PURPOSE: To compare two intensity levels (standard versus enhanced) of a nutrition and physical activity intervention versus a control (usual programs) on nutrition knowledge, body mass index, fitness, academic performance, behavior, and medication use among elementary school students. DESIGN: Quasi-experimental with three arms. SETTING: Elementary schools, students' homes, and a supermarket. SUBJECTS: A total of 1,487 third-grade students. INTERVENTION: The standard intervention (SI) provided daily physical activity in classrooms and a program on making healthful foods, using food labels. The enhanced intervention (EI) provided these plus additional components for students and their families. MEASURES: Body mass index (zBMI), food label literacy, physical fitness, academic performance, behavior, and medication use for asthma or attention-deficit hyperactivity disorder (ADHD). ANALYSIS: Multivariable generalized linear model and logistic regression to assess change in outcome measures. RESULTS: Both the SI and EI groups gained less weight than the control (p < 0.001), but zBMI did not differ between groups (p = 1.00). There were no apparent effects on physical fitness or academic performance. Both intervention groups improved significantly but similarly in food label literacy (p = 0.36). Asthma medication use was reduced significantly in the SI group, and nonsignificantly (p = 0.10) in the EI group. Use of ADHD medication remained unchanged (p = 0.34). CONCLUSION: The standard intervention may improve food label literacy and reduce asthma medication use in elementary school children, but an enhanced version provides no further benefit.

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