Marcus 2009.

Study characteristics
Methods	Study design: cluster‐RCT Intervention period: 4 years Follow‐up period (post‐intervention): nil Differences in baseline characteristics: reported Reliable outcomes: reported (anthropometry and accelerometry) Protection against contamination: NR Unit of allocation: school Unit of analysis: child. Primary analysis used observed cases, but sensitivity analyses were carried out using FAS population (evaluated with replacement for missing data by LOCF)
Participants	N (controls baseline) = 1465 N (controls follow‐up) = 1300 N (interventions baseline) = 1670 N (interventions follow‐up) = 1538 Setting: schools (N = 5 intervention, N = 5 control) Recruitment: all consenting students in selected schools up to 4th school year Geographic region: Sweden Percentage of eligible population enrolled: 90%‐100% Mean age: control: 7.5 (1.3) years; intervention: 7.4 (1.3) years Sex: both sexes included
Interventions	Intervention was designed to change the school environment to promote healthy eating and PA during school and in after‐school care. Daily PA (30 min per child) was integrated into regular school curriculum and facilitated by classroom teachers Classroom teachers encouraged healthy eating, eating less sweetened foods, and to choose healthy items for school lunch and afternoon snack (provided by schools) School changes in items provided to increase health (lower sugar, more fibre, lower fat etc), eliminate unhealthy celebration foods and restrict foods for excursions and sports days Awareness raising activities included STOPP newsletter to parents and schools twice a year School nurses were also trained in obesity‐related problems Combined effects of dietary interventions and PA interventions vs control
Outcomes	Prevalence overweight/obese PA, accelerometer Eating habits Process evaluation: reported
Implementation‐related factors	Theoretical basis: NR Resources for intervention implementation (e.g. funding needed or staff hours required): NR Who delivered the intervention: reported PROGRESS categories assessed at baseline: reported (place, race, occupation, gender, education, social status) PROGRESS categories analysed at outcome: reported (gender, education) Outcomes relating to harms/unintended effects: reported Intervention included strategies to address diversity or disadvantage: NR Economic evaluation: NR
Notes	Funding: the study was supported by grants from Stockholm County Council, Swedish Council for working life and social research, Swedish Research Council, Freemason’s in Stockholm Foundation for Children’s Welfare and Signhild Engkvist Foundation.
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Quote: "Five of the selected schools were thereafter randomized to intervention and five schools to control."
Allocation concealment (selection bias)	Unclear risk	NR
Blinding (performance bias and detection bias) All outcomes	Unclear risk	NR
Incomplete outcome data (attrition bias) All outcomes	Low risk	Figure 1 indicates all randomised (FAS) included in a sensitivity analysis ‐ data not presented, these results were not different. Quote: "The primary analysis was carried out using the observed cases population, and a sensitivity analysis was performed using the FAS population. The FAS population was evaluated with replacement for missing data by the last observation carried forward approach, i.e. where only one measurement was observed, and the estimated change in BMIsds was set to 0."
Selective reporting (reporting bias)	Low risk	Protocol/trial registration document seen. All outcomes reported
Other bias	Low risk	No additional threats to validity
Other bias‐ timing of recruitment of clusters	Low risk	Figure shows recruitment happened prior to randomisation