Effectiveness of parent‐centred interventions for the prevention and treatment of childhood overweight and obesity in community settings: a systematic review Randomized controlled trial of a good practice approach to treatment of childhood obesity in Malaysia: Malaysian Childhood Obesity Treatment Trial (MASCOT). Ethnic and sex variations in overweight self-perception: relationship to sedentariness. Associations between anthropometric characteristics, physical activity, and breast cancer risk in a Canadian cohort Sedentary behavior and psychiatric symptoms in overweight and obese adults with schizophrenia and schizoaffective disorders (WAIST Study) Madres para la Salud: design of a theory-based intervention for postpartum Latinas. Decreasing sedentary behaviors in treating pediatric obesity. Breaking bad habits by improving executive function in individuals with obesity Relative Contribution of Physical Activity, Sedentary Behaviors, and Dietary Habits to the Prevalence of Obesity among Kuwaiti Adolescents Emotional Health Predicts Changes in Body Mass Index (BMI-z) Among Black and Latino Youth Protocol for systematic reviews of determinants/correlates of obesity-related dietary and physical activity behaviors in young children (preschool 0 to 6 years): evidence mapping and syntheses Effects of decreasing sedentary behavior and increasing activity on weight change in obese children. Outcomes of a 12-Month Technology-Based Intervention to Promote Weight Loss in Adolescents at Risk for Type 2 Diabetes Adolescent beverage habits and changes in weight over time: findings from Project EAT. Television watching and other sedentary behaviors in relation to risk of obesity and type 2 diabetes mellitus in women. Sitting Behavior and Obesity The influence of exercise and BMI on injuries and illnesses in overweight and obese individuals: a randomized control trial Sex differences in obese children and siblings in family-based obesity treatment. The effect of weight management interventions that include a diet component on weight‐related outcomes in pregnant and postpartum women: a systematic review protocol Small Changes in Nutrition and Physical Activity Promote Weight Loss and Maintenance: 3-Month Evidence from the ASPIRE Randomized Trial The Arthritis, Diet and Activity Promotion Trial (ADAPT): design, rationale, and baseline results.
Background Worldwide in 2000 , 10 % of children aged five to 17 years were reported as being overweight with an additional 2‐3 % being obese . Overweight and obesity in childhood can adversely impact on both physical and psychological health . The rise in the prevalence of childhood obesity is a complex issue but widely recognised contributors include increased energy intake , decreased levels of physical activity and greater time spent in sedentary pursuits . A large number of environmental and cultural factors have also been identified as contributing to the problem . Evidence to support an optimal approach to treating childhood obesity is limited with many studies showing only modest results at best in the long‐term . However , the importance of family‐based treatment that combines diet , physical activity and behavioral components has been acknowledged in a recent Cochrane Systematic Review . It has also been suggested that interventions offered in the community setting may help overcome barriers to participation , by making programs more accessible and allowing the targeting of specific sub‐groups of the population . Objectives The objective of this review was to identify the effectiveness of parent‐centred interventions implemented in the community setting in modifying eating and physical activity behaviors or weight‐related outcomes of children . Inclusion criteria Types of participants This review considered studies that included free‐living children of pre‐school , primary and secondary school age and /or their parents/guardians aged > 18 years . Types of intervention(s)/phenomena of interest Intervention programs were required to have a parental component , to target eating and /or exercise behaviors for the prevention or treatment of obesity , and child weight status reported . Types of studies All intervention studies were included in the review including : r and omized controlled trials ( RCTs ) ; non‐r and omized controlled trials , longitudinal studies , cohort ( both retrospective and prospect i ve ) , case control and time series studies which had been conducted in a community setting . Types of outcomes This review considered studies that included overweight/obesity related outcomes , eating behavior outcomes , physical activity behaviour outcomes , and sedentary behavior outcomes and constructs . Search strategy A literature search of community‐based parent‐centred intervention studies to promote nutrition and physical activity for the prevention and treatment and of childhood overweight and obesity was performed in eight electronic data bases dating from 1975 to April 2009 . Method ological quality Studies were critically appraised for method ological quality using st and ardized tools . Data collection Data was extracted by one review er using a st and ardized data extraction form developed by the research ers and checked for accuracy and consistency by a second review er . Data synthesis Data in relation to setting , methodology , intervention components and effect on weight , dietary intake and physical activity was extracted , and described in a narrative synthesis . Where possible a meta‐ analysis was undertaken . Results Of the home‐based interventions , five of nine studies reported statistically significant changes in anthropometric outcomes post intervention . Of the 10 studies in the before and after school care setting , seven reported a significant decrease in a weight‐related outcome post intervention , with only one reporting an increase . Conclusions Results from the review support the after‐school setting as the most promising for community intervention setting for targeting parents as agents of change within child obesity prevention and treatment programs . Implication s for practice At this stage , interventions to support parents should target the after‐school environment as opposed to being conducted in the home , summer camps , leisure centers or churches . Targeting a decrease in energy intake and sweetened beverages in parallel with increasing number of daily steps and decreasing screen time use . Implication s for research Future studies of high quality are needed across the full range of community setting s. Given that currently most of the higher quality RCTs and the studies showing positive impacts of weight change are in the after‐school setting , further studies in this area using similar method ologies to those already published will facilitate future meta‐analyses in this area CONTEXT Few r and omized controlled trials ( RCTs ) of interventions for the treatment of childhood obesity have taken place outside the Western world . AIM To test whether a good practice intervention for the treatment of childhood obesity would have a greater impact on weight status and other outcomes than a control condition in Kuala Lumpur , Malaysia . METHODS Assessor-blinded RCT of a treatment intervention in 107 obese 7- to 11-year olds . The intervention was relatively low intensity ( 8 hours contact over 26 weeks , group based ) , aim ing to change child sedentary behavior , physical activity , and diet using behavior change counselling . Outcomes were measured at baseline and six months after the start of the intervention . Primary outcome was BMI z-score , other outcomes were weight change , health-related quality of life ( Peds QL ) , objective ly measured physical activity and sedentary behavior ( Actigraph accelerometry over 5 days ) . RESULTS The intervention had no significant effect on BMI z score relative to control . Weight gain was reduced significantly in the intervention group compared to the control group ( + 1.5 kg vs. + 3.5 kg , respectively , t-test p < 0.01 ) . Changes in health-related quality of life and objective ly measured physical activity and sedentary behavior favored the intervention group . CONCLUSIONS Treatment was associated with reduced rate of weight gain , and improvements in physical activity and quality of life . More substantial benefits may require longer term and more intensive interventions which aim for more substantive lifestyle changes OBJECTIVE With increasing frequency , health promotion messages advocating physical activity are cl aim ing weight loss as a benefit . However , messages promoting physical activity as a weight loss strategy may have limited effectiveness and cross-cultural relevance . We recently found self-perceived overweight to be a more robust correlate of sedentary behavior than BMI in Los Angeles County adults . In this study , we examined ethnic and sex differences in overweight self-perception and their association with sedentariness in this sample . RESEARCH METHODS AND PROCEDURES We conducted bivariate and multivariate analyses of cross-sectional survey data  from a representative sample of Los Angeles County adults . RESULTS Women were more likely to perceive themselves to be overweight than men overall ( 73.2 % of overweight/non-obese and 24.1 % of average weight women vs. 44.5 % of overweight/non-obese and 5.6 % of average weight men ) and within each ethnic group . African-Americans were least likely ( 41.3 % of overweight/non-obese African-Americans self-identified as overweight ) and whites were most likely to consider themselves overweight ( 60.6 % of overweight/non-obese whites self-identified as overweight ) . Overweight ( vs. average weight ) self-perception was correlated with sedentariness among average weight adults ( 45.3 % vs. 33.0 % , p < 0.001 ) , overweight adults ( 43.4 % vs. 33.6 % , p < 0.001 ) , men ( average and overweight : 38.4 % vs. 27.8 % , p < 0.001 ) , overweight whites ( 41.9 % vs. 29.7 % , p = 0.0012 ) , and African-Americans and Latinos ( 41.6 % vs. 33.9 % , p = 0.005 ) . DISCUSSION These data suggest that our society 's emphasis on weight loss rather than lifestyle change may inadvertently discourage physical activity adoption/maintenance among non-obese individuals . However , further research is needed , particularly from prospect i ve cohort and intervention studies , to eluci date the relationship between overweight self-perception and healthy lifestyle change Abstract Obesity , physical inactivity , and sedentary behavior , concomitants of the modern environment , are potentially modifiable breast cancer risk factors . This study investigated the association of anthropometric measurements , physical activity and sedentary behavior  , with the risk of incident , invasive breast cancer using a prospect i ve cohort of women enrolled in the Canadian Study of Diet , Lifestyle and Health . Using a case-cohort design , an age-stratified subcohort of 3,320 women was created from 39,532 female participants who returned completed self-administered lifestyle and dietary question naires at baseline . A total of 1,097 incident breast cancer cases were identified from the entire cohort via linkage to the Canadian Cancer Registry . Cox regression models , modified to account for the case-cohort design , were used to estimate hazard ratios ( HR ) and 95 % confidence intervals ( CI ) for the association between anthropometric characteristics , physical activity , and the risk of breast cancer . Weight gain as an adult was positively associated with risk of post-menopausal breast cancer , with a 6 % increase in risk for every 5 kg gained since age 20 ( HR 1.06 ; 95 % CI 1.01–1.11 ) . Women who exercised more than 30.9 metabolic equivalent task ( MET ) hours per week had a 21 % decreased risk of breast cancer compared to women who exercised less than 3 MET hours per week ( HR 0.79 ; 95 % CI 0.62–1.00 ) , most evident in pre-menopausal women ( HR 0.62 ; 95 % CI 0.43–0.90 ) . As obesity reaches epidemic proportions and sedentary lifestyles have become more prevalent in modern population s , programs targeting adult weight gain and promoting physical activity may be beneficial with respect to reducing breast cancer morbidity OBJECTIVE Examine the association between sedentary behavior and psychiatric symptoms among overweight and obese adults with schizophrenia or schizoaffective disorders ( SZO/SA ) . DESIGN R and omized clinical trial ; Weight Assessment and Intervention in Schizophrenia Treatment ( WAIST ) Study : baseline data collected 2005 - 2008 . SETTING University of Pittsburgh Medical Center , Pittsburgh , PA , USA . PARTICIPANTS Community-dwelling adults diagnosed with SZO/SA , with mild symptom severity [ Positive and Negative Syndrome Scale (PANSS)<90 ] , who were interested in losing weight , age 18 - 70years , BMI > 27kg/m(2 ) . MEASUREMENTS Objective ly measured  sedentary behavior by accelerometry , and  psychopathology  assessed by PANSS . Participants wore the actigraphs for 7 consecutive days during their waking hours . Sedentary behavior was defined as ≤100 counts per minute during wear-time and excluded sleep and non-wear time . RESULTS On average , 81 % of the participant 's monitoring time or 756min/day was classified as sedentary behavior using accelerometry . No association was observed between sedentary behaviors and PANSS psychiatric symptoms [ total ( p≥0.75 ) , positive ( p≥0.81 ) , negative ( p≥0.59 ) and general psychopathology ( p≥0.65 ) subscales ] . No association was observed between sedentary behaviors and age , race , gender and BMI . CONCLUSION From a clinical and public health perspective , the amount of time ( approximately 13h ) and percentage of time ( 81 % excluding non-wear time associated with sleeping ) engaged in sedentary behavior among overweight and obese adults in this population is alarming , and points to an urgent need for interventions to decrease sedentary behaviors . The lack of associations between sedentary behavior and psychiatric symptoms may be due to a ceiling effect for sedentary behavior BACKGROUND Weight gain in young women suggests that childbearing may be an important contributor to the development of obesity in women .  Depressive symptoms can interfere with resumption of normal activity levels following childbirth or with the initiation of or adherence to physical activity programs essential for losing pregnancy weight . Depression symptoms may function directly to promote weight gain through a physiologic mechanism . Obesity and its related insulin resistance may contribute to depressed mood physiologically . Although physical activity has well-established beneficial effects on weight management and depression , women tend to under participate in physical activity during childbearing years . Further , the mechanisms underpinning the interplay of overweight , obesity , physical activity , depression , and inflammatory processes are not clearly explained . OBJECTIVES This report describes the theoretical rationale , design considerations , and cultural relevance for " Madres para la Salud " [ Mothers for Health ] . DESIGN AND METHODS Madres para la Salud is a 12 month prospect i ve , r and omized controlled trial exploring the effectiveness of a culturally specific intervention using " bouts " of physical activity to effect changes in body fat , systemic and fat tissue inflammation , and postpartum depression symptoms in sedentary postpartum Latinas . SUMMARY The significance and innovation of Madres para la Salud includes use of a theory-driven approach to intervention , specification and cultural relevance of a social support intervention , use of a Promotora model to incorporate cultural approaches , use of objective measures of physical activity in post partum Latinas women , and the examination of biomarkers indicative of cardiovascular risk related to physical activity behaviors in postpartum Latinas BACKGROUND Epidemiological studies have shown television watching to be a risk factor for the development of obesity in children . The effect of reducing television watching and other sedentary behaviors as a component of a comprehensive obesity treatment program has not been thoroughly tested . OBJECTIVE To compare the influence of targeting decreases in sedentary behavior vs. increases in physical activity in the comprehensive treatment of obesity in 8- to 12-year-old children . DESIGN R and omized , controlled outcome study . SETTING Childhood obesity research clinic . DESIGN Ninety families with obese 8- to 12-year-old children were r and omly assigned to groups that were provided a comprehensive family-based behavioral weight control program that included dietary , and behavior change information but differed in whether sedentary or physically active behaviors were targeted and the degree of behavior change required . RESULTS Results during 2 years showed that targeting either decreased sedentary behaviors or increased physical activity was associated with significant decreases in percent overweight and body fat and improved aerobic fitness . Self-reported activity minutes increased and targeted sedentary time decreased during treatment . Children substituted nontargeted sedentary behaviors for some of their targeted sedentary behaviors . CONCLUSION These results support reducing sedentary behaviors as an adjunct in the treatment of pediatric obesity Background Two primary factors that contribute to obesity are unhealthy eating and sedentary behavior  . These behaviors are particularly difficult to change in the long-term because they are often enacted habitually . Cognitive Remediation Therapy has been modified and applied to the treatment of obesity ( CRT-O ) with preliminary results of a r and omized controlled trial demonstrating significant weight loss and improvements in executive function . The objective of this study was to conduct a secondary data analysis of the CRT-O trial to evaluate whether CRT-O reduces unhealthy habits that contribute to obesity via improvements in executive function . Method Eighty participants with obesity were r and omized to CRT-O or control . Measures of executive function ( Wisconsin Card Sort Task and Trail Making Task ) and unhealthy eating and sedentary behavior habits were administered at baseline , post-intervention and at 3 month follow-up . Results Participants receiving CRT-O demonstrated improvements in both measures of executive function and reductions in both unhealthy habit outcomes compared to control . Mediation analyses revealed that change in one element of executive function performance ( Wisconsin Card Sort Task perseverance errors ) mediated the effect of CRT-O on changes in both habit outcomes . Conclusion These results suggest that the effectiveness of CRT-O may result from the disruption of unhealthy habits made possible by improvements in executive function . In particular , it appears that cognitive flexibility , as measured by the Wisconsin Card Sort task , is a key mechanism in this process . Improving cognitive flexibility may enable individuals to capitalise on interruptions in unhealthy habits by adjusting their behavior in line with their weight loss goals rather than persisting with an unhealthy choice . Trial registration The RCT was registered with the Australian New Zeal and Registry of Clinical Trials ( trial i d : ACTRN12613000537752 ) Background The increasing rate of obesity among Kuwaiti adolescents is associated with immediate and long term-risks to their health and well-being . Objective To up date data on the prevalence of overweight and obesity among Kuwaiti adolescents and to examine the relative contribution of selected lifestyle factors to overweight and obesity in this population . Methods The present study is part of the Arab Teens Lifestyle Study ( ATLS ) . A total of 906 adolescents ( 463 boys and 443 girls ) aged between 14 and 19 years were selected from Kuwaiti schools by a multistage stratified r and omization process . A vali date d question naire was used to collect data on  physical activity , sedentary lifestyle , and eating habits . The International Obesity Task Force ( IOTF ) cutoff values for adolescents under 18 years of age were used to define overweight and obesity . Total energy expenditure was calculated using metabolic equivalent-minutes per week . A general linear model was used to establish the proportion of the variance ( expressed in partial eta squared ) in excess weight attributable to differences in eating habits and physical activity . Results The prevalence of overweight and obesity was 50.5 % in boys and 46.5 % in girls . Among boys , moderate and vigorous activities were found to be significantly negatively associated with overweight and obesity ( p < .05 ) , whereas in girls , only those with not less than moderate activities were negatively associated with overweight and obesity ( p < .05 ) . Sedentary behaviors , time spent watching television , and time spent working on the computer were not significantly associated with obesity in either sex . Consumption of breakfast , vegetables , and fast foods ( boys and girls ) and potatoes , cakes and doughnuts , and sweets ( girls only ) was significantly associated with overweight and obesity ( p < .05 ) . In general , the partial eta square explained by physical activity was less than 3.6 % in boys compared with less than 1.0 % in girls , and eating habits explained less than 1.8 % in boys compared with 2.5 % in girls . Conclusions Physical activity explains a greater proportion of variation in body mass index than do eating habits , particularly in boys . Eating habits explain a greater proportion of variation in body mass index than does physical activity in girls . Prospect i ve studies are needed to clarify the relative effects of sedentary behaviors on overweight in adolescents Childhood obesity is a complex and multifaceted health problem linked to elevated risk for chronic diseases , such as diabetes , cancer , hypertension , and cardiovascular disease.1,2 Although research has increased dramatically in the past 2 decades , questions regarding factors driving overweight and obesity remain , particularly among youth of color who experience disproportionate rates of obesity and comorbid health conditions.3 Adolescence is a critical period in the developmental trajectory,4 in part because overweight and obese adolescents are more likely to remain overweight and /or obese in adulthood.3 Overweight and obesity have been associated with adverse symptoms and intra- and interpersonal psychological , social , and emotional issues that continue into adulthood , including depression and anxiety , social withdrawal , feeling worthless , lower self-esteem , and behavioral problems.5–7 Poor mental health may lead to increases in weight due to fluctuations in appetite , obesogenic behaviors ( eg , overeating ) to cope with negative mood , sedentary behavior , and increased isolation.8 Chronic stress or experiences of discrimination may also influence physiology and behaviors that affect weight gain.9 On the other h and , increased body mass index ( BMI ) could result in adverse emotional outcomes over time due to weight-based stigma , bullying , or poor self-esteem.5,6 The few longitudinal studies that have examined the association between emotional health and physical health outcomes have primarily taken a narrow focus of mental health symptoms ( e.g. , only examining depression)10 or behavioral concerns ( e.g. , conduct).11 Physical outcomes , including BMI , were often collected by self-report12 and /or retrospectively.13 Furthermore , they have been limited to predominantly White sample s of older adolescents or adults.12,13 Persistent racial and ethnic disparities in overweight and obesity further complicate research as well as clinical prevention and intervention efforts . Black and Latino youth experience disproportionate levels of overweight and obesity beginning as early as preschool and are more likely to remain obese as adults compared with Whites.14 Blacks and Latinos also are at disproportionate risk for multiple negative health conditions associated with overweight and obesity , such as diabetes.14,15 Reasons for such disparities remain poorly understood and understudied . Although emotional health has been associated with weight in both adults and youth,16 prior research has been limited to cross-sectional studies .17 Longitudinal , prospect i ve design s are critical to explicate the association between emotional health and BMI among Black and Latino youth . The primary objective of this study is to examine whether negative emotional symptoms prospect ively predict increases in BMI z-scores ( BMI -z ) across 2 years among a sample of predominantly Black and Latino , urban youth . We hypothesize that more negative emotional symptoms measured at baseline ( grade s 5 and 6 ) would predict increases in BMI -z scores 2 years later . Results can inform programs and interventions aim ed at reducing obesity in youth of color Background The aim of these review s is to inform the design and content of interventions to reduce obesity in young children . The behaviors that are associated with obesity/overweight have been studied extensively ; however , the factors associated with these behaviors in young children ( 0 to 6 years ) have not been systematic ally review ed . Over the past few years the focus of obesity prevention has shifted to preschool children because of the high prevalence of obesity at school entry and recognition that habits formed in early life could track into adulthood . In order to develop effective interventions and change behavior , it is important to underst and the factors that are associated with those behaviors . For example , we need to underst and whether it would be more important to target the family , childcare setting s or the wider environment and identify the most effective way of changing these energy balance related behaviors . Methods / Design Quantitative ( intervention and observational ) and qualitative literature on determinants/correlates of fruit and vegetable intake , sugar sweetened beverage and other unhealthy diet intake , and physical activity and sedentary behaviors in young children will be systematic ally identified , mapped and review ed . A common search strategy ( no language or period restrictions ) will be used to identify papers from eight electronic data bases and this will be supplemented by h and - search ing . Next , studies in developed countries that examine the factors associated with these behaviors in children aged 0 to 6 years ( at baseline ) will be screened and mapped descriptively followed by in-depth data extraction , quality assessment and synthesis . Data from quantitative studies will be summarized using either forest plots or harvest plots and narrative synthesis , and qualitative studies using thematic analysis . Qualitative evidence will be integrated with the quantitative evidence , using a parallel synthesis approach , to provide a deeper underst and ing of effective strategies to influence these energy balance related behaviors . Discussion In addition to updating and mapping current research , these review s will be the first to comprehensively synthesize and integrate both the quantitative and qualitative evidence pertaining to determinants/correlates/barriers/facilitators of obesity related behaviors in this young age group ( 0 to 6 years ) with the aim of informing future interventions . Systematic review registration International Prospect i ve Register for Systematic Review s ( PROSPERO ) Registration number : Obese children 8 - 12 years old from 61 families were r and omized to treatment groups that targeted increased exercise , decreased sedentary behaviors , or both ( combined group ) to test the influence of reinforcing children to be more active or less sedentary on child weight change . Significant decreases in percentage overweight were observed after 4 months between the sedentary and the exercise groups ( -19.9 vs. -13.2 ) . At 1 year , the sedentary group had a greater decrease in percentage overweight than did the combined and the exercise groups ( -18.7 vs. -10.3 and -8.7 ) and greater decrease in percentage of body fat ( -4.7 vs. -1.3 ) . All groups improved fitness during treatment and follow-up . Children in the sedentary group increased their liking for high-intensity activity and reported lower caloric intake than did children in the exercise group . These results support the goal of reducing time spent in sedentary activities to improve weight loss Background : Obese adolescents are at risk for type 2 diabetes mellitus ( T2DM ) . Obesity interventions delivered through media , such as the web and text messages [ short message service ( SMS ) ] may be beneficial when targeting obese adolescents . Methods : A r and omized controlled trial , Pace-Internet for Diabetes Prevention Intervention ( PACEi-DP ) , compared three forms of an obesity intervention to usual care ( UC ) : ( a ) website only ( W ) ; ( b ) website , monthly group sessions , and follow-up calls ( WG ) ; and ( c ) website and SMS ( WSMS ) .  Participants were overweight or obese adolescents at risk for T2DM ( n = 101 ; age 12–16 years ; mean body mass index ( BMI ) percentile = 97.6 ; 74.3 % Hispanic ) . In addition to the website , WSMS participants received SMS supporting intervention goals and behavioral strategies and communicated via SMS with a case manager . WG participants had additional group activities related to weight loss and received follow-up calls from a health coach . UC participants were given printed material s and encouraged to attend three initial group sessions . Repeated measures mixed model regression analyses tested treatment effects for anthropometric , behavioral , and behavioral change strategy outcomes . Results : There were no treatment effects for BMI , adiposity , physical activity , or diet at 12 months . Treatment effects were observed for sedentary behavior , with the W arm having a greater decrease in sedentary behavior ( 4.9 to 2.8 h/day ) than the UC arm ( p = .006 ) . Conclusion : Although not sufficient to produce weight loss , the combination of web intervention and group sessions with telephone follow-up yielded improvements in sedentary behavior and in the use of behavior change strategies expected to lead to behavior change BACKGROUND Obesity in adolescence has been increasing in the past several decades . Beverage habits among adolescents include increased consumption of sugar-sweetened beverages and decreased consumption of milk . OBJECTIVE This study aim ed to examine the association between beverage consumption and 5-y body weight change  in 2294 adolescents . DESIGN Project EAT ( Eating Among Teens ) is a 5-y longitudinal study of eating patterns among adolescents . Surveys were completed in 1998 - 1999 ( time 1 ) and in 2003 - 2004 ( time 2 ) . Multivariable linear regression was used to examine the association between beverage consumption at time 2 and change in body mass index from time 1 to time 2 , with adjustments for age , socioeconomic status , race , cohort , physical activity , sedentary behavior , coffee , tea , time 1 body mass index , and beverage variables . RESULTS In prospect i ve analyses , consumption of beverages was not associated with weight gain , except for consumption of low-calorie soft drinks ( positive association , P = 0.002 ) and white milk ( inverse association , P = 0.03 ) , but these associations did not appear to be a monotonic linear dose-response relation . The positive association with low-calorie soft drinks was no longer present after adjustment for dieting and parental weight-related concerns , which suggests that the use of low-calorie soft drinks is a marker for more general dietary behaviors and weight concerns . CONCLUSIONS We showed no association between sugar-sweetened beverage consumption , juice consumption , and adolescent weight gain over a 5-y period . A direct association between diet beverages and weight gain appeared to be explained by dieting practice s. Adolescents who consumed little or no white milk gained significantly more weight than their peers who consumed white milk . Future research that examines beverage habits and weight among adolescents should address portion sizes , adolescent maturation , and dieting behaviors CONTEXT Current public health campaigns to reduce obesity and type 2 diabetes have largely focused on increasing exercise , but have paid little attention to the reduction of sedentary behaviors . OBJECTIVE To examine the relationship between various sedentary behaviors , especially prolonged television ( TV ) watching , and risk of obesity and type 2 diabetes in women . DESIGN , SETTING , AND PARTICIPANTS Prospect i ve cohort study conducted from 1992 to 1998 among women from 11 states in the Nurses ' Health Study . The obesity analysis included 50 277 women who had a body mass index ( BMI ) of less than 30 and were free from diagnosed cardiovascular disease , diabetes , or cancer and completed questions on physical activity and sedentary behaviors at baseline . The diabetes analysis included 68 497 women who at baseline were free from diagnosed diabetes mellitus , cardiovascular disease , or cancer . MAIN OUTCOME MEASURES Onset of obesity and type 2 diabetes mellitus . RESULTS During 6 years of follow-up , 3757 ( 7.5 % ) of 50 277 women who had a BMI of less than 30 in 1992 became obese ( BMI > or = 30 ) . Overall , we documented 1515 new cases of type 2 diabetes .  Time spent watching TV was positively associated with risk of obesity and type 2 diabetes . In the multivariate analyses adjusting for age , smoking , exercise levels , dietary factors , and other covariates , each 2-h/d increment in TV watching was associated with a 23 % ( 95 % confidence interval [ CI ] , 17%-30 % ) increase in obesity and a 14 % ( 95 % CI , 5%-23 % ) increase in risk of diabetes ; each 2-h/d increment in sitting at work was associated with a 5 % ( 95 % CI , 0%-10 % ) increase in obesity and a 7 % ( 95 % CI , 0%-16 % ) increase in diabetes . In contrast , st and ing or walking around at home ( 2 h/d ) was associated with a 9 % ( 95 % CI , 6%-12 % ) reduction in obesity and a 12 % ( 95 % CI , 7%-16 % ) reduction in diabetes . Each 1 hour per day of brisk walking was associated with a 24 % ( 95 % CI , 19%-29 % ) reduction in obesity and a 34 % ( 95 % CI , 27%-41 % ) reduction in diabetes . We estimated that in our cohort , 30 % ( 95 % CI , 24%-36 % ) of new cases of obesity and 43 % ( 95 % CI , 32%-52 % ) of new cases of diabetes could be prevented by adopting a relatively active lifestyle ( < 10 h/wk of TV watching and > or = 30 min/d of brisk walking ) . CONCLUSIONS Independent of exercise levels , sedentary behaviors , especially TV watching , were associated with significantly elevated risk of obesity and type 2 diabetes , whereas even light to moderate activity was associated with substantially lower risk . This study emphasizes the importance of reducing prolonged TV watching and other sedentary behaviors for preventing obesity and diabetes Background Prospect i ve studies report associations between indicators of time spent sitting and  obesity risk .  Most studies use a single indicator of sedentary behavior and are unable to clearly identify whether sedentary behavior is a cause or a consequence of obesity . Purpose To investigate cross-sectional and prospect i ve associations between multiple sitting time indicators and  obesity  and examine the possibility of reverse causality . Methods Using data from the Whitehall II cohort , multiple logistic models were fitted to examine associations between prevalent obesity ( BMI ≥30 ) at Phase 5 ( 1997–1999 ) , and incident obesity between Phases 5 and 7 ( 2003–2004 ) across four levels of five sitting exposures ( work sitting , TV viewing , non-TV leisure-time sitting , leisure-time sitting , and total sitting ) . Using obesity data from three prior phases ( 1985–1988 , 1991–1993 ; and recalled weight at age 25 years ) , linear regression models were fitted to examine the association between prior obesity and sitting time at Phase 5 . Analyses were conducted in 2012 . Results None of the sitting exposures were associated with obesity either cross-sectionally or prospect ively . Obesity at one previous measurement phase was associated with a 2.43-hour/week ( 95 % CI=0.07 , 4.78 ) increase in TV viewing ; obesity at three previous phases was associated with a 7.42-hour/week ( 95 % CI=2.7 , 12.46 ) increase in TV-viewing hours/week at Phase 5 . Conclusions Sitting time was not associated with obesity cross-sectionally or prospect ively . Prior obesity was prospect ively associated with time spent watching TV per week but not other types of sitting Background Medically treated injuries have been shown to increase with increasing body mass index ( BMI ) . Information is lacking on the frequency and type of injuries and illnesses among overweight and obese adults who engage in regular physical activities as part of weight loss or weight gain prevention programs . Methods Sedentary adults with BMI s between 25 and 40 kg/m2 ( n = 397 ) enrolled in one of two r and omized clinical trials that emphasized exercise as part of a weight loss or weight gain prevention program . Interventions differed by duration of the exercise goal ( 150 , 200 , or 300 minutes/week or control group ) . Walking was prescribed as the primary mode of exercise . At six month intervals , participants were asked , " During the past six months , did you have any injury or illness that affected your ability to exercise ? " Longitudinal models were used to assess the effects of exercise and BMI on the pattern of injuries/illnesses attributed to exercise over time ; censored linear regression was used to identify predictors of time to first injury/illness attributed to exercise . Results During the 18-month study , 46 % reported at least one injury/illness , and 32 % reported at least one injury that was attributed to exercise .  Lower-body musculoskeletal injuries ( 21 % ) were the most commonly reported injury followed by cold/flu/respiratory infections ( 18 % ) and back pain/injury ( 10 % ) . Knee injuries comprised one-third of the lower-body musculoskeletal injuries . Only 7 % of the injuries were attributed to exercise alone , and 59 % of the injuries did not involve exercise . BMI ( p ≤ 0.01 ) but not exercise ( p ≥ 0.41 ) was significantly associated with time to first injury and injuries over time . Participants with higher BMI s were injured earlier or had increased odds of injury over time than participants with lower BMI s. Due to the linear dose-response relationship between BMI and injury/illness , any weight loss and reduction in BMI was associated with a decrease risk of injury/illness and delay in time to injury/illness . Conclusions Overweight and obese adults who were prescribed exercise as part of weight loss or weight gain prevention intervention were not at increased risk of injury compared to overweight adults r and omized not to participate in prescribed exercise . Since onset of injury/illness and pattern of injuries over time in overweight and obese individuals were attributed to BMI , weight reduction may be an avenue to reduce the risk of injury/illness in sedentary and previously sedentary overweight and obese adults . Trial Registration Clinical trials.gov NCT00177502 and OBJECTIVE The primary goal was to evaluate sex differences in child weight control programs that targeted increasing physical activity ( increase ) or the combination of reducing sedentary behavior and increasing physical activity ( combined ) . A second goal was to evaluate the benefits of family-based interventions on nontargeted siblings . RESEARCH METHODS AND PROCEDURES Sixty-seven families with obese children and 89 siblings were r and omized to interventions that targeted increasing physical activity ( increase ) or the combination of reducing sedentary behavior and increasing physical activity ( combined ) . Targeted participants and nontargeted siblings were followed for 1 year . RESULTS At 12 months , boys showed significantly better percentages of overweight changes ( -15.8 % ) for the combined treatment than girls ( -1.0 % ) , with no significant differences for the increase intervention for boys ( -9.3 % ) or girls ( -7.6 % ) . Boys adhered to treatment better than girls ( p < 0.01 ) . Adherence and predilection for physical activity were significant predictors of targeted child weight loss at 1 year in multiple regression analysis . Predictors of sibling weight loss included age , number of siblings , targeted child percentage of overweight change , and the interaction of group assignment by same sex of treated sibling . DISCUSSION Gender may influence response to programs that attempt to decrease sedentary behavior , and generalization of treatment effects to siblings may depend on the intervention and characteristics of the siblings Review question / objective What are the effects of weight management interventions that include a diet component on weight‐related outcomes in pregnant and postpartum women ? The primary objective of this systematic review is to evaluate the effectiveness of weight management interventions which include a diet component and are aim ed at limiting gestational weight gain and postpartum weight retention in women . The second objective of this systematic review is to investigate included intervention components with respect to effect on weight‐related outcomes . This may include , but is not limited to : length of intervention , use of face‐to‐face counselling , group or individual consultations , use of other interventions components including exercise , use of goals and use of support tools like food diaries , coaching , including email or text message support . Background Around half of all women of reproductive age are either overweight or obese,1,2,3 with women aged 25‐34 years having a greater risk of substantial weight gain compared with men of all ages.1,4 Excessive gestational weight gain ( GWG ) and postpartum weight retention ( PPWR ) may play a significant role in long term obesity . Having one child doubles the five‐ and 10‐year obesity incidence for women , with many women who gain excessive weight during pregnancy remaining obese permanently.5 Excessive GWG and /or PPWR can also significantly contribute to short‐ and long‐term adverse health outcomes for mother , baby and future pregnancies.6,7 Maternal obesity increases the risk of pregnancy related complications such as pre‐eclampsia , gestational diabetes mellitus , stillbirth and the rate of caesarean section.8 Childhood obesity is a further long term complication of maternal obesity for offspring , which may persist in to adulthood.9 Excess GWG is also a risk factor for PPWR both in the short and long‐term.10,11 Nehring et al. conducted a meta‐ analysis with over 65,000 women showing that , compared to women who gained weight within recommendations during pregnancy , women with GWG above Institute of Medicine weight gain recommendations , 12 retained an additional 3.1 kg and 4.7 kg after three and greater than or equal to 15 years postpartum , respectively.13 The health risk associated with PPWR is highlighted in a study of 151,025 Swedish women followed between 1992 and 2001.The study identified the risk of adverse pregnancy outcomes for those who gained three or more units of Body Mass Index ( kg/m2 ) between consecutive pregnancies ( an average of two years ) was much higher compared with women whose BMI changed from ‐1.0 and 0.9 units.14 Long‐term chronic disease risk may also be affected by PPWR as weight retention at the end of the first year post‐partum has been found to be a predictor of maternal overweight 15 years later.15With around 14‐20 % of women retaining 5 kg or more 12 months postpartum,16,5 the risk of developing conditions like diabetes , metabolic syndrome and cardiovascular disease may be increased.17 It becomes evident that interventions which aim to support attainment of healthy weight both in the antenatal and postpartum periods are key health priorities for women during this life stage . Lifestyle factors of overweight , having poor diet quality , and not undertaking enough moderate‐to‐vigorous physical activity are amongst the top five predictors of mortality in women.18 Additionally it is noted that , for many women , pregnancy and the postpartum period are associated with a reduction in physical activity.19 It is known that a combination of poor dietary choices , an increase in sedentary time and reduction in physical activity are all contributors to the development of overweight and obesity . With this in mind , current research has focused on lifestyle interventions to limit GWG and PPWR . Thangaratinam et al. review ed 44 r and omized controlled trials ( 7278 women ) where interventions including diet , physical activity or both were evaluated for their influence on maternal weight during  pregnancy.20 Results indicate that all were significantly effective in reducing GWG compared with the control group . More specifically , dietary interventions were the most effective in reducing weight gain , with a mean weight loss of ‐3.84 kg compared with ‐0.72 kg and ‐1.06 kg for physical activity and the mixed ( diet plus physical activity ) approach , respectively.20 This finding is supported by Hill and colleagues ' recent systematic review of theory based interventions to limit GWG.21 Included studies in this review reported an underpinning theory base and were classified as adopting a dietary , physical activity or mixed approach . Hill et al. concluded that studies which included a diet intervention were significantly more effective at limiting GWG.21 In 2011 Tanentsapf et al. review ed the effect of dietary interventions alone for reducing GWG in normal weight , overweight and obese pregnant women.22 This review analysed 13 r and omized controlled trials and quasi‐r and omized controlled trials with a dietary intervention to prevent excessive GWG in women . The review concluded that dietary interventions during pregnancy were effective in reducing GWG with an effect of ‐1.92 kg ( n=1434 ) compared with the control group.22 Tanentsapf et al. identified that trials differed in the conduct of the interventions with various diet and non‐diet related components utilised . Dietary approaches were highly variable with some trials focusing only on calorie restriction and others included additional target macronutrient distribution for intake . Some trials further provided feedback based on maternal weight gain guidelines .12 Interventions also varied in delivery method with a variety of modes used , including face‐to‐face , individual or group consultations and /or written correspondence . The frequency of communication , despite the type or mix , also changed from trial to trial with additional methods via telephone , posted material s , feedback or food diaries utilised . The inclusion of physical activity in addition to diet intervention was also common . Whilst the recent review by Tanentsapf et al.22 identified that dietary interventions are effective in reducing GWG , the review did not investigate the impact that different intervention components , delivery methods or dietary counselling approaches had on gestational weight management . It remains unclear as to which intervention components optimize GWG in women . The impact of lifestyle interventions has also been investigated in the postpartum period . The recent systematic review from van der Pligt et al. reported seven of 11 studies review ed were successful in limiting PPWR.23 As with studies aim ed at limiting GWG , interventions included in van der Pligt et al. 's review differed greatly in their conduct . Six of these seven studies included both dietary and physical activity components for the intervention , with the final successful study including a diet only intervention . Five of the successful studies recruited overweight or obese women only . Intervention time varied considerably in successful studies with some running for as little at ten days , and others up to six months . Bertz et al. demonstrated that their 12‐week behavior modification intervention which targeted diet alone or diet and exercise , including two individual sessions with a dietitian and physical therapist , provision of scales for weight self‐monitoring and bi‐weekly text messages was successful in achieving significant weight loss following the intervention , and sustained at one year.24 The diet intervention and the diet and exercise intervention  yielded significant weight loss compared to the control . Following 12 weeks a reduction of ‐8.3 + /‐ 4.2 kg for diet intervention and ‐6.9 + /‐ 3.0 kg for diet and exercise was observed . Additionally after one year , the diet intervention showed ‐10.2 + /‐ 5.7 kg reduction and ‐7.3 + /‐ 6.3 kg for the diet and exercise intervention (p<0.001).24 Colleran et al. also found significant weight change results by implementing a 16‐week intervention which consisted of weekly individual sessions with a dietitian regarding calorie restriction , two additional home visits regarding exercise , weekly food diary completion and email support.25 The intervention group had greater weight loss compared to the control group ( ‐5.8 kg + /‐ 3.5 kg vs ‐1.6 kg + /‐ 5.4 kg ) . It can be seen that various methods have been utilized in investigating the impact of diet and physical activity interventions on PPWR . The review by van der Pligt et al.23 highlights the impact successful lifestyle interventions can have on postpartum weight change . However , this review did not investigate the different intervention strategies utilized . It remains unclear as to the optimal setting , delivery method , diet strategy , contact frequency or intervention length to limit PPWR . Previous systematic review s for both GWG and PPWR have focused on the effectiveness of lifestyle interventions as a whole for weight management in pregnant and postpartum women.20,23 And despite Tanentsapf et al. 's focus on dietary interventions for GWG,22 much is still unknown about the effectiveness of differing diet interventions over the antenatal and postpartum period . Specifically , the impact of differing diet intervention strategies on maternal weight gain is not known . Firstly , this systematic review will focus on whether  weight management interventions which include a dietary component  are effective in pregnant and postpartum women . In addition to this , this review will investigate the different intervention strategies utilized and their effectiveness in maternal weight management . A search of systematic review protocol data bases has shown that there is no current review underway for this topic Background Current obesity interventions use intensive behavior changes to achieve large initial weight loss . However , weight regain after treatment is common , and drop out rates are relatively high . Smaller behavioral changes could produce initial weight loss and be easier to sustain after active treatment . Purpose We examined the efficacy of an intervention that targeted small but cumulative participant-chosen changes in diet and physical activity (  ASPIRE ) and compared this treatment to st and ard didactic and wait-list control groups . The primary outcome measures were body weight , waist circumference , and intra-abdominal fat . Methods Fifty-nine overweight or obese sedentary adults were r and omized to one of three groups : ( 1 ) the ASPIRE group ( n = 20 ) , ( 2 ) a st and ard educationally-based treatment group ( n = 20 ) , or ( 3 ) a wait list control group ( n = 19 ) for 4 months . Active treatment groups received identical resistance and aerobic training programs . Results Intention-to-treat analyses showed that participants in the ASPIRE group lost significantly more weight than the st and ard and control groups ( −4.4 vs. −1.1 and + 0.1 kg , respectively ) , and the greater initial weight loss in the ASPIRE group was sustained 3 months after active treatment ( 4.1 kg ) . An alternative analytic strategy ( 0.3 kg/month weight gain for those lost to follow-up ) showed continued weight loss ( −0.2 kg after active treatment ; −4.6 kg from baseline ) at follow-up in the ASPIRE group . Similar patterns were observed for the other adiposity measures . Conclusion More modest behavioral changes are capable of promoting weight loss , decreasing adiposity markers and sustaining these changes over 3 months . Longer-term studies comparing this approach with traditional behavioral weight loss treatments are warranted Osteoarthritis ( OA ) of the knee leads to restrictions of physical activity and ability to perform activities of daily living . Obesity is a risk factor for knee OA and it appears to exacerbate knee pain and disability . The Arthritis , Diet , and Activity Promotion Trial ( ADAPT ) was developed to test the efficacy of lifestyle behavioral changes on physical function , pain , and disability in obese , sedentary older adults with knee OA . This controlled trial r and omized 316 sedentary overweight and obese older adults in a two-by-two factorial design into one of four 18-month duration intervention groups : Healthy Lifestyle Control ; Dietary Weight Loss ; Structured Exercise ; or Combined Exercise and Dietary Weight Loss . The weight-loss goal for the diet groups was a 5 % loss at 18 months . The intervention was modeled from principles derived from the group dynamics literature and social cognitive theory . Exercise training consisted of aerobic and strength training for 60 minutes , three times per week in a group and home-based setting . The primary outcome measure was self-report of physical function using the Western Ontario and McMaster University Osteoarthritis Index . Other measurements included timed stair climb , distance walked in 6 minutes , strength , gait , knee pain , health-related quality of life , knee radiographs , body weight , dietary intake , and cost-effectiveness of the interventions . We report baseline data stratified by level of overweight and obesity focusing on self-reported physical function and physical performance tasks . The results from ADAPT will provide approaches clinicians should recommend for behavioral therapies that effectively reduce the incidence of disability associated with knee OA
Conclusions Meta- analysis of data from prospect i ve cohort studies showed small , inconsistent and non-significant associations between sedentary behavior and body weight
Background The cumulative effect of too much sedentary behavior may contribute to  weight gain and obesity .
Objective The aim of this study was to conduct a systematic review and meta- analysis of prospect i ve cohorts and r and omized controlled studies to determine the association between sedentary  behavior  and body weight and obesity in adults .