The increasing prevalence of overweight and obese children along with accompanying comorbidities has prompted an early acknowledgement of a healthy lifestyle. The purpose of this study was to examine the effect of a teacher-centered, school-based intervention on cardiovascular disease (CVD) risk and health behavior in elementary school children. 935 first- and second-grade children in southwest Germany provided valid data at baseline and follow-up. Trained technicians measured height and weight along with blood pressure, cholesterol, and intra-abdominal fat to determine CVD risk. Parent questionnaires were used to assess children’s health behavior. Within one year CVD risk declined in the intervention group, particularly due to an attenuation of the age-related increase in mean arterial pressure. The age-related decline in habitual sports participation was attenuated, and children in the intervention groups displayed higher odds of playing outside. Further, the consumption of sugar-sweetened beverages declined in the intervention group, and TV time remained stable, while it increased in the control group. These results indicate that a teacher-centered intervention positively affects health behavior and CVD risk. The incorporation of the intervention by the classroom-teacher should allow for a sustainable participation, which may result in more pronounced effects over time. 1. Introduction The prevalence of overweight and obesity has increased in many industrialized countries [1], and obesity has already been declared as one of the leading threats for public health [2]. Of particular concern is the increasing number of overweight or obese children and adolescents [1], which has lead to the occurrence of various cardiovascular and metabolic disease risks that were previously only observed in adults [3]. Further, overweight children are more likely to become overweight adults [4] and, therefore, have an increased risk for all-cause mortality [5]. In addition to the impact on individual health and quality of life, the increased risk for various chronic diseases associated with excess body fat puts a significant economic burden on the society [6]. While physiologic and genetic aspects need to be considered, high energy intake and insufficient physical activity (PA) have been primarily emphasized as part of the problem [7]. As lifestyle patterns are established at a young age and health behavior has been shown to track into adulthood [8], primary prevention programs that promote sufficient PA and healthy eating patterns at an early age are warranted. Children
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