Randomized, Controlled Trial of a Best-Practice Individualized Behavioral Program for Treatment of Childhood Overweight: Scottish Childhood Overweight Treatment Trial (SCOTT) Obesity in children. Part 2: Prevention and management Identifying Evidence-Based Competences Required to Deliver Behavioural Support for Smoking Cessation Evaluation of a multiple ecological level child obesity prevention program: Switch® what you Do, View, and Chew Dutch obesity intervention in teenagers: effectiveness of a school-based program on body composition and behavior. Three-year maintenance of improved diet and physical activity: the CATCH cohort. Child and Adolescent Trial for Cardiovascular Health. Clinical efficacy of group-based treatment for childhood obesity compared with routinely given individual counseling Short- and Long-Term Beneficial Effects of a Combined Dietary–Behavioral–Physical Activity Intervention for the Treatment of Childhood Obesity Physical activity to prevent obesity in young children: cluster randomised controlled trial Design of the Dutch Obesity Intervention in Teenagers (NRG-DOiT): systematic development, implementation and evaluation of a school-based intervention aimed at the prevention of excessive weight gain in adolescents Efficacy of a child-centred and family-based program in promoting healthy weight and healthy behaviors in Chinese American children: a randomized controlled study. Association between general and central adiposity in childhood, and change in these, with cardiovascular risk factors in adolescence: prospective cohort study Outcome data from the LEAP (Live, Eat and Play) trial: a randomized controlled trial of a primary care intervention for childhood overweight/mild obesity Hip-Hop to Health Jr. for Latino preschool children. Reducing sedentary behaviour and increasing physical activity among 10-year-old children: overview and process evaluation of the 'Switch-Play' intervention. Dietary and exercise interventions for juvenile obesity: long-term effect of behavioral and public health models. How to identify randomized controlled trials in MEDLINE: ten years on. A pilot study of interpersonal psychotherapy for preventing excess weight gain in adolescent girls at-risk for obesity. Twelve-Month Effectiveness of a Parent-led, Family-Focused Weight-Management Program for Prepubertal Children: A Randomized, Controlled Trial Outcomes and costs of primary care surveillance and intervention for overweight or obese children: the LEAP 2 randomised 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 Can Australian general practitioners tackle childhood overweight/obesity? Methods and processes from the LEAP (Live, Eat and Play) randomized controlled trial. Two-year follow-up results for Hip-Hop to Health Jr.: a randomized controlled trial for overweight prevention in preschool minority children. Sensible treatment of obesity in rural youth (STORY): design and methods. Adolescent BMI trajectory and risk of diabetes versus coronary disease. A community-based obesity prevention program for minority children: rationale and study design for Hip-Hop to Health Jr. School-based cardiovascular health promotion: the child and adolescent trial for cardiovascular health (CATCH). CONSORT 2010 Statement: updated guidelines for reporting parallel group randomised trials Comparison of parent-only vs family-based interventions for overweight children in underserved rural settings: outcomes from project STORY.
OBJECTIVE . The objective of this study was to determine whether a generalizable best- practice individualized behavioral intervention  reduced BMI z score relative to st and ard dietetic care among overweight children . METHODS . The design consisted of an assessor-blinded , r and omized , controlled trial involving 134 overweight children ( 59 boys , 75 girls ; BMI ≥ 98th centile relative to United Kingdom 1990 reference data for children aged 5–11 years ) who were r and omly assigned to a best- practice behavioral program ( intervention ) or st and ard care ( control ) .  The intervention used family-centered counseling and behavioral strategies to modify diet , physical activity , and sedentary behavior . BMI z score , weight , objective ly measured physical activity and sedentary behavior , fat distribution , quality of life , and height z score were recorded at baseline and at 6 and 12 months . RESULTS . The intervention had no significant effect relative to st and ard care on BMI z score from baseline to 6 months and 12 months . BMI z score decreased significantly in both groups from baseline to 6 and 12 months . For those who complied with treatment , there was a significantly smaller weight increase in those in the intervention group compared with control subjects from baseline to 6 months . There were significant between-group differences in favor of the intervention for changes in total physical activity , percentage of time spent in sedentary behavior , and light-intensity physical activity . CONCLUSIONS . A generalizable , best- practice individualized behavioral intervention had modest benefits on objective ly measured physical activity and sedentary behavior but no significant effect on BMI z score compared with st and ard care among overweight children . The modest magnitude of the benefits observed perhaps argues for a longer-term and more intense intervention , although such treatments may not be realistic for many health care systems # # # # Summary points In the first part of this article we described how obesity in children is measured , its prevalence , whether children should be screened , and the risk factors for and consequences of obesity.1 In this part we review the current evidence on the prevention and management of childhood obesity . # # # # Sources and selection criteria This review draws on the Foresight report , guidance from the National Institute for Health and Clinical Excellence and the Australian National Health Medical Research Council , and Cochrane review . In April 2008 we search ed the Cochrane Library data base of review s and the Centre for Review s and Dissemination data bases using the search term “ obesity ” . We also conducted a Medline search ( ( Child$ or paediatric or pediatric or adolescent ) and ( Obes$ or overweight ) ) limited to 1 January 2005 to 6 May 2008 and “ review articles ” ; this identified 1105 articles . We read the abstract s of these articles and retrieved relevant papers . We also used articles from our own bibliographies collected over the past 10 years . The evidence to support the measurement , prevention , and management of obesity in children is still relatively weak , with few r and omised controlled trials or systematic review s. The strength of evidence is developing and the up date d Cochrane review that will be published in 2009 Background No systematic basis has yet been published for specifying competences needed to underpin behavioural support for  smoking cessation . Purpose The purpose of this study was to develop and apply a system for identifying competences required for the delivery of individual and group-based behavioural support for smoking cessation . Methods Sets of recommended competences for behavioural support were identified from a range of guidance documents . Where possible , these were compared with ones based on behaviour change techniques identified within behavioural support programmes found to be effective in r and omised controlled trials ( RCTs ) and , for individual behavioural support , ones associated with higher success rates in the English Stop Smoking Services . Results Ninety-four competences were identified ( 71 individual and 23 additional group competences ) , of which 59 were cited in at least two guidance documents ( 51 and 8 , respectively ) . Fourteen of the individual competences and three of the group competences were supported by RCT evidence and , for individual competences , nine were supported by evidence from the services . Conclusions It is possible to identify competences recommended for behavioural support for smoking cessation and subsets supported by different types of evidence . This approach can form the basis for the development of assessment and training of stop smoking practitioners and is currently doing so in a national programme in Engl and . With further research , the list of evidence -based competences is likely to be extended 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 determine whether a multicomponent health promotion intervention for Dutch adolescents ( defined as persons between 12 and 14 years of age ) would be successful in influencing body composition and dietary and physical activity behavior in both the short and long terms . DESIGN R and omized controlled trial . SETTING Ten intervention and 8 control prevocational secondary schools . PARTICIPANTS A total of 1108 adolescents ( mean age , 12.7 years ) . Intervention An interdisciplinary program with an adapted curriculum for 11 lessons in biology and physical education and environmental change options . MAIN OUTCOME MEASURES Body height and weight , waist circumference , 4 skinfold thickness measurements , and dietary and physical activity behavior data . RESULTS Multilevel analyses showed that the intervention remained effective in preventing unfavorable increases in important measures of body composition after 20-month follow-up in girls ( biceps skinfold and sum of 4 skinfolds ) and boys ( triceps , biceps , and subscapular skinfolds ) . Consumption of sugar-containing beverages was significantly lower in intervention schools both after intervention ( boys : -287 mL/d ; 95 % confidence interval [ CI ] , -527 to -47 ; girls : -249 ; -400 to -98 ) and at 12-month follow-up ( boys : -233 ; -371 to -95 ; girls : -271 ; -390 to -153 ) . For boys , screen-viewing behavior was significantly lower in the intervention group after 20 months ( -25 min/d ; 95 % CI , -50 to -0.3 ) . No significant intervention effects on consumption of snacks or active commuting to school were found . CONCLUSION The Dutch Obesity Intervention in Teenagers program result ed in beneficial effects on the sum of skinfold thickness measurements in girls and consumption of sugar-containing beverages in both boys and girls in both the short and long terms OBJECTIVE To assess differences through grade 8 in diet , physical activity , and related health indicators of students who participated in the Child and Adolescent Trial for Cardiovascular Health ( CATCH ) school and family intervention from grade s 3 through 5 . DESIGN Follow-up of the 4-center , r and omized , controlled field trial with 56 intervention and 40 control elementary schools . PARTICIPANTS We studied 3714 ( 73 % ) of the initial CATCH cohort of 5106 students from ethnically diverse background s in California , Louisiana , Minnesota , and Texas at grade s 6 , 7 , and 8 . RESULTS Self-reported daily energy intake from fat at baseline was virtually identical in the control ( 32.7 % ) and intervention ( 32.6 % ) groups . At grade 5 , the intake for controls remained at 32.2 % , while the intake for the intervention group declined to 30.3 % ( P<.001 ) . At grade 8 , the between-group differential was maintained ( 31.6 % vs 30.6 % , P = .01 ) . Intervention students maintained significantly higher self-reported daily vigorous activity than control students ( P = .001 ) , although the difference declined from 13.6 minutes in grade 5 to 11.2 , 10.8 , and 8.8 minutes in grade s 6 , 7 , and 8 , respectively . Significant differences in favor of the intervention students also persisted at grade 8 for dietary knowledge and dietary intentions , but not for social support for physical activity . No impact on smoking behavior or stages of contemplating smoking was detected at grade 8 . No significant differences were noted among physiologic indicators of body mass index , blood pressure , or serum lipid and cholesterol levels . CONCLUSION The original CATCH results demonstrated that school-level interventions could modify school lunch and school physical education programs as well as influence student behaviors . This 3-year follow-up without further intervention suggests that the behavioral changes initiated during the elementary school years persisted to early adolescence for self-reported dietary and physical activity behaviors Objective : The aim of the study was to compare the efficacy of group treatment stressing a health-promoting lifestyle with routine counseling in the treatment of childhood obesity . Design and subjects : Seventy obese children ( weight for height 115–182 % ) aged 7–9 years were r and omized either to routine counseling ( two appointments for children ) or to family-based group treatment  ( 15 separate sessions for parents and children ) . These sessions included nutrition education , physical activity education and behavioral therapy . Outcome measures : Children 's weights and heights were measured at baseline , after the 6-month intervention and after the 6-month follow-up . The change of weight for height based on Finnish growth charts was used as the primary , and changes in body mass index ( BMI ) and BMI st and ard deviation scores ( BMI -SDS ) as secondary outcome measures . Results : Children attending the group treatment  lost more weight for height ( 6.8 % ) than children receiving routine counseling  ( 1.8 % ) ( P=0.001 ) . The difference was significant when the data were analyzed in four groups by the cut-off limits of 0 , −5 and −10 % for the change in weight for height . The respective decreases in BMI were 0.8 vs 0.0 ( P=0.003 ) and in BMI -SDS 0.3 vs 0.2 ( P=0.022 ) . The results remained similar in adjusted analyses . Both group and routine programs were feasible with a high , 87–99 % , participation rate in sessions and appointments and very low , 3 % or less , attrition rate from the programs . Six months after the intervention , beneficial effects were partly lost , but for changes in weight for height and BMI , the differences between the two treatment programs still were significant , and for BMI -SDS , there was a trend . Conclusions : Family-based group treatment that stresses a health-promoting lifestyle and is given separately for parents and children , offers an effective mode of therapy to treat obese school-aged children Background . Obesity has become the most common pediatric chronic disease in the modern era . Early prevention and treatment of childhood and adolescent obesity is m and ated . Surprisingly , however , only a minor fraction of obese children participate in weight reduction interventions , and the longer-term effects of these weight-reduction interventions among children have not been eluci date d. Objective . To examine prospect ively the short- and long-term effects of a 3-month , combined dietary-behavioral-physical activity intervention on anthropometric measures , body composition , dietary and leisure-time habits , fitness , and lipid profiles among obese children . Methods . In this r and omized prospect i ve study , 24 obese subjects completed the 3-month intervention and were compared with 22 obese , age- and gender-matched , control subjects . Results . At 3 months , there were significant differences in changes in body weight ( −2.8 ± 2.3 kg vs 1.2 ± 2.2 kg ) , BMI ( −1.7 ± 1.1 kg/m2 vs −0.2 ± 1.0 kg/m2 ) , body fat percentage ( from skinfold tests ; −3.3 ± 2.6 % vs 1.4 ± 4.7 % ) , serum total cholesterol level ( −24.6 ± 15.1 mg/dL vs 0.8 ± 18.7 mg/dL ) , low-density lipoprotein cholesterol level ( −23.3 ± 15.2 mg/dL vs −3.7 ± 17.3 mg/dL ) , and fitness ( 215 ± 107 seconds vs 50 ± 116 seconds ) in the intervention group versus the control group . After a 1-year follow-up period , there were significant differences between the intervention group ( n = 20 ) and the control group ( n = 20 ) in body weight ( 0.6 ± 6.0 kg vs 5.3 ± 2.7 kg ) , BMI ( −1.7 ± 2.3 kg/m2 vs 0.6 ± 0.9 kg/m2 ) , and body fat percentage . There was a significant increase in leisure-time physical activity among the intervention participants , compared with a decrease among the control subjects . Conclusions . Our data demonstrate the short- and longer-term beneficial effects of a combined dietary-behavioral-physical activity intervention among obese children . These results highlight the importance of multidisciplinary programs for the treatment of childhood obesity and emphasize their encouraging long-term effects Objective To assess whether a physical activity intervention reduces body mass index in young children . Design Cluster r and omised controlled single blinded trial over 12 months . Setting Thirty six nurseries in Glasgow , Scotl and . Participants 545 children in their preschool year , mean age 4.2 years ( SD 0.2 ) at baseline . Intervention Enhanced physical activity programme in nursery ( three 30 minute sessions a week over 24 weeks ) plus home based health education aim ed at increasing physical activity through play and reducing sedentary behaviour . Main outcome measure Body mass index , expressed as a st and ard deviation score relative to UK 1990 reference data . Secondary measures were objective ly measured physical activity and sedentary behaviour ; fundamental movement skills ; and evaluation of the process . Results Group allocation had no significant effect on the primary outcome measure at six and 12 months or on measures of physical activity and sedentary behaviour by accelerometry . Children in the intervention group had significantly higher performance in movement skills tests than control children at six month follow-up ( P=0.0027 ; 95 % confidence interval 0.3 to 1.3 ) after adjustment for sex and baseline performance . Conclusions Physical activity can significantly improve motor skills but did not reduce body mass index in young children in this trial . Trial registration Current Controlled Trials IS RCT N36363490 Background Only limited data are available on the development , implementation , and evaluation processes of weight gain  prevention programs  in adolescents . To be able to learn from successes and failures of such interventions , integral written and published reports are needed . Methods Applying the Intervention Mapping ( IM ) protocol , this paper describes the development , implementation , and evaluation of the Dutch Obesity Intervention in Teenagers ( DOiT ) , a school-based intervention program aim ed at the prevention of excessive weight gain . The intervention focussed on the following health behaviours : ( 1 ) reduction of the consumption of sugar-sweetened beverages , ( 2 ) reduction of energy intake derived from snacks , ( 3 ) decrease of levels of sedentary behaviour  , and ( 4 ) increase of levels of physical activity ( i.e. active transport behaviour and sports participation).The intervention program consisted of an individual classroom-based component ( i.e. an educational program , covering 11 lessons of both biology and physical education classes ) , and an environmental component ( i.e. encouraging and supporting changes at the school canteens , as well as offering additional physical education classes).We evaluated the effectiveness of the intervention program using a r and omised controlled trial design . We assessed the effects of the intervention on body composition ( primary outcome measure ) , as well as on behaviour , behavioural determinants , and aerobic fitness ( secondary outcome measures ) . Furthermore , we conducted a process evaluation . Discussion The development of the DOiT-intervention result ed in a comprehensive school-based weight gain prevention program , tailored to the needs of Dutch adolescents from low socio-economic background OBJECTIVE To examine the efficacy of an interactive , child-centred and family-based program in promoting healthy weight and healthy lifestyles in Chinese American children . DESIGN A r and omized controlled study of a culturally sensitive behavioral intervention . SUBJECTS Sixty-seven Chinese American children ( ages , 8 - 10 years ; normal weight and overweight ) and their families . MEASUREMENTS Anthropometry , blood pressure , measures of dietary intake , physical activity , knowledge and self-efficacy regarding physical activity and diet at baseline and 2 , 6 and 8 months after baseline assessment . RESULTS Linear mixed modeling indicated a significant effect of the intervention in decreasing body mass index , diastolic blood pressure and fat intake while increasing vegetable and fruit intake , actual physical activity and knowledge about physical activity . CONCLUSION This interactive child-centred and family-based behavioral program appears feasible and effective , leading to reduced body mass index and improved overweight-related health behaviors in Chinese American children . This type of program can be adapted for other minority ethnic groups who are at high risk for overweight and obesity and have limited access to programs that promote healthy lifestyles Objectives To examine the prospect i ve associations between body mass index ( BMI ) , waist circumference , and fat mass in childhood and cardiovascular risk factors at age 15 - 16 . Design Prospect i ve cohort study . Setting Avon Longitudinal Study of Parents and Children . Participants 5235 children aged 9 - 12 at start of study . Main exposures BMI , waist circumference , and fat  mass determined by dual energy x ray absorptiometry , assessed at age 9 - 12 and at age 15 - 16 . Main outcome measures Systolic and diastolic blood pressure and concentrations of fasting glucose , insulin , triglycerides , low density lipoprotein cholesterol , and high density lipoprotein cholesterol assessed at age 15 - 16 . Results In girls a 1 SD greater BMI at age 9 - 12 was associated with cardiovascular risk factors at age 15 - 16 in fully adjusted models : odds ratio 1.23 ( 95 % confidence interval 1.10 to 1.38 ) for high systolic blood pressure ( ≥130 mm Hg ) ; 1.19 ( 1.03 to 1.38 ) for high concentration of low density lipoprotein cholesterol ( ≥2.79 mmol/l ) ; 1.43 ( 1.06 to 1.92 ) for high concentration of triglycerides ( ≥1.7 mmol/l ) ; 1.25 ( 1.08 to 1.46 ) for low concentration of high density lipoprotein cholesterol ( < 1.03 mmol/l ) ; and 1.45 ( 1.22 to 1.73 ) for high concentration of insulin ( ≥16.95 IU/l ) . Equivalent results in boys were 1.24 ( 1.13 to 1.37 ) for systolic blood pressure ; 1.30 ( 1.07 to 1.59 ) for low density lipoprotein cholesterol ; 1.96 ( 1.51 to 2.55 ) for triglycerides ; 1.39 ( 1.22 to 1.57 ) for high density lipoprotein cholesterol , and 1.84 ( 1.56 to 2.17 ) for insulin . BMI was associated with high fasting glucose ( ≥5.6 mmol/l ) only in boys ( 1.18 , 1.03 to 1.36 ) . With these binary outcomes there was statistical evidence that associations differed between girls and boys for fasting glucose ( P=0.03 ) and insulin ( P<0.001 ) . When risk factors were examined as continuous outcomes there was evidence for stronger associations of BMI with more adverse levels in boys than girls for fasting insulin , glucose , and triglyceride concentrations ( all interaction P≤0.03 ) . BMI , waist circumference , and fat mass were all strongly correlated with each other ( r=0.89 - 0.94 ) , and associations of the three with cardiovascular outcomes were of similar magnitude with statistical evidence of consistency in associations ( all P>0.2 for heterogeneity ) . When waist circumference or fat mass or both were added to models including BMI they did not increase the variation in cardiovascular risk factors already explained by BMI and confounders alone . Girls who were overweight/obese at age 9 - 12 but were normal weight by 15 - 16 had similar odds of adverse levels of risk factors to those who were normal weight at both ages . In boys odds of high systolic blood pressure , high concentrations of triglycerides and insulin , and low concentrations of high density lipoprotein cholesterol remained higher in this group compared with those who were normal weight at both ages but were lower than in those who remained overweight/obese at both ages . Conclusions Measurements of waist circumference or directly assessed fat mass in childhood do not seem to be associated with cardiovascular risk factors in adolescence any more strongly than BMI . Girls who favourably alter their overweight status between childhood and adolescence have cardiovascular risk profiles broadly similar to those who were normal weight at both time points , but boys who change from overweight to normal show risk factor profiles intermediate between those seen in boys who are normal weight at both ages or overweight at both ages Objectives : To reduce gain in body mass index ( BMI ) in overweight/mildly obese children in the primary care setting . Design : R and omized controlled trial ( RCT ) nested within a baseline cross-sectional BMI survey . Setting : Twenty nine general practice s , Melbourne , Australia . Participants : ( 1 ) BMI survey : 2112 children visiting their general practitioner ( GP ) April – December 2002 ; ( 2 ) RCT : individually r and omized overweight/mildly obese ( BMI z-score < 3.0 ) children aged 5 years 0 months–9 years 11 months ( 82 intervention , 81 control).Intervention : Four st and ard GP consultations over 12 weeks , targeting change in nutrition , physical activity and sedentary behaviour , supported by purpose - design ed family material s . Main outcome measures : Primary : BMI at 9 and 15 months post-r and omization . Secondary : Parent-reported child nutrition , physical activity and health status ; child-reported health status , body satisfaction and appearance/self-worth . Results : Attrition was 10 % . The adjusted mean difference ( intervention – control ) in BMI was −0.2 kg/m2 ( 95 % CI : −0.6 to 0.1 ; P=0.25 ) at 9 months and −0.0 kg/m2 ( 95 % CI : −0.5 to 0.5 ; P=1.00 ) at 15 months . There was a relative improvement in nutrition scores in the intervention arm at both 9 and 15 months . There was weak evidence of an increase in daily physical activity in the intervention arm . Health status and body image were similar in the trial arms . Conclusions : This intervention did not result in a sustained BMI reduction , despite the improvement in parent-reported nutrition . Brief individualized solution-focused approaches may not be an effective approach to childhood overweight . Alternatively , this intervention may not have been intensive enough or the GP training may have been insufficient ; however , increasing either would have significant cost and re source implication s at a population level OBJECTIVE Hip-Hop to Health Jr. was a diet/physical activity intervention design ed to reduce gains in BMI ( kilograms per meter squared ) in preschool minority children . RESEARCH METHODS AND PROCEDURES Twelve predominantly Latino Head Start centers participated in a group-r and omized trial conducted between Fall 2001 and Winter 2003 . Six centers were r and omized to a culturally proficient 14-week ( three times weekly  ) diet/physical activity intervention . Parents participated by completing weekly homework assignments . The children in the other six centers received a general health intervention that did not address either diet or physical activity . The primary outcome was change in BMI , and secondary outcomes were changes in dietary intake and physical activity . Measures were collected at baseline , post-intervention , and at Years 1 and 2 follow-up . RESULTS There were no significant differences between intervention and control schools in either primary or secondary outcomes at post-intervention , Year 1 , or Year 2 follow-ups . DISCUSSION When Hip-Hop to Health Jr. was conducted in predominantly black Head Start centers , it was effective in reducing subsequent increases in BMI in preschool children . In contrast , when the program was conducted in Latino centers , it was not effective . Although the intervention did not prevent excessive weight gain in Latino children , it was very well received . Future interventions with this population may require further cultural tailoring and a more robust parent intervention Overweight and obesity has doubled among children in Australia . There is an urgent need to develop primary prevention strategies to prevent current and future unhealthy weight gain . The aims of this paper are to describe a r and omized controlled trial ( ' Switch-Play ' ) developed to prevent unhealthy weight gain among 10-year-old children and to report the findings of the process evaluation . Children from three government primary schools were r and omized by class to one of four conditions : a  behavioural modification group ( BM ; n = 69 ) ; a fundamental motor skills group ( FMS ; n = 73 ) ; a  combined BM and FMS group ( n = 90 ) ; or a control ( usual classroom lessons ) group ( n = 61 ) . Children in the BM group participated in 19 sessions that encouraged them to reduce screen-based behaviours , and identified physical activity alternatives . The FMS group participated in 19 lessons that focused on mastery of six skills : run , throw , dodge , strike , vertical jump and kick . The combined group participated in all the BM and FMS activities . The intervention specialist teacher reported that the children showed high enjoyment and engagement ( 88 % lessons attended ) in most aspects of the programme . At-home tasks were completed by 57 - 62 % of the children , and 92 % completed the in-class tasks . Two-thirds of the children in the BM group participated in the behavioural contracting to switch off the TV . Most of the children reported high enjoyment of the programmes , and only a small proportion ( 7 - 17 % ) reported difficulties in switching off their nominated TV shows . More than half the children reported reducing their TV viewing ; however , less than half reported increasing their physical activity . It was found that most aspects of the intervention arms of the programme were successfully delivered to the majority of children participating in ' Switch-Play ' ; that the programmes were delivered as intended ; and that the programmes were favourably evaluated by participating children and their parents We investigated the influence of nutrition and exercise interventions within cognitive/behavioral and public health formats on  weight and blood lipid profiles in obese children . Compliance was also examined as well as the relationship of the compliance measures with clinical outcome variables . Three conditions were compared over 16 sessions : nutrition and eating-habit change followed by exercise ( NE ) , exercise followed by nutrition and eating-habit change ( EN ) , and an information control ( INFO ) . NE and EN were presented in a cognitive/ behavioral framework which focused on the development of self-regulation whereas the INFO condition received the same material in a public health/educational model . NE and EN participants evidence d modest , yet significant , reductions in weight and blood lipids , and the impact of these two interventions endured at a five-year follow-up . In contrast , INFO participants displayed stable weight and blood lipids during the course of the program , and most remained morbidly obese at follow-up . Improved nutrition , increased physical activity and fitness were significantly correlated with weight and lipid reductions OBJECTIVE The research ers sought to assess whether the widely used 1994 Cochrane Highly Sensitive Search Strategy ( HSSS ) for r and omized controlled trials ( RCTs ) in MEDLINE could be improved in terms of sensitivity , precision , or parsimony . METHODS A gold st and ard of 1,347 RCT records and a comparison group of 2,400 non-trials were r and omly selected from MEDLINE .  Terms occurring in at least 1 % of RCT records were identified . Fifty percent of the RCT and comparison group records were r and omly selected , and the ability of the terms to discriminate RCTs from non-trial records was determined using logistic regression . The best performing combinations of terms were tested on the remaining records and in MEDLINE . RESULTS The best discriminating term was " Clinical Trial " ( Publication Type ) . In years where the Cochrane assessment of MEDLINE records had taken place , the strategies identified few additional unindexed records of trials . In years where Cochrane assessment has yet to take place , " R and omized Controlled Trial " ( Publication Type ) proved highly sensitive and precise . Adding six more search terms identified further , unindexed trials at reasonable levels of precision and with sensitivity almost equal to the Cochrane HSSS . CONCLUSIONS Most reports of RCTs in MEDLINE can now be identified easily using " R and omized Controlled Trial " ( Publication Type ) . More sensitive search es can be achieved by a brief strategy , the Centre for Review s and Dissemination/Cochrane Highly Sensitive Search Strategy ( 2005 revision ) OBJECTIVE Interpersonal psychotherapy ( IPT ) is effective at reducing binge episodes and inducing weight stabilization in obese adults with binge eating disorder . METHOD We piloted the administration of IPT to girls at-risk for excess weight gain ( BMI 75th-97th percentile ; IPT-WG ) with and without loss of control ( LOC ) eating . Thirty-eight girls ( 12 - 17 years ) were r and omized to IPT-WG or a st and ard-of-care health education group . RESULTS All 38 girls completed the programs and all follow-up visits through 6 months . Thirty-five of 38 returned for a complete assessment visit at 1 year . Among girls with baseline LOC ( n = 20 ) , those in IPT-WG experienced greater reductions in such episodes than girls in health education ( p = .036 ) . Regardless of LOC status , over 1 year girls in IPT-WG were less likely to increase their BMI as expected for their age and BMI percentile ( p = .028 ) . DISCUSSION IPT-WG is feasible and acceptable to adolescent girls at-risk for adult obesity and may prevent excess weight gain over 1 year BACKGROUND . Parenting-skills training may be an effective age-appropriate child behavior-modification strategy to assist parents in addressing childhood overweight . OBJECTIVE . Our goal was to evaluate the relative effectiveness of parenting-skills training as a key strategy for the treatment of overweight children . DESIGN . The design consisted of an assessor-blinded , r and omized , controlled trial involving 111 ( 64 % female ) overweight , prepubertal children 6 to 9 years of age r and omly assigned to  parenting-skills training plus intensive lifestyle education , parenting-skills training alone , or a 12-month wait-listed control . Height , BMI , and waist-circumference z score and metabolic profile were assessed at baseline , 6 months , and 12 months ( intention to treat ) . RESULTS . After 12 months , the BMI z score was reduced by ∼10 % with parenting-skills training plus intensive lifestyle education versus ∼5 % with parenting-skills training alone or wait-listing for intervention . Waist-circumference z score fell over 12 months in both intervention groups but not in the control group . There was a significant gender effect , with greater reduction in BMI and waist-circumference z scores in boys compared with girls . CONCLUSION . Parenting-skills training combined with promoting a healthy family lifestyle may be an effective approach to weight management in prepubertal children , particularly boys . Future studies should be powered to allow gender sub analysis Objective To determine whether ascertainment of childhood obesity by surveillance followed by structured secondary prevention in primary care improved outcomes in overweight or mildly obese children . Design R and omised controlled trial nested within a baseline cross sectional survey of body mass index ( BMI ) . R and omisation and outcomes measurement , but not participants , were blinded to group assignment . Setting 45 family practice s ( 66 general practitioners ) in Melbourne , Australia . Participants 3958 children visiting their general practitioner in May 2005-July 2006 were surveyed for  BMI . Of these , 258 children aged 5 years 0 months up to their 10th birthday who were overweight or obese by International Obesity Taskforce criteria were r and omised to intervention ( n=139 ) or control ( n=119 ) groups . Children who were very obese ( UK BMI z score ≥3.0 ) were excluded .  Intervention Four st and ard consultations over 12 weeks targeting change in nutrition , physical activity , and sedentary behaviour , supported by purpose design ed family material s. Main outcomes measures Primary measure was BMI at 6 and 12 months after r and omisation . Secondary measures were mean activity count/min by 7-day accelerometry , nutrition score from 4-day abbreviated food frequency diary , and child health related quality of life . Differences were adjusted for socioeconomic status , age , sex , and baseline BMI . Results Of 781 eligible children , 258 ( 33 % ) entered the trial ; attrition was 3.1 % at 6 months and 6.2 % at 12 months . Adjusted mean differences ( intervention − control ) at 6 and 12 months were , for BMI , −0.12 ( 95 % CI −0.40 to 0.15 , P=0.4 ) and −0.11 ( −0.45 to 0.22 , P=0.5 ) ; for physical activity in counts/min , 24 ( −4 to 52 , P=0.09 ) and 11 ( −26 to 49 , P=0.6 ) ; and , for nutrition score , 0.2 ( −0.03 to 0.4 , P=0.1 ) and 0.1 ( −0.1 to 0.4 , P=0.2 ) . There was no evidence of harm to the child . Costs to the healthcare system were significantly higher in the intervention arm . Conclusions Primary care screening followed by brief counselling did not improve BMI , physical activity , or nutrition in overweight or mildly obese 5 - 10 year olds , and it would be very costly if universally implemented . These findings are at odds with national policies in countries including the US , UK , and Australia . Trial registration IS RCT N 52511065 ( www.is rct n.org 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 BACKGROUND General practitioners ( GPs ) could make an important contribution to management of childhood overweight . However , there are no efficacy data to support this , and the feasibility of this approach is unknown . OBJECTIVES To determine if GPs and families can be recruited to a r and omized controlled trial ( RCT ) , and if GPs can successfully deliver an intervention to families with overweight/obese 5- to 9-year-old children . METHODS A convenience sample of 34 GPs from 29 family medical practice s attended training sessions on management of childhood overweight . Practice staff trained in child anthropometry conducted a cross-sectional body mass index ( BMI ) survey of 5- to 9-year-old children attending these practice s. The intervention focused on achievable goals in nutrition , physical activity and sedentary behaviour , and was delivered in four solution-focused behaviour change consultations over 12 weeks . RESULTS General practitioners were recruited from across the sociodemographic spectrum . All attended at least two of the three education sessions and were retained throughout the trial . Practice staff weighed and measured 2112 children in the BMI survey , of whom 28 % were overweight/obese ( 17.5 % overweight , 10.5 % obese ) , with children drawn from all sociodemographic quintiles . Of the eligible overweight/obese children , 163 ( 40 % ) were recruited and retained in the LEAP RCT ; 96 % of intervention families attended at least their first consultation . CONCLUSIONS Many families are willing to tackle childhood overweight with their GP . In addition , GPs and families can participate successfully in the careful trials that are needed to determine whether an individualized , family-based primary care approach is beneficial , harmful or ineffective OBJECTIVES To assess the impact of a culturally proficient dietary/physical activity intervention on changes in body mass index ( BMI ) ( kg/m 2 ) . STUDY DESIGN R and omized controlled trial ( Hip-Hop to Health Jr. ) conducted between September 1999 and June 2002 in 12 Head Start preschool programs in Chicago , Illinois . RESULTS Intervention children had significantly smaller increases in BMI compared with control children at 1-year follow-up , 0.06 vs 0.59 kg/m 2 ; difference -0.53 kg/m 2 ( 95 % CI -0.91 to -0.14 ) , P = .01 ; and at 2-year follow-up , 0.54 vs 1.08 kg/m 2 ; difference -0.54 kg/m 2 ( 95 % CI -0.98 to -0.10 ) , P = .02 , with adjustment for baseline age and BMI . The only significant difference between intervention and control children in food intake/physical activity was the Year 1 difference in percent of calories from saturated fat , 11.6 % vs 12.8 % ( P = .002 ) . CONCLUSIONS Hip-Hop to Health Jr. was effective in reducing subsequent increases in BMI in preschool children . This represents a promising approach to prevention of overweight among minority children in the preschool years Project STORY is a 3-arm , r and omized , planning and feasibility study assessing the effectiveness of two behavioral weight management interventions in an important and at-risk population , overweight children and their parents in medically underserved rural counties . Participants will include 90 parent-child dyads from rural counties in north central Florida . Families will be r and omized to one of three conditions : ( a ) a Family-Based Behavioral Group Intervention , ( b ) a Parent-Only Behavioral Group Intervention , and ( c ) a waitlist control condition .  Child and parent participants will be assessed at baseline ( month 0 ) , post-treatment ( month 4 ) and follow-up ( month 10 ) . Assessment and intervention sessions will be held at Cooperative Extension offices within each local participating county . The primary outcome measure is change in child body mass index ( BMI ) z-score . Additional key outcome measures include child dietary intake , physical activity , self-esteem , body image , and parent BMI . The goals of the study are to ( a ) assess the feasibility of recruitment in rural setting s , ( b ) develop and evaluate training protocol for group leaders , ( c ) determine strategies to increase adherence to monitoring and goal setting protocol , ( d ) evaluate strategies for participant retention , ( e ) assess the relative cost-effectiveness of the interventions , ( f ) assess the acceptability of the intervention to families and Cooperative Extension administrators and personnel , and ( g ) if successful , estimate the sample size needed for a full-scale trial . This research has potential implication s for medically underserved rural communities with limited re sources and preventive health care services . If successful , a Parent-Only intervention program may provide a cost-effective and practical intervention for families in underserved rural communities BACKGROUND The association of body-mass index ( BMI ) from adolescence to adulthood with obesity-related diseases in young adults has not been completely delineated . METHODS We conducted a prospect i ve study in which we followed 37,674 apparently healthy young men for incident angiography-proven coronary heart disease and diabetes through the Staff Periodic Examination Center of the Israeli Army Medical Corps . The height and weight of participants were measured at regular intervals , with the first measurements taken when they were 17 years of age . RESULTS During approximately 650,000 person-years of follow-up ( mean follow-up , 17.4 years ) , we documented 1173 incident cases of type 2 diabetes and 327 of coronary heart disease . In multivariate models adjusted for age , family history , blood pressure , lifestyle factors , and biomarkers in blood , elevated adolescent BMI ( the weight in kilograms divided by the square of the height in meters ; mean range for the first through last deciles , 17.3 to 27.6 ) was a significant predictor of both diabetes ( hazard ratio for the highest vs. the lowest decile , 2.76 ; 95 % confidence interval [ CI ] , 2.11 to 3.58 ) and angiography-proven coronary heart disease ( hazard ratio , 5.43 ; 95 % CI , 2.77 to 10.62 ) . Further adjustment for BMI at adulthood completely ablated the association of adolescent BMI with diabetes ( hazard ratio , 1.01 ; 95 % CI , 0.75 to 1.37 ) but not the association with coronary heart disease ( hazard ratio , 6.85 ; 95 % CI , 3.30 to 14.21 ) . After adjustment of the BMI values as continuous variables in multivariate models , only elevated BMI in adulthood was significantly associated with diabetes ( β=1.115 , P=0.003 ; P=0.89 for interaction ) . In contrast , elevated BMI in both adolescence ( β=1.355 , P=0.004 ) and adulthood ( β=1.207 , P=0.03 ) were independently associated with angiography-proven coronary heart disease ( P=0.048 for interaction ) . CONCLUSIONS An elevated BMI in adolescence -- one that is well within the range currently considered to be normal -- constitutes a substantial risk factor for obesity-related disorders in midlife . Although the risk of diabetes is mainly associated with increased BMI close to the time of diagnosis , the risk of coronary heart disease is associated with an elevated BMI both in adolescence and in adulthood , supporting the hypothesis that the processes causing incident coronary heart disease , particularly atherosclerosis , are more gradual than those result ing in incident diabetes . ( Funded by the Ch aim Sheba Medical Center and the Israel Defense Forces Medical Corps . ) UNLABELLED BACKGROUND ; The increasing prevalence of overweight among children in the United States presents a national health priority . Higher rates of overweight/obesity among minority women place their children at increased risk . Although increased rates of overweight are observed in 4- to 5-year-old children , they are not observed in 2- to 3-year-old children . Therefore , early prevention efforts incorporating families are critical . METHODS The primary aim of Hip-Hop to Health Jr. is to alter the trajectory toward overweight/obesity among preschool African-American and Latino children . This 5-year r and omized intervention is conducted in 24 Head Start programs , where each site is r and omized to either a 14-week dietary/physical activity intervention or a general health intervention . RESULTS This paper presents the rationale and design of the study . Efficacy of the intervention will be determined by weight change for the children and parent/caretaker . Secondary measures include reductions in dietary fat and increases in fiber , fruit/vegetable intake , and physical activity . Baseline data will be presented in future papers . CONCLUSIONS The problem of overweight/obesity is epidemic in the United States . Behaviors related to diet and physical activity are established early in life and modeled by family members . Early intervention efforts addressing the child and family are needed to prevent obesity later in life . This paper describes a comprehensive , family-oriented obesity prevention program for minority preschool children The Child and Adolescent Trial for Cardiovascular Health ( CATCH ) is a multisite intervention research study that builds on significant progress made in school health education research in the 1980s . The study has three phases : Phase I deals with study design , intervention , and measurement development , Phase II involves the main trial in 96 schools in four states , and Phase III focuses on analysis . The intervention program targets third-fifth grade students and focuses on multiple cardiovascular health behaviors  , including  eating habits , physical activity  , and  cigarette smoking . Classroom curricula , school environmental change , and family involvement programs are developed for each grade level and behavioral focus . This paper describes Phase II of CATCH with a rationale for cardiovascular health promotion with youth . The process of change that appears to be necessary for school-based health promotion and that will be tested in CATCH are presented as a framework to guide these efforts The CONSORT statement is used worldwide to improve the reporting of r and omised controlled trials . Kenneth Schulz and colleagues describe the latest version , CONSORT 2010 , which up date s the reporting guideline based on new method ological evidence and accumulating experience . To encourage dissemination of the CONSORT 2010 Statement , this article is freely accessible on bmj.com and will also be published in the Lancet , Obstetrics and Gynecology , PLoS Medicine , Annals of Internal Medicine , Open Medicine , Journal of Clinical Epidemiology , BMC Medicine , and Trials OBJECTIVE To assess the effectiveness of parent-only vs family-based interventions for  pediatric weight management in underserved rural setting s. DESIGN A 3-arm r and omized controlled clinical trial . SETTING All sessions were conducted at Cooperative Extension Service offices in underserved rural counties . PARTICIPANTS Ninety-three overweight or obese children ( 8 - 14 years old ) and their parent(s ) . INTERVENTION Families were r and omized to ( 1 ) a behavioral family-based intervention , ( 2 ) a behavioral parent-only intervention , or ( 3 ) a wait-list control group . OUTCOME MEASURE The primary outcome measure was change in children 's st and ardized body mass index ( BMI ) . RESULTS Seventy-one children completed posttreatment ( month 4 ) and follow-up ( month 10 ) assessment s. At the month 4 assessment , children in the parent-only intervention demonstrated a greater decrease in BMI z score ( mean difference [ MD ] , 0.127 ; 95 % confidence interval [ CI ] , 0.027 to 0.226 ) than children in the control condition . No significant difference was found between the family-based intervention and the control condition ( MD , 0.065 ; 95 % CI , -0.027 to 0.158 ) . At month 10 follow-up , children in the parent-only and family-based intervention groups demonstrated greater decreases in BMI z score from before treatment compared with those in the control group ( MD , 0.115 ; 95 % CI , 0.003 to 0.220 ; and MD , 0.136 ; 95 % CI , 0.018 to 0.254 , respectively ) . No difference was found in weight status change between the parent-only and family-based interventions at either assessment . CONCLUSIONS A parent-only intervention may be a viable and effective alternative to family-based treatment of childhood overweight . Cooperative Extension Service offices have the potential to serve as effective venues for the dissemination of obesity-related health promotion programs
Rates of childhood obesity are increasing , and it is essential to identify the active components of interventions aim ing to prevent and manage obesity in children .
A systematic review of behaviour change interventions was conducted to find evidence of behaviour change techniques ( BCTs ) that are most effective in changing physical activity and /or eating behaviour for the prevention or management of childhood obesity .