title: Energy Balance 4 Kids with Play: Results from a Two-Year Cluster-Randomized Trial.
abstract: BACKGROUND
  Identifying sustainable approaches to improving the physical activity (PA) and nutrition environments in schools is an important public health goal. This study examined the impact of Energy Balance for Kids with Play (EB4K with Play), a school-based intervention developed by the Academy of Nutrition and Dietetics Foundation and Playworks, on students' PA, dietary habits and knowledge, and weight status over 2 years.
  
  
  METHODS
  This cluster-randomized, controlled trial took place in four intervention and two control schools over 2 years (n=879; third- to fifth-grade students). PA (fourth and fifth grades only), dietary knowledge and behaviors, school policies, and BMI z-score were assessed at baseline (fall 2011), midpoint (spring 2012), and endpoint (fall 2012 for accelerometers; spring 2013 for all other outcomes).
  
  
  RESULTS
  At endpoint, there were no group differences in change in PA or dietary behaviors, although BMI z-score decreased overall by -0.07 (p=0.05). Students' dietary knowledge significantly increased, as did the amount of vegetables schools served. Post-hoc analyses stratified by grade revealed that, relative to control students, fourth-grade intervention students reduced school-day sedentary time by 15 minutes (p=0.023) and third-grade intervention students reduced BMI z-score by -0.2 (0.05; p<0.05). There were no significant differences for older students.
  
  
  CONCLUSIONS
  EB4K with Play, which leverages the existing infrastructure of two national programs, increases children's dietary knowledge and may improve weight status and decrease sedentary behaviors among younger children. Future iterations should examine programming specific for different age groups.
authors.affiliation: 1 School of Public Health, University of California Berkeley , Berkeley, CA.
authors.forename: Kristine
authors.initials: K
authors.lastname: Madsen
authors.affiliation: 1 School of Public Health, University of California Berkeley , Berkeley, CA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Linchey
authors.affiliation: 2 Atkins Center for Weight and Health, University of California Berkeley , Berkeley, CA.
authors.forename: Dana
authors.initials: D
authors.lastname: Gerstein
authors.affiliation: 2 Atkins Center for Weight and Health, University of California Berkeley , Berkeley, CA.
authors.forename: Michelle
authors.initials: M
authors.lastname: Ross
authors.affiliation: 3 EF Myers Consulting , Trenton, IL.
authors.forename: Esther
authors.initials: E
authors.lastname: Myers
authors.affiliation: 4 Academy of Nutrition and Dietetics Foundation , Chicago, IL.
authors.forename: Katie
authors.initials: K
authors.lastname: Brown
authors.affiliation: 2 Atkins Center for Weight and Health, University of California Berkeley , Berkeley, CA.
authors.forename: Patricia
authors.initials: P
authors.lastname: Crawford
mesh_terms: D002648:Child; D002664:Child Nutritional Physiological Phenomena; D016000:Cluster Analysis; D005260:Female; D006293:Health Promotion / Q000458:organization & administration*; D006801:Humans; D008297:Male; D063766:Pediatric Obesity / Q000517:prevention & control*; D010988:Play and Playthings; D016730:Program Development; D015397:Program Evaluation; D012572:School Health Services / Q000458:organization & administration*