 6 intervention and 8 matched control schools . Outcomes were assessed longitudinally using preintervention ( fall 1995 ) and follow-up ( spring 1997 ) student survey food frequency and activity measures and follow-up 24-hour recall measures of diet and activity . Change was also assessed using yearly repeated cross-sectional surveys of all grade 5 students from 1995 through 1997 . PARTICIPANTS Longitudinal data were collected from 479 students initially in grade 4 in Baltimore , Md , public schools ; 91 % were African American . Repeated 24-hour recall measures in 1997 were collected for a r and om sub sample of 336 students . Cross-sectional survey data were collected from all grade 5 students in 1995,1996 , and 1997 ( n = 2103 ) . INTERVENTION The Eat Well and Keep Moving Program was taught by classroom teachers over 2 years in math , science , language arts , and social studies classes . Material s provided links to school food services and families and provided training and wellness programs for teachers and other staff members . Intervention material s focused on decreasing consumption of foods high in total and saturated fat and increasing fruit and vegetable intake , as well as reducing television viewing and increasing physical activity . MAIN OUTCOME MEASURES Dietary intake and physical activity measured via repeated 24-hour recall were primary end points , with additional food frequency and activity measures . RESULTS The 24-hour recall measures indicated that , after controlling for baseline covariates , the percentages of total energy from fat and saturated fat were reduced among students in intervention compared with control schools ( -1.4 % ; 95 % confidence interval [ CI ] , -2.8 to -0.04 ; P = .04 and -0.60 % ; 95 % CI , -1.2 to -0.01 ; P = .05 ) . There was an increase in fruit and vegetable intake ( 0.36 servings/4184 kJ ; 95 % CI , 0.10 - 0.62 ; P=.01 ) , in vitamin C intake ( 8.8 mg/4184 kJ ; 95 % CI , 2.0 - 16 ; P=.01 ) , and in fiber consumption ( 0.7 g/4184 kJ ; 95 % CI , 0.0 - 1.4 ; P=.05 ) . Television viewing was marginally reduced ( -0.55 h/d ; 95 % CI , -1.04 to 0.04 ; P=.06 ) . Analysis of longitudinal and repeated cross-sectional food frequency data indicated similar significant decreases in the percentages of total energy from fat and saturated fat . CONCLUSION Evaluation of the Eat Well and Keep Moving Program indicates effectiveness in improving dietary intake of students and reducing television viewing The purpose of the present study was to evaluate an intervention to prevent  weight gain among households ( HHs ) in the community . Ninety HHs were r and omized to intervention or control group for 1 year . Intervention consisted of six face-to-face group sessions , placement of a television ( TV ) locking device on all home TVs , and home-based intervention activities . Measures were collected in person at baseline and 1 year . Weight , height , eating behaviors , physical activity ( PA ) , and TV viewing were measured among HH members ages ≥ 12 years . Follow-up rate at 1 year was 96 % . No significant intervention effects were observed for change in HH BMI -z score . Intervention HHs significantly reduced TV viewing , snacks/sweets intake , and dollars per person spent eating out , and increased ( adults only ) PA and self-weighing frequency compared with control HHs . A 1 year obesity prevention intervention targeting entire HHs was effective in reducing TV viewing , snack/sweets intake and eating out purchases . Innovative methods are needed to strengthen the home food environment intervention component . Longer intervention duration s also need to be evaluated BACKGROUND The primary care setting offers the opportunity to reach children and parents to encourage healthy lifestyle behaviours , and improve weight status among children . OBJECTIVE Test the feasibility of Helping H AND ( Healthy Activity and Nutrition Directions ) , an obesity intervention for 5- to 8-year-old children in primary care clinics . METHODS A r and omized controlled pilot study of Helping H AND , a 6-month intervention , targeted children with body mass index 85 - 99%tile and their parents . Intervention group attended monthly sessions and self-selected child behaviours and parenting practice s to change . Control group received regular paediatric care and was wait-listed for Helping H AND . Session completion , participant satisfaction , child anthropometrics , dietary intake , physical activity , TV viewing and behaviour-specific parenting practice s were measured pre and post intervention . RESULTS Forty parent-child dyads enrolled : 82.5 % were Hispanic , 80 % had a girl and 65 % reported income ≤ $ 30 , 000/year . There was 20 % attrition from Helping H AND ( attended < 4/6 sessions ) . Families self-selected 4.35 ( SD 1.75 ) behaviours to target during the 6-month programme and each of the seven behaviours was selected by 45 - 80 % of the families . There were no between group differences in the child 's body mass index z-score , dietary intake or physical activity post intervention . Intervention group viewed 14.9 ( SE 2.3 ) h/week of TV post intervention versus control group 23.3 ( SE 2.4 ) h/week ( P < 0.05 ) . CONCLUSION Helping H AND is feasible , due to low attrition , good programme attendance , and clinical ly relevant improvements in some child and parenting behaviours Low levels of physical activity coupled with high levels of television viewing have been linked with obesity in children . The objective of this study was to assess the efficacy of ' Switch Off-Get Active ' , a 16-week controlled health education intervention , in increasing physical activity and reducing screen time and BMI in primary school children . A secondary objective was to compare children with high and low screen time . Participants were 312 children aged 10.2+/-0.7 years , attending nine schools in areas of social disadvantage . The 10-lesson , teacher-led intervention , conducted in spring 2003 , emphasised self-monitoring , budgeting of time and selective viewing . Differences , adjusted for baseline values by ANCOVA , existed between intervention and control children at follow-up for self-reported physical activity ( intervention + 0.84 30 min blocks/day , 95%CI 0.11 - 1.57 , p<0.05 ) and self-efficacy for physical activity ( p<0.05 ) but not self-reported screen time ( intervention--0.41 blocks/day , 95%CI--0.93 - 0.12 , p=0.13 ) or BMI ( p=0.63 ) . Cross-sectional comparisons at baseline indicated lower physical activity , self-efficacy for physical activity and aerobic fitness and a higher BMI in children with high screen time . In conclusion , health education interventions can increase physical activity in primary school children but follow-ups of longer duration may be needed to demonstrate intervention effects on BMI OBJECTIVE To assess the effects of reducing television viewing and computer use on children 's  body mass index ( BMI ) as a risk factor for the development of overweight in young children . DESIGN R and omized controlled clinical trial . SETTING University children 's hospital . PARTICIPANTS Seventy children aged 4 to 7 years whose BMI was at or above the 75th BMI percentile for age and sex . INTERVENTIONS Children were r and omized to an intervention to reduce their television viewing and computer use by 50 % vs a monitoring control group that did not reduce television viewing or computer use . MAIN OUTCOME MEASURES Age- and sex-st and ardized BMI ( z BMI ) , television viewing , energy intake , and physical activity were monitored every 6 months during 2 years . RESULTS Children r and omized to the intervention group showed greater reductions in targeted sedentary behavior ( P < .001 ) , z BMI ( P < .05 ) , and energy intake ( P < .05 ) compared with the monitoring control group . Socioeconomic status moderated z BMI change ( P = .01 ) , with the experimental intervention working better among families of low socioeconomic status . Changes in targeted sedentary behavior mediated changes in z BMI ( P < .05 ) . The change in television viewing was related to the change in energy intake ( P < .001 ) but not to the change in physical activity ( P = .37 ) . CONCLUSIONS Reducing television viewing and computer use may have an important role in preventing obesity and in lowering  BMI in young children , and these changes may be related more to changes in energy intake than to changes in physical activity OBJECTIVE To evaluate the short- and long-term results of FATaintPHAT , a Web-based computer-tailored intervention aim ing to increase physical activity , decrease sedentary behavior , and promote healthy eating to contribute to the prevention of excessive weight gain  among adolescents . DESIGN Cluster r and omized trial with an intervention group and a no-intervention control group . SETTING Twenty schools in the Netherl and s. PARTICIPANTS A total of 883 students ( aged 12 - 13 years ) . INTERVENTION The FATaintPHAT ( VETisnietVET in Dutch ) Web-based computer-tailored intervention . OUTCOME MEASURES Self-reported behaviors ( diet , physical activity , sedentary behavior ) and pedometer counts were measured at baseline and at 4-month and 2-year follow-up ; body mass index ( BMI ) , waist circumference , and fitness were measured at baseline and at 2-year follow-up . Descriptive and multilevel regression analyses were conducted among the total study population and among students not meeting behavioral recommendations at baseline ( students at risk ) . RESULTS The complete case analyses showed that FATaintPHAT had no effect on BMI and waist circumference . However , the intervention was associated with lower odds ( 0.54 ) of drinking more than 400 mL of sugar-sweetened beverages per day and with lower snack intake ( β = -0.81 snacks/d ) and higher vegetable intake ( β = 19.3 g/d ) but also with a lower step count ( β = -10 856 steps/wk ) at 4-month follow-up . In addition , among students at risk , FATaintPHAT had a positive effect on fruit consumption ( β = 0.39 g/d ) at 4-month follow-up and on step count ( β = 14 228 steps/wk ) at 2-year follow-up but an inverse effect on the odds of sports participation ( odds ratio , 0.45 ) at 4-month follow-up . No effects were found for sedentary behavior . CONCLUSION The FATaintPHAT intervention was associated with positive short-term effects on diet but with no effects or unfavorable effects on physical activity and sedentary behavior Translational or implementation research that assesses the effectiveness of strategies to promote health behaviours among children that have been previously tested under ' ideal ' conditions is rarely reported . Switch-2-Activity aim ed to examine the effectiveness of an abbreviated programme delivered by teachers targeting children 's television viewing , computer use , physical activity and potential mediators of behaviour change . Fifteen schools from disadvantaged areas in Melbourne , Australia agreed to participate in the study ( 43 % school-level response rate ) . Out of the 1566 Grade s 5 and 6 ( 9 - 12 year old ) children invited to take part in the study , 1048 ( 67 % response rate ) provided informed consent . Schools were r and omized to either an intervention or wait-list control condition . Teachers delivered six lessons , which included strategies such as self-monitoring , behavioural contracting and budgeting of screen time . Children completed a self-report survey at baseline and post-intervention examining screen-based behaviours , physical activity , self-efficacy and behavioural capability . Teachers reported implementation of and attitudes to the programme . Seventy-one per cent of teachers delivered at least four of the six lessons . Most teachers reported that the material s were easy to follow and deliver ; however , many teachers reported modifying the material s in some way . Among boys , there were favourable small intervention effects on weekend screen time [ ( coefficient = -0.62 , 95 % 95 % confidence interval : -1.15 , -0.10 , p = 0.020 ) ] . The intervention also had significant positive effects on children 's self-efficacy for reducing television viewing and on behavioural capability ( television viewing styles ) . Future studies that assess the translation of efficacious programmes and that test whether such programmes are equally effective in different setting s ( e.g. in the family setting ) are urgently required BACKGROUND Data are lacking on primary care interventions to reduce children 's television viewing .  Low-income African-American children watch greater amounts of television than their peers . DESIGN / METHODS A r and omized controlled pilot and feasibility trial was conducted . Twenty-eight families with 7- to 12-year-old African-American children receiving primary care at an urban community clinic serving a low-income population were r and omized to receive counseling alone or counseling plus a behavioral intervention that included an electronic television time manager . The main outcome was hours of children 's television , videotape , and video game use . Parents/guardians and children completed baseline and 4-week follow-up self-report surveys . Additional outcomes included overall household television use , time spent in organized physical activity and playing outside , and meals eaten by the child while watching television . RESULTS Both intervention groups reported similar decreases in children 's television , videotape , and video game use ( mean changes of -13.7 , SD=26.1 and -14.1 , SD=16.8 hours per week ) . The behavioral intervention group reported significantly greater increases in organized physical activity ( changes of + 2.5 , SD=5.9 and -3.6 , SD=4.7 hours per week ; p = 0.004 ) and nearly significant greater increases in playing outside ( changes of 1.0 , SD=5.9 and -4.7 , SD=9.4 hours per week ; p < 0.06 ) . Changes in overall household television use and meals eaten while watching television also appeared to favor the behavioral intervention , with small to medium effect sizes , but differences were not statistically significant . CONCLUSIONS This small pilot and feasibility study evaluated two promising primary care-based interventions to reduce television , videotape , and video game use among low-income African-American children . The effects on physical activity suggest that the behavioral intervention may be more effective This paper describes the development , implementation and evaluation of a school- and family-based intervention to prevent obesity in children aged 5 - 7 years . In addition , the efficacy of three different intervention programmes was compared . Children aged 5 - 7 years ( n=213 ) were recruited from three primary schools in Oxford and r and omly allocated to a control group or one of three intervention groups : nutrition group , physical activity group , and combined nutrition and physical activity group . The setting for the interventions was lunchtime clubs , where an interactive and age-appropriate nutrition and /or physical activity curriculum was delivered . The intervention lasted for 20 weeks over four school terms ( approximately 14 months ) . Children 's growth , nutrition knowledge , diet and physical activity were assessed at baseline and at the end of the intervention . Significant improvements in nutrition knowledge were seen in all children ( p<0.01 ) between baseline and post-intervention , and results were highly significant in the nutrition and combined group ( p<0.001 ) . Overall , fruit and vegetable intake increased significantly ( p<0.01 and < 0.05 , respectively ) , with changes seen in fruit consumption in the nutrition group ( p<0.05 ) and the control group ( p<0.05 ) in particular . No significant changes in the rates of overweight and obesity were seen as a result of the intervention . Gender differences were not detected in the majority of assessment s and there was no clear effect of programme type per se . This pilot study has demonstrated that school may be a suitable setting for the promotion of healthy lifestyles in children , but requires replication in other social setting s. Future initiatives should be long-lasting , multi-faceted and sustainable , involving all children in a school , and should target the whole environment and be behaviourally focused . The ultimate goal of any such programme is to lead to positive behaviour change which will have a beneficial effect on long-term health . Successful targeting of the family remains a challenge to such interventions PURPOSE The number of youth that meet activity guidelines is decreasing and easy access to reinforcing sedentary behaviors competes with increasing physical activity . In the laboratory , open-loop feedback that used pedometer activity counts to gain access to sedentary alternatives doubled physical activity . This study evaluated the influence of open-loop feedback and reinforcement on physical activity and television ( TV ) time in a small clinical trial . METHODS Children ( 8 - 12 yr old ) were r and omized to an open-loop feedback plus reinforcement intervention ( N = 11 ) or no feedback , no reinforcement control ( N = 7 ) . Subjects wore an accelerometer for 6 wk and attended meetings to download the accelerometer . Accumulating physical activity counts gave subjects in the open-loop group access to  TV time , controlled by a TV Allowance device , with 400 counts = 1 h of TV . The control group had no feedback for activity and free access to TV . RESULTS The open-loop group had a 24 % increase in physical activity , which was greater ( P = 0.02 ) than the control group . TV time of the open-loop group was reduced by 18 % or 20 min x d(-1 ) whereas the control group increased by 13 min x d(-1 ) , but these were not significant changes . The change in time spent watching television was directly related to the change in BMI z-score ( r = 0.69 , P = 0.002 ) . CONCLUSION Open-loop feedback increases physical activity in children , thus helping children to achieve physical activity recommendations . Reductions in TV watching may reduce or minimize gains in body weight OBJECTIVE To evaluate the impact of a Special Supplemental Nutrition Program for Women , Infants , and Children (WIC)-based  intervention on the food and beverage intake , physical activity , and television watching of children ages 1 - 5 . DESIGN Longitudinal surveys of intervention and control participants at baseline , 6 months , and 12 months . RESULTS Analysis of variance tests showed that the intervention had a small but significant impact on TV watching and fruit intake . The intervention was most protective for children younger than 2 years of age . CONCLUSIONS AND IMPLICATION S Although the impact of the intervention was relatively small and limited to the youngest children served by WIC , findings suggest that the WIC setting is appropriate for improving healthful behaviors that are linked to reducing the rates of early childhood overweight Obese children 8 - 12 years old from 61 families were r and omized to treatment groups that targeted increased exercise , decreased sedentary behaviors , or both ( combined group ) to test the influence of reinforcing children to be more active or less sedentary on child weight change . Significant decreases in percentage overweight were observed after 4 months between the sedentary and the exercise groups ( -19.9 vs. -13.2 ) . At 1 year , the sedentary group had a greater decrease in percentage overweight than did the combined and the exercise groups ( -18.7 vs. -10.3 and -8.7 ) and greater decrease in percentage of body fat ( -4.7 vs. -1.3 ) . All groups improved fitness during treatment and follow-up . Children in the sedentary group increased their liking for high-intensity activity and reported lower caloric intake than did children in the exercise group . These results support the goal of reducing time spent in sedentary activities to improve weight loss BACKGROUND Television viewing has been associated with increased violence in play and higher rates of obesity . Although there are interventions to reduce television viewing by school-aged children , there are none for younger children . OBJECTIVE To develop and evaluate an intervention to reduce television viewing by preschool children . DESIGN R and omized controlled trial conducted in 16 preschool and /or day care centers in rural upstate New York . PATIENTS Children aged 2.6 through 5.5 years . INTERVENTION Children attending intervention centers received a 7-session program design ed to reduce television viewing as part of a health promotion curriculum , whereas children attending the control centers received a safety and injury prevention program . OUTCOME MEASUREMENTS Change in parent-reported child television/video viewing and measured growth variables . RESULTS Before the intervention , the intervention and control groups viewed 11.9 and 14.0 h/wk of television/videos , respectively . Afterward , children in the intervention group decreased their television/video viewing 3.1 h/wk , whereas children in the control group increased their viewing by 1.6 h/wk , for an adjusted difference between the groups of -4.7 h/wk ( 95 % confidence interval , -8.4 to -1.0 h/wk ; P = .02 ) . The percentage of children watching television/videos more than 2 h/d also decreased significantly from 33 % to 18 % among the intervention group , compared with an increase of 41 % to 47 % among the control group , for a difference of -21.5 % ( 95 % confidence interval , -42.5 % to -0.5 % ; P = .046 ) . There were no statistically significant differences in children 's growth between groups . CONCLUSIONS This study is the first to show that a preschool-based intervention can lead to reductions in  young children 's television/video viewing . Further research is needed to determine the long-term effects associated with reductions in young children 's television viewing OBJECTIVES This pilot study evaluated the feasibility ( recruitment , retention , and acceptability ) and preliminary efficacy of a six-week home-based electronic time monitor intervention on New Zeal and children 's television watching in 2008 . METHODS Twenty-nine children aged 9 to 12 years who watched more than 20 h of television per week ( 62 % male , mean age 10.4 years ) were r and omised to either the intervention or the control group . The intervention group received an electronic TV time monitor for 6 weeks and advice to restrict TV watching to 1 h per day or less . The control group was given verbal advice to restrict TV watching . RESULTS Participant retention at 6 weeks was 93 % . Semi-structured interviews with intervention families confirmed moderate acceptability of TV time monitors and several perceived benefits including better awareness of household TV viewing and improved time planning . Drawbacks reported included disruption to parents ' TV watching and increased sibling conflict . Time spent watching television decreased by 4.2 h ( mean change [ SD ] : -254 [ 536 ] min ) per week in the intervention group compared with no change in the control group ( -3 [ 241 ] min ) , but the difference between groups was not statistically significant , p=0.77 . Both groups reported decreases in energy intake from snacks and total screen time and increases in physical activity measured by pedometer and between-group differences were not statistically significant . CONCLUSIONS Electronic TV time monitors are feasible to use for home-based TV watching interventions although acceptability varies between families . Preliminary findings from this pilot suggest that such devices have potential to decrease children 's TV watching but a larger trial is needed to confirm effectiveness . Future research should be family-orientated ; take account of other screen time activities ; and employ TV time monitors as just one of a range of strategies to decrease sedentary behaviour OBJECTIVE Many adolescents do not meet national guidelines for participation in regular moderate or vigorous physical activity ( PA ) ; limitations on sedentary behaviors ; or dietary intake of fruits and vegetables , fiber , or total dietary fat . This study evaluated a health care-based intervention to improve these behaviors . DESIGN R and omized controlled trial . SETTING Primary care with follow-up at home . PARTICIPANTS Eight hundred seventy-eight adolescent girls and boys aged 11 to 15 years . INTERVENTIONS Two experimental conditions : ( 1 ) Primary care , office-based , computer-assisted diet and PA assessment and stage-based goal setting followed by brief health care provider counseling and 12 months of monthly mail and telephone counseling and ( 2 ) a comparison condition addressing sun exposure protection . MAIN OUTCOME MEASURES Minutes per week of moderate plus vigorous PA measured by self-report and accelerometer ; self-report of days per week of PA and sedentary behaviors ; and percentage of energy from fat and servings per day of fruits and vegetables measured by three 24-hour diet recalls . Body mass index ( calculated as weight in kilograms divided by the square of height in meters ) was a secondary outcome . RESULTS Compared with adolescents in the sun protection condition , girls and boys in the diet and PA intervention significantly reduced sedentary behaviors ( intervention vs control change , 4.3 to 3.4 h/d vs 4.2 to 4.4 h/d for girls , respectively [ P = .001 ] ; 4.2 to 3.2 h/d vs 4.2 to 4.3 h/d for boys , respectively [ P = .001 ] ) . Boys reported more active days per week ( intervention vs control change : 4.1 to 4.4 d/wk vs 3.8 to 3.8 d/w , respectively [ P = .01 ] ) , and the number of servings of fruits and vegetables for girls approached significance ( intervention vs control change , 3.5 to 4.2 servings/d vs 3.5 to 3.9 servings/d , respectively [ P = .07 ] ) . No intervention effects were seen with percentage of calories from fat or minutes of PA per week . Percentage of adolescents meeting recommended health guidelines was significantly improved for girls for consumption of saturated fat ( intervention vs control change , 23.4 % to 41.0 % vs 18.5 % to 31 % , respectively [ relative risk , 1.33 ; 95 % confidence interval , 1.01 - 1.68 ] ) and for boys ' participation in d/wk of PA ( intervention vs control change , 45.3 % to 55.4 % vs 41.9 % to 38.0 % , respectively [ relative risk , 1.47 ; 95 % confidence interval , 1.19 - 1.75 ] ) . No between-group differences were seen in body mass index . CONCLUSIONS Improvements in some diet , PA , and sedentary behaviors in adolescents can be enabled through the use of a 1-year , integrated intervention using the computer , health provider counseling , mail , and telephone . The amount of intervention received may contribute to its efficacy BACKGROUND The average adult watches almost 5 hours of television ( TV ) per day , an amount associated with increased risks for obesity . This trial examines the effects of TV reduction on energy intake ( EI ) , energy expenditure ( EE ) , energy balance , body mass index ( BMI ) , ( calculated as weight in kilograms divided by height in meters squared ) , and sleep in overweight and obese adults . METHODS R and omized controlled trial of 36 adults with a BMI of 25 to 50 who self-reported a minimum of 3 h/d of TV viewing . Participants were enrolled in home-based protocol s from January through July 2008 . After a 3-week observation phase , participants were stratified by BMI and r and omized to an observation-only control group ( n = 16 ) or an intervention group ( n = 20 ) for 3 additional weeks . The intervention consisted of reducing TV viewing by 50 % of each participant 's objective ly measured baseline enforced by an electronic lock-out system . RESULTS Although not statistically significant , both groups reduced their EI ( -125 kcal/d [ 95 % CI , -303 to 52 ] vs -38 [ 95 % CI , -265 to 190 ] ) ( P = .52 ) for intervention and control group participants , respectively , where CI indicates confidence interval . The intervention group significantly increased EE ( 119 kcal/d [ 95 % CI , 23 to 215 ] ) compared with controls ( -95 kcal/d [ 95 % CI , -254 to 65 ] ) ( P = .02 ) . Energy balance was negative in the intervention group between phases ( -244 kcal/d [ 95 % CI , -459 to -30 ] ) but positive in controls ( 57 kcal/d [ 95 % CI , -216 to 330 ] ) ( P = .07 ) . The intervention group showed a greater reduction in BMI ( -0.25 [ 95 % CI , -0.45 to -0.05 ] vs -0.06 [ 95 % CI , -0.43 to 0.31 ] in controls ) ( P = .33 ) . There was no change in sleep . CONCLUSION Reducing TV viewing in our sample produced a statistically significant increase in EE but no apparent change in EI after 3 weeks of intervention . Trial Registration clinical trials.gov Identifier : NCT00622050 Objectives : To evaluate the effectiveness of an intervention to prevent excess weight gain , reduce time spent in screen behaviours , promote participation in and enjoyment of physical activity ( PA ) , and improve fundamental movement skills among children . Participants : In 2002 , 311 children ( 78 % response ; 49 % boys ) , average age 10 years 8 months , were recruited from three government schools in low socioeconomic areas of Melbourne , Australia . Design : Group-r and omized controlled trial . Children were r and omized by class to one of the four conditions : a behavioural modification group ( BM ; n=66 ) ; a fundamental movement skills group ( FMS ; n=74 ) ; a combined BM/FMS group ( BM/FMS ; n=93 ) ; and a control ( usual curriculum ) group ( n=62 ) . Data were collected at baseline , post intervention , 6- and 12-month follow-up periods . Results :  BMI data were available for 295 children at baseline and 268 at 12-month follow-up . After adjusting for food intake and PA , there was a significant intervention effect from baseline to post intervention on age- and sex-adjusted BMI in the BM/FMS group compared with controls ( −1.88 kg m−2 , P<0.01 ) , which was maintained at 6- and 12-month follow-up periods ( −1.53 kg m−2 , P<0.05 ) . Children in the BM/FMS group were less likely than controls to be overweight/obese between baseline and post intervention ( adjusted odds ratio (AOR)=0.36 , P<0.05 ) ; also maintained at 12-month follow-up ( AOR=0.38 , P<0.05 ) . Compared with controls , FMS group children recorded higher levels and greater enjoyment of PA ; and BM children recorded higher levels of PA and TV viewing across all four time points . Gender moderated the intervention effects for participation in and enjoyment of PA , and fundamental movement skills . Conclusion : This programme represents a promising approach to preventing excess weight gain and promoting participation in and enjoyment of PA . Examination of the mediators of this intervention and further tailoring of the programme to suit both genders is required OBJECTIVE To examine the effectiveness of a primary care-based obesity intervention over the first year ( 6 intervention contacts ) of a planned 2-year study . DESIGN Cluster r and omized controlled trial . SETTING Ten pediatric practice s , 5 intervention and 5 usual care . PARTICIPANTS Four hundred seventy-five children aged 2 to 6 years with body mass index ( BMI ) in the 95th percentile or higher or 85th to less than 95th percentile if at least 1 parent was overweight ; 445 ( 93 % ) had 1-year outcomes . INTERVENTION Intervention practice s received primary care restructuring , and families received motivational interviewing by clinicians and educational modules targeting television viewing and fast food and sugar-sweetened beverage intake . OUTCOME MEASURES Change in BMI and obesity-related behaviors from baseline to 1 year . RESULTS Compared with usual care , intervention participants had a smaller , nonsignificant change in BMI ( -0.21 ; 95 % confidence interval [ CI ] , -0.50 to 0.07 ; P = .15 ) , greater decreases in television viewing ( -0.36 h/d ; 95 % CI , -0.64 to -0.09 ; P = .01 ) , and slightly greater decreases in fast food ( -0.16 serving/wk ; 95 % CI , -0.33 to 0.01 ; P = .07 ) and sugar-sweetened beverage ( -0.22 serving/d ; 95 % CI , -0.52 to 0.08 ; P = .15 ) intake . In post hoc analyses , we observed significant effects on BMI among girls ( -0.38 ; 95 % CI , -0.73 to -0.03 ; P = .03 ) but not boys ( 0.04 ; 95 % CI , -0.55 to 0.63 ; P = .89 ) and among participants in households with annual incomes of $ 50 000 or less ( -0.93 ; 95 % CI , -1.60 to -0.25 ; P = .01 ) but not in higher-income households ( 0.02 ; 95 % CI , -0.30 to 0.33 ; P = .92 ) . CONCLUSION After 1 year , the High Five for Kids intervention was effective in reducing television viewing but did not significantly reduce BMI Objective : Given the increasing prevalence of pediatric obesity , we evaluated two kindergarten-based strategies for reducing overweight in preschool children in the Haute-Garonne Department in France . Methods : Kindergartens ( n=79 ) were r and omly assigned to one of the two strategies and followed for 2 years . In the first group ( Epidémiologie et prévention de l’obésité infantile , EPIPOI-1 ) , parents and teachers received basic information on overweight and health , and children underwent screening to identify those with overweight ( body mass index ( BMI ) ⩾90th percentile ) or at risk for overweight ( BMI between 75 and 90th percentile ) , who were then followed up by their physicians . EPIPOI-2 children , in addition , received kindergarten-based education to promote healthy practice s related to nutrition , physical activity and sedentary behaviors . Data on control children from non-intervention kindergartens ( n=40 ) were retrieved from medical records at the Division of School Health . Results : At baseline , groups differed significantly on age and school area ( underprivileged/ not ) . Owing to a significant interaction between school area and group , analyses were stratified by school area . At baseline , groups did not differ on overweight prevalence and BMI z-scores for any school area . After intervention , prevalence of overweight , BMI z-score and change in BMI z-score were significantly lower in intervention groups compared with controls in underprivileged areas . Using multilevel analysis adjusted for potential confounders , a significant effect on overweight prevalence at the end of the study was noted for EPIPOI-1 in underprivileged areas only ( odds ratio and 95 % confidence interval : 0.18 ( 0.07–0.51 ) . In non-underprivileged areas , the gain in BMI z-score was lower in EPIPOI-2 group compared with control and EPIPOI-1 . Conclusion : Our results suggest that simple measures involving increasing awareness on overweight and health , and periodic monitoring of weight and height with follow-up care when indicated , could be useful to reduce  overweight in young children from underprivileged areas . A reinforced strategy with an education component , in addition , may be indicated in children in non-underprivileged areas OBJECTIVE To examine acceptability , attrition , adherence , and preliminary efficacy of mobile phone short message service ( SMS ; text messaging ) for monitoring healthful behaviors in children . DESIGN All r and omized children received a brief psychoeducational intervention . They then either monitored target behaviors via SMS with feedback or via paper diaries ( PD ) or participated in a no-monitoring control ( C ) for 8 weeks . SETTING University of North Carolina at Chapel Hill . PARTICIPANTS Fifty-eight children ( age 5 - 13 ) and parents participated ; 31 completed ( SMS : 13/18 , PD : 7/18 , C : 11/22 ) . INTERVENTION Children and parents participated in a total of 3 group education sessions ( 1 session weekly for 3 weeks ) to encourage increasing physical activity and decreasing screen time and sugar-sweetened beverage consumption . MAIN OUTCOME MEASURES Treatment acceptability , attrition , and adherence to self-monitoring . ANALYSIS Descriptive statistics and nonparametric tests were used to analyze differences across time and group . RESULTS Children in SMS had somewhat lower attrition ( 28 % ) than both PD ( 61 % ) and C ( 50 % ) , and significantly greater adherence to self-monitoring than PD ( 43 % vs 19 % , P < .02 ) . CONCLUSIONS AND IMPLICATION S Short message service may be a useful tool for self-monitoring healthful behaviors  in children , although the efficacy of this approach needs further study . Implication s suggest that novel technologies may play a role in improving health
target: Among children , these interventions demonstrated reduced screen time , increased physical activity , and improved diet- and weight-related outcomes .
background: CONTEXT Sedentary time spent with screen media is associated with obesity among children and adults .
  Obesity has potentially serious health consequences , such as heart disease and diabetes .
  This Community Guide systematic review examined the effectiveness and economic efficiency of behavioral interventions aim ed at reducing recreational ( i.e. , neither school- nor work-related ) sedentary screen time , as measured by screen time , physical activity , diet , and weight-related outcomes .