A randomized controlled trial to evaluate self-determination theory for exercise adherence and weight control: rationale and intervention description Effectiveness of parent‐centred interventions for the prevention and treatment of childhood overweight and obesity in community settings: a systematic review Exercise autonomous motivation predicts 3-yr weight loss in women. Kids and adults now! Defeat Obesity (KAN-DO): rationale, design and baseline characteristics. Treatment of pediatric obesity using a parent-only approach: a case example. The effect of weight management interventions that include a diet component on weight‐related outcomes in pregnant and postpartum women: a systematic review protocol Exploring the mechanisms of weight loss in the SHED-IT intervention for overweight men: a mediation analysis The Arthritis, Diet and Activity Promotion Trial (ADAPT): design, rationale, and baseline results. Weight Loss and Self-Regulatory Eating Efficacy in Older Adults: The Cooperative Lifestyle Intervention Program Translating weight loss and physical activity programs into the community to preserve mobility in older, obese adults in poor cardiovascular health. Processes of behavior change and weight loss in a theory-based weight loss intervention program: a test of the process model for lifestyle behavior change Mediators of weight loss and weight loss maintenance in middle-aged women. Temporal Aspects of Psychosocial Predictors of Increased Fruit and Vegetable Intake in Adults with Severe Obesity: Mediation by Physical Activity Study protocol: evaluation of ‘JenMe’, a commercially-delivered weight management program for adolescents: a randomised controlled trial Practical Lessons Learned from Adolescent and Parent Experiences Immediately and 12 Months following a Family-Based Healthy Lifestyle Intervention. The effect of family-based multidisciplinary cognitive behavioral treatment in children with obesity: study protocol for a randomized controlled trial Exercise, self-efficacy, and mobility performance in overweight and obese older adults with knee osteoarthritis. Mediators of weight loss in the 'Healthy Dads, Healthy Kids' pilot study for overweight fathers The Extension Family Lifestyle Intervention Project (E-FLIP for Kids): design and methods. Systematic review of interventions in the management of overweight and obese children which include a dietary component Systematic review of interventions in the management of overweight and obese children which include a dietary component. The Nutrition and Enjoyable Activity for Teen Girls (NEAT girls) randomized controlled trial for adolescent girls from disadvantaged secondary schools: rationale, study protocol, and baseline results Motivational "spill-over" during weight control: increased self-determination and exercise intrinsic motivation predict eating self-regulation. A community based prevention of weight gain intervention (Mothers In Motion) among young low-income overweight and obese mothers: design and rationale A randomized trial of a lifestyle intervention in obese endometrial cancer survivors: quality of life outcomes and mediators of behavior change Examining the Behavioral Processes through which Lifestyle Interventions Promote Weight Loss: Results from the PREMIER Trial Evaluating clinic and community-based lifestyle interventions for obesity reduction in a low-income Latino neighborhood: Vivamos Activos Fair Oaks Program Long-term effects of an inpatient weight-loss program in obese children and the role of genetic predisposition-rationale and design of the LOGIC-trial Behavioral Mediators of Treatment Effects in the Weight Loss Maintenance Trial Relationship of Exercise Program Participation with Weight Loss in Adults with Severe Obesity: Assessing Psychologically Based Mediators "MOVE!" Outcomes of a weight loss program modified for veterans with serious mental illness. Methods and baseline characteristics of a randomized trial treating early childhood obesity: the Positive Lifestyles for Active Youngsters (Team PLAY) trial.
Background Research on the motivational model proposed by Self-Determination Theory ( SDT ) provides theoretically sound insights into reasons why people adopt and maintain exercise and other health behaviors , and allows for a meaningful analysis of the motivational processes involved in behavioral self-regulation . Although obesity is notoriously difficult to reverse and its recidivism is high , adopting and maintaining a physically active lifestyle is arguably the most effective strategy to counteract it in the long-term . The purpose s of this study are twofold : i ) to describe a 3-year r and omized controlled trial ( RCT ) aim ed at testing a novel obesity treatment program based on SDT , and ii ) to present the rationale behind SDT 's utility in facilitating and explaining health behavior change , especially physical activity/exercise , during obesity treatment . Methods Study design , recruitment , inclusion criteria , measurements , and a detailed description of the intervention ( general format , goals for the participants , intervention curriculum , and main SDT strategies ) are presented . The intervention consists of a 1-year group behavioral program  for overweight and moderately obese women , aged 25 to 50 ( and pre-menopausal ) , recruited from the community at large through media advertisement . Participants in the intervention group meet weekly or bi-weekly with a multidisciplinary intervention team ( 30 2 h sessions in total ) , and go through a program covering most topics considered critical for successful  weight control .  These topics and especially their delivery were adapted to comply with SDT and Motivational Interviewing guidelines . Comparison group receive a general health education curriculum . After the program , all subjects are follow-up for a period of 2 years . Discussion Results from this RCT will contribute to a better underst and ing of how motivational characteristics , particularly those related to physical activity/exercise behavioral self-regulation , influence treatment success , while exploring the utility of Self-Determination Theory for promoting health behavior change in the context of obesity . Trial Registration Clinical Trials Gov. Identifier 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 PURPOSE This study evaluated exercise-related predictors of  successful long-term weight control in women by analyzing the extent to which sustained exercise participation and self-determination theory (SDT)-based exercise motivation variables mediated the impact of a behavioral weight control intervention on 3-yr weight change . METHODS Longitudinal r and omized controlled trial consisting of a 1-yr SDT-based intervention and a 2-yr follow-up with 221 female participants ( means ± SD : age = 37.6 ± 7 yr , body mass index = 31.6 ± 4.1 kg·m(-2 ) ) . The tested model incorporated experimentally manipulated perceived need support , motivational regulations , and 2-yr exercise adherence as mediators of the intervention 's impact on 3-yr weight change . Paths were tested using partial least squares analysis . Where there were significant intervening paths , tests of mediation were conducted . RESULTS Treatment had significant effects on 1- and 2-yr autonomous regulations , 2-yr physical activity , and 3-yr weight change , fully mediated by the tested paths ( effect ratio = 0.10 - 0.61 ) . Moderate and vigorous exercise at 2 yr had a significant effect ( P < 0.001 ) on weight loss success at 3 yr and partially mediated the effect of treatment on weight change . The 2-yr autonomous regulation effects on follow-up weight change were only partially mediated by physical activity ( effect ratio = 0.42 ) . CONCLUSIONS This application of SDT to physical activity and weight management showed that not all types of motivation predict long-term behavioral outcomes and that sustained moderate and vigorous exercise mediated long-term weight change . It provides strong evidence for a link between experimentally increased autonomous motivation and exercise and long-term weight loss maintenance . Results highlight the importance of interventions targeting the internalization of exercise behavioral regulation and making exercise and physical activity positive and meaningful experiences rather than simply focusing on immediate behavior change in overweight/obese women BACKGROUND Prevention of childhood obesity is a public health priority . Parents influence a child 's weight by modeling healthy behaviors , controlling food availability and activity opportunities , and appropriate feeding practice s. Thus interventions should target education and behavioral change in the parent , and positive , mutually reinforcing behaviors within the family . METHODS This paper presents the design , rationale and baseline characteristics of Kids and Adults Now ! - Defeat Obesity ( KAN-DO ) , a r and omized controlled behavioral intervention trial targeting weight maintenance in children of healthy weight , and weight reduction in overweight children . 400 children aged 2 - 5 and their overweight or obese mothers in the Triangle and Triad regions of North Carolina are r and omized equally to control or the KAN-DO intervention , consisting of mailed family kits encouraging healthy lifestyle change . Eight ( monthly ) kits are supported by motivational counseling calls and a single group session . Mothers are targeted during a hypothesized " teachable moment " for health behavior change ( the birth of a new baby ) , and intervention content addresses : parenting skills ( ( e.g. , emotional regulation , authoritative parenting ) , healthy eating , and physical activity . RESULTS The 400 mother-child dyads r and omized to trial are 75 % white and 22 % black ; 19 % have a household income of $ 30,000 or below . At baseline , 15 % of children are overweight ( 85th-95th percentile for body mass index ) and 9 % are obese ( ≥ 95th percentile ) . CONCLUSION This intervention addresses childhood obesity prevention by using a family-based , synergistic approach , targeting at-risk children and their mothers during key transitional periods , and enhancing maternal self-regulation and responsive parenting as a foundation for health behavior change OBJECTIVE There is a great need for solution-oriented studies and descriptions of interventions for pediatric obesity in real-world setting s. This report describes a group-based behavioral parent-only intervention to promote healthier lifestyle habits and reduce weight status in an obese 12-year-old female participant . METHOD The behavioral parent-only intervention program described was part of a r and omized controlled trial that evaluated the impact of 2 behavioral interventions that addressed dietary intake , physical activity , and weight status in overweight and obese youth living in rural setting s. Both the child and parent were targeted for behavior change . The intervention included 12 group sessions over 4 months . Behavioral strategies , including self-monitoring , goal setting , performance feedback , reinforcement , stimulus control , and instruction in behavioral parenting strategies were flexibly applied to meet the needs of the family . Assessment s were completed at baseline , month-4 posttreatment , and month-10 follow-up . RESULTS The parent attended 10 of 12 treatment sessions . At follow-up the child had lost 17 pounds and grew 1.7 in . in height . The child also experienced improved quality of dietary intake and a drop in the number of self-reported unhealthy weight control behaviors . The parent experienced no notable decrease or increase in BMI . CONCLUSIONS The report describes the successful application of a behavioral intervention to address pediatric obesity that uses a parent-only approach . It is hoped that this presentation will facilitate discussion and help encourage further presentations of how the flexible application of evidence d-based interventions can be applied in real-world setting 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 Statistical mediation analysis can be used to improve the design of obesity prevention and treatment programs by identifying the possible mechanisms through which an intervention achieved its effects . The aim of this study was to identify mediators of weight loss in an Internet-based weight-loss program specifically design ed for overweight men . Methods The Self-Help , Exercise and Diet using Information Technology ( SHED-IT ) program was a 3-month r and omized controlled trial ( Internet-based intervention group vs information only control group ) that was implemented in 2007 with baseline and 6-month follow-up assessment of weight , physical activity and dietary behaviors . Intention-to-treat and per- protocol mediation analyses were conducted using a product-of-coefficients test . Results Participants ( N = 65 ) were overweight and obese male academic ( n = 10 ) and non-academic ( n = 27 ) staff and students ( n = 28 ) from the University of Newcastle , Australia . Mean ( SD ) age = 35.9 ( 11.1 ) years and mean ( SD ) BMI = 30.6 ( 2.8 ) . In the intention-to-treat analysis , both groups lost weight , but relative to the control group , the intervention did not have a statistically significant ' total effect ' on weight , τ = -.507 , p = .716 ( 95 % CI = -3.277 to 2.263 ) . In the per- protocol analysis , the intervention had a statistically significant ' total effect ' on weight , τ = -4.487 , p < .05 ( 95 % CI = -8.208 to -.765 ) . The intervention did not have a statistically significant effect on any of the hypothesized mediators and none of the behavioral variables mediated weight loss in the SHED-IT program . Although participants in the intervention group reduced their fat intake over the study period , the changes did not satisfy the criteria for mediation . Conclusion Few studies have examined the mediators of weight loss in obesity treatment interventions . While none of the hypothesized mediators satisfied the criteria for mediation in the current study , there was some evidence to suggest that overweight men in the SHED-IT intervention reduced their fat intake over the study period . Future obesity treatment and prevention programs should explore behavioral mediators of weight loss using appropriate statistical methods .Trial Registration Australian New Zeal and Clinical Trials Registry No : ANZCTRN12607000481471 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 Objectives . Using the weight efficacy lifestyle question naire ( WEL ) , we examined whether a group-mediated intervention for weight loss among older , obese adults result ed in changes in self-regulatory self-efficacy for eating behavior and whether these changes mediated weight loss . Methods . This was a r and omized controlled design , and 288 older adults received 1 of 3 treatments for 6 months : physical activity only ( PA ) , weight loss + physical activity ( WL + PA ) , or a successful aging ( SA ) health education program . The WEL was administered prior to r and omization and again at the 6-month follow-up visit . Results . A significant treatment effect was observed for the WEL , F ( 2,249 ) = 15.11 , p < .0001 , partial eta2 = .11 , showing that improvement occurred only in the WL + PA group as compared with PA and SA . Changes in WEL scores partially mediated the effects of the WL + PA intervention on weight loss . Discussion . These results illustrate that WL + PA can be effective in improving  older adults ’ self-efficacy for the self-regulation of eating behavior and that these changes are prospect ively related to the amount of weight loss . Further research is warranted on an exp and ed concept of self-efficacy as well as controlled experimental studies on eating behavior in older adults BACKGROUND Limitations in mobility are common among older adults with cardiovascular and cardiometabolic disorders and have profound effects on health and well-being . With the growing population of older adults in the United States , effective and scalable public health approaches are needed to address this problem . Our goal was to determine the effects of a physical activity and weight loss intervention on 18-month change in mobility among overweight or obese older adults in poor cardiovascular health . METHODS The study design was a translational , r and omized controlled trial of physical activity ( PA ) and weight loss ( WL ) on mobility in overweight or obese older adults with cardiovascular disease ( CVD ) or at risk for CVD . The study was conducted within the community infrastructure of Cooperative Extension Centers . Participants were r and omized to 1 of 3 interventions : PA , WL + PA , or a successful aging ( SA ) education control arm . The primary outcome was time to complete a 400-m walk in seconds ( 400MWT ) . RESULTS A significant treatment effect ( P = .002 ) and follow-up testing revealed that the WL + PA group improved their 400MWT ( adjusted mean [ SE ] , 323.3 [ 3.7 ] seconds ) compared with both PA ( 336.3 [ 3.9 ] seconds ; P = .02 ) and SA ( 341.3 [ 3.9 ] seconds ; P < .001 ) . Participants with poorer mobility at baseline benefited the most ( P < .001 ) . CONCLUSION Existing community infrastructures can be effective in delivering lifestyle interventions to enhance mobility in older adults in poor cardiovascular health with deficits in mobility ; attention should be given to intervening on both weight and sedentary behavior since weight loss is critical to long-term improvement in mobility . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00119795 Background Process evaluation is important for improving theories of behavior change and behavioral intervention methods . The present study reports on the process outcomes of a pilot test of the theoretical model ( the Process Model for Lifestyle Behavior Change ; PMLBC ) underpinning an evidence -informed , theory-driven , group-based intervention design ed to promote healthy eating and physical activity for people with high cardiovascular risk . Methods 108 people at high risk of diabetes or heart disease were r and omized to a group-based weight management intervention targeting diet and physical activity plus usual care , or to usual care . The intervention comprised nine group based sessions design ed to promote motivation , social support , self-regulation and underst and ing of the behavior change process . Weight loss , diet , physical activity and theoretically defined mediators of change were measured pre-intervention , and after four and 12 months . Results The intervention result ed in significant improvements in fiber intake ( M between-group difference = 5.7 g/day , p < .001 ) but not fat consumption ( −2.3 g/day , p = 0.13 ) , that were predictive of weight loss at both four months ( M between-group difference = −1.98 kg , p < .01 ; R2 = 0.2 , p < 0.005 ) , and 12 months ( M difference = −1.85 kg , p = 0.1 ; R2 = 0.1 , p < 0.01 ) . The intervention was successful in improving the majority of specified mediators of behavior change , and the predicted mechanisms of change specified in the PMBLC were largely supported . Improvements in self-efficacy and underst and ing of the behavior change process were associated with engagement in coping planning and self-monitoring activities , and successful dietary change at four and 12 months . While participants reported improvements in motivational and social support variables , there was no effect of these , or of the intervention overall , on physical activity . Conclusions The data broadly support the theoretical model for supporting some dietary changes , but not for physical activity . Systematic intervention design allowed us to identify where improvements to the intervention may be implemented to promote change in all proposed mediators . More work is needed to explore effective mechanisms within interventions to promote physical activity behavior Long-term behavioral self-regulation is the hallmark of successful weight control . We tested mediators of weight loss and weight loss maintenance in middle-aged women who participated in a r and omized controlled 12-month weight management intervention . Overweight and obese women ( N = 225 , BMI = 31.3 + /- 4.1 kg/m(2 ) ) were r and omly assigned to a control or a 1-year group intervention design ed to promote autonomous self-regulation of body weight . Key exercise , eating behavior , and body image variables were assessed before and after the program , and tested as mediators of weight loss ( 12 months , 86 % retention ) and weight loss maintenance ( 24 months , 81 % retention ) . Multiple mediation was employed and an intention-to-treat analysis conducted . Treatment effects were observed for all putative mediators ( Effect size : 0.32 - 0.79 , P < 0.01 vs. controls ) . Weight change was -7.3 + /- 5.9 % ( 12-month ) and -5.5 + /- 5.0 % ( 24-month ) in the intervention group and -1.7 + /- 5.0 % and -2.2 + /- 7.5 % in controls . Change in most psychosocial variables was associated with 12-month weight change , but only flexible cognitive restraint ( P < 0.01 ) , disinhibition ( P < 0.05 ) , exercise self-efficacy ( P < 0.001 ) , exercise intrinsic motivation ( P < 0.01 ) , and body dissatisfaction ( P < 0.05 ) predicted 24-month weight change . Lower emotional eating , increased flexible cognitive restraint , and fewer exercise barriers mediated 12-month weight loss ( R(2 ) = 0.31 , P < 0.001 ; effect ratio : 0.37 ) , but only flexible restraint and exercise self-efficacy mediated 24-month weight loss ( R(2 ) = 0.17 , P < 0.001 ; effect ratio : 0.89 ) . This is the first study to evaluate self-regulation mediators of weight loss and 2-year weight loss maintenance , in a large sample of overweight women . Results show that lowering emotional eating and adopting a flexible dietary restraint pattern are critical for sustained weight loss . For long-term success , interventions must also be effective in promoting exercise intrinsic motivation and self-efficacy Effective and reliable obesity treatments are lacking because of a poor underst and ing of the health behavior change process . Community-based organizations with the capacity to train existing staff members are particularly well-positioned to implement evidence -based treatment protocol s to impact obesity-related behaviors such as unhealthy eating and lack of physical activity . The aim of this study was to assess temporal aspects of psychosocial predictors ( self-regulation , mood , and self-efficacy ) on increased fruit and vegetable intake in adults with severe obesity , while also accounting for mediation by physical activity volume . A 6-month , r and omized field investigation was conducted . Severely obese adults volunteered for behavioral support of physical activity coupled with nutrition education ( n = 73 ) or cognitive-behavioral methods for nutrition change ( n = 71 ) . Improvements in self-regulation , mood , self-efficacy , fruit and vegetable intake ( FV ) , and physical activity ( PA ) were significant , with significantly greater self-regulation at month 6 for the cognitive-behavioral group . Increase in FV was predicted by changes in the above psychosocial variables over 6 months , with mood change over 3 months also a significant predictor . Change in PA mediated the above relationships , with a reciprocal effect between changes in PA and FV . Findings have implication s for the large-scale behavioral treatment of obesity Background Early lifestyle intervention with overweight and obese adolescents could help to avoid serious health events in early adulthood , ultimately alleviating some of the strain on the public health system due to obesity-related morbidity . Commercial weight loss programs have wide reach into the community setting , and have demonstrated success in long term weight management in adults , beyond that of current public health care . Commercial weight-management programs have not been evaluated as a method of delivery for overweight and obese adolescents . This study aims to evaluate the efficacy of a new adolescent weight management program in a commercial environment . Methods One hundred and forty adolescents , 13 to 17 years old , will be r and omised to either a weight management program intervention or a wait-listed group for 12 weeks . The commercial program will consist of a combined dietary and lifestyle approach targeting improved health behaviours for weight-loss or weight-stability . Participants will be overweight or obese ( above the 85th percentile for BMI ) and without existing co-morbidities . Outcome measures will be assessed at baseline and after 12 weeks . Primary outcome measures will be changes in BMI Z-score and waist-height ratio . Secondary outcome measures will include changes in behaviour , physical activity and psychosocial wellbeing . Intervention participants will be followed up at 6 months following completion of the initial program . Ethics approval has been granted from the Monash University Human Research Ethics Committee ( CF11/3687–2011001940 ) . Discussion This independent evaluation of a weight management program for adolescents , delivered in a commercial setting , will provide initial evidence for the effectiveness of such programs ; which may offer adolescents an avenue of weight-management with ongoing support prior to the development of obesity related co-morbidities . Trial registration The protocol for this study is registered with the International Clinical Trials Registry IS RCT N13602313 BACKGROUND Adolescence is a critical time to intervene and establish healthy long-term behaviors to decrease the impact of adult obesity in the future . The purpose of this study was to identify key intervention strategies and techniques for community interventions by analyzing the short-term and longer-term shared experiences of both adolescents with overweight or obesity and their parents involved in a community-based , healthy lifestyle intervention .  METHODS Qualitative interviews and focus groups were conducted with teens ( aged 12 - 16 years with a BMI above the 85th percentile ) and their parents immediately following the 8-week intervention ( n = 37 teens , n = 33 parents ) and at 12 months follow-up ( n = 23 teens , n = 20 parents ) . Results were analyzed thematically . RESULTS Both teens and parents reported high satisfaction with the program . Immediately following the 8-week intervention , teens reported enjoying participating in exercise with similar peers . Parents described inaccurate expectations from the program . After the 12-month follow-up , teens reported struggling with a cyclical pattern of health behaviors , and parents described a sense of loss following the intensive program and improved communication skills with their adolescent . CONCLUSIONS Several practical strategies emerged for use in future community programs for adolescents with overweight or obesity . Future programs should consider management of expectations , perceptions vs. outcomes , and the cyclical nature of behavior change in adolescents . Strategies for future health behavior change interventions with overweight adolescents should address time management , translation of knowledge into behavior change , successful implementation of practical goal - setting strategies , and increasing intrinsic motivation Background The prevalence of childhood obesity has increased rapidly during the last three decades in the Netherl and s. It is assumed that mainly environmental factors have contributed to this trend . Parental overweight and low social economic status are risk factors for childhood obesity . Childhood obesity affects self-esteem and has negative consequences on cognitive and social development . Obese children tend to become obese adults , which increases the risk for developing cardiovascular complications , type 2 diabetes mellitus , and psychosocial problems . Additionally , the secretion of several gastrointestinal hormones , responsible for appetite and food intake , is impaired in obese subjects . Weight reduction through lifestyle changes in order to change health risks is , until now , suggested as the preferred treatment for childhood obesity . The objective of this study is the effect evaluation of a family-based cognitive behavioral multidisciplinary lifestyle treatment . The intervention aims to establish long-term weight reduction and stabilization , reduction of obesity-related health consequences and improvement of self-image by change of lifestyle and learning cognitive behavioral techniques . Study design / Methods In this r and omized clinical trial newly presented children with obesity ( 8 - 17 years old ) are divided , by r and omization , in an intervention and  control  group , both consisting of 40 obese children . The intervention is carried out in groups of 8 - 11 children , and consists of respectively 7 and 5 separate group meetings for the children and their parents and 1 joint group meeting of 2 ½ hours . Main topics are education on nutrition , self-control techniques , social skills , physical activity and improvement of self-esteem . The control group is given advice on physical activity and nutrition . For normal data comparison , data were collected of 40 normal-weight children , 8 - 17 years old . Discussion Because of the increasing prevalence of childhood obesity and the impact on the individual as well as on society , prevention and treatment of obesity in children is of great importance . For evaluation of short- and long-term effects of the treatment , measurements are taken before and after 3 months of treatment , and after 12 and 24 months follow-up . During these visits clinical and biochemical data are determined , cardiovascular fitness tests are performed and quality of life question naires are completed . Trial registration International St and ard R and omised Controlled Trial Number Register IS RCT OBJECTIVE To examine changes in mobility-related self efficacy following exercise and dietary weight loss interventions in overweight and obese older adults with knee osteoarthritis ( OA ) , and to determine if self efficacy and pain mediate the effects of the interventions on mobility task performance . METHODS The Arthritis , Diet , and Activity Promotion Trial was an 18-month , single-blind , r and omized , controlled trial comparing the effects of exercise alone , dietary weight loss alone , a combination of exercise plus dietary weight loss , and a healthy lifestyle control intervention in the treatment of 316 overweight or obese older adults with symptomatic knee OA . Participants completed measures of stair-climb time and 6-minute walk distance , self efficacy for completing each mobility task , and self-reported pain at baseline , 6 months , and 18 months during the trial . RESULTS Mixed model analyses of covariance of baseline adjusted change in the outcomes demonstrated that the exercise + dietary weight loss intervention produced greater improvements in mobility-related self efficacy ( P = 0.0035 ) , stair climb ( P = 0.0249 ) and 6-minute walk performance ( P = 0.00031 ) , and pain ( P = 0.09 ) when compared with the healthy lifestyle control intervention . Mediation analyses revealed that self efficacy and pain served as partial mediators of the beneficial effect of exercise + dietary weight loss on stair-climb time . CONCLUSION Exercise + dietary weight loss results in improved mobility-related self efficacy ; changes in these task-specific control beliefs and self-reported pain serve as independent partial mediators of the beneficial effect of exercise + dietary weight loss on stair-climb performance Background A poor underst and ing of the specific lifestyle behaviors that result in weight loss has hindered the development of effective interventions . The aim of this paper was to identify potential behavioral mediators of weight loss in the Healthy Dads , Healthy Kids ( HDHK ) intervention  for overweight fathers . Findings The three-month intervention was evaluated in a r and omized controlled trial and conducted in Newcastle , New South Wales , Australia . Baseline , three month ( immediate post-intervention ) and six month assessment s were conducted . Recruitment and follow-up occurred between October 2008 and May 2009 . The study sample included 53 overweight/obese men [ mean ( SD ) age=40.6 ( 97.1 ) years ; body mass index ( BMI ) = 33.2 ( 3.9 ) kgm-2 ] and their primary school-aged children [ n=71 , 54 % boys ; age=8.2 ( 2.0 ) years ] who were r and omized to HDHK program or a wait-list control group .  Physical activity ( PA )  was assessed using pedometers and dietary behaviors were measured using a vali date d food frequency question naire . The intervention result ed in significant weight loss ( 5.131.27 kg , P<0.0001 ) and increased PA among fathers ( 2769750 steps/day , P<0.001 ) and their children ( 1486521 steps/day , P<0.01 ) . Fathers PA mediated weight loss in the intervention ( AB=2.31 , 95 % CI=4.63 to 0.67 ) and was responsible for 47 % of the intervention effect . Changes in dietary behaviors were not statistically significant . Conclusions PA was an important mediator of weight loss in the HDHK intervention . Encouraging overweight fathers to be more active with their children appears to be a promising strategy for obesity treatment in men The Extension Family Lifestyle Intervention Project ( E-FLIP for Kids ) is a three-arm , r and omized controlled trial assessing the effectiveness of two behavioral weight management interventions in an important and at-risk population , overweight and obese children and their parents in rural counties . Participants will include 240 parent-child dyads from nine rural counties in north central Florida . Dyads 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 ) an Education Control Condition . Child and parent participants will be assessed at baseline ( month 0 ) , post-treatment ( month 12 ) and follow-up ( month 24 ) . Assessment and intervention sessions will be held at Cooperative Extension Service offices within each participating county . The primary outcome measure is change in child BMI z-score . Additional key outcome measures include child body fat , waist circumference , dietary intake , physical activity , blood lipids , blood glucose , blood pressure , physical fitness , quality of life , and program and participants costs . Parent BMI , dietary intake , and physical activity also will be assessed . R and omized controlled trials testing the effectiveness of childhood obesity interventions in real-world community-based setting s are extremely valuable , but much too rare . The E-FLIP for Kids trial will evaluate the impact of a community-based intervention delivered to families in rural setting s utilizing the existing Cooperative Extension Service network on long-term child behavior , weight status and biological markers of diabetes and early cardiovascular disease . If successful , a Parent-Only intervention program may provide a cost-effective and practical intervention for families in underserved rural communities Background The prevalence of overweight and obesity in children and adolescents is increasing at an alarming rate around the world and prevention has become a key public health objective . Treatment and management of those already overweight and obese must be aligned with the best available evidence on effectiveness , if the risk of obesity‐related morbidity and mortality is yet be reduced . Diet plays a pivotal role in successful treatment of obesity but to date , there is limited evidence on which to base practice . Objectives To identify and present the best available evidence on the optimal dietetic treatment and management of children and adolescent who are overweight or obese . Search strategy Published English language literature was search ed using the electronic data bases CINAHL , MEDLINE , PRE‐ MEDLINE , DARE , COCHRANE , EMBASE , AUSTROM , Current Concepts and Dissertation Abstract s. The data bases were limited to English Language from 1975 until 2003 . Government reports from the UK , USA and Australian were also search ed and a h and search performed for the Journal of the Dietitians Association of Australia , International Journal of Obesity and the Journal of Human Nutrition and Dietetics and the bibliographies of retrieved articles . Selection criteria ( i ) Interventions that evaluated the effectiveness of nutrition or dietary interventions to treat or manage overweight and obesity ; ( ii ) Children aged less than 18 years ; and ( iii ) Participants were defined as overweight or obese by relative weight or a measure of body weight status , studies that reported body weight per se were excluded . Data collection and analysis An experienced professional librarian search ed the data bases , and two trained research assistants independently identified studies for retrieval and assessed each article for inclusion . The included studies were critically appraised for method ological quality by two people independently . Data were extracted from the appropriate articles and when a discrepancy arose , a third party would arbitrate . Main results There were 116 articles that met the inclusion criteria . While 49 articles described r and omised controlled trials , they arose from 37 separate studies . There were 67 non‐r and omised trials . Meta‐analyses were performed on eight studies that included both a dietary intervention component and an adequate control group and on four studies that had follow‐up data . There was a high degree of heterogeneity between studies and this made comparisons between studies problematic . Interventions that include diet therapy generally result in significant weight loss , at least in the short term . Many studies were poorly design ed and had no or only minimal follow up . The details of the dietary intervention were often inadequately described and dietary outcomes rarely reported , making repetition of the studies difficult . Review ers ' conclusions There is an urgent need for high quality studies investigating the optimal dietary approach to management of paediatric  overweight and obesity . These studies require adequate follow up to ascertain if weight loss can be sustained in the long term . Details of the dietary prescription , adherence to the dietary intervention and diet‐specific outcomes need to be reported in order to inform best practice Background The prevalence of overweight and obesity in children and adolescents is increasing at an alarming rate around the world and prevention has become a key public health objective . Treatment and management of those already overweight and obese must be aligned with the best available evidence on effectiveness , if the risk of obesity-related morbidity and mortality is yet be reduced . Diet plays a pivotal role in successful treatment of obesity but to date , there is limited evidence on which to base practice . Objectives To identify and present the best available evidence on the optimal dietetic treatment and management of children and adolescent who are overweight or obese . Search strategy Published English language literature was search ed using the electronic data bases CINAHL , MEDLINE , PRE- MEDLINE , DARE , COCHRANE , EMBASE , AUSTROM , Current Concepts and Dissertation Abstract s. The data bases were limited to English Language from 1975 until 2003 . Government reports from the UK , USA and Australian were also search ed and a h and search performed for the Journal of the Dietitians Association of Australia , International Journal of Obesity and the Journal of Human Nutrition and Dietetics and the bibliographies of retrieved articles . Selection criteria ( i ) Interventions that evaluated the effectiveness of nutrition or dietary interventions to treat or manage overweight and obesity ; ( ii ) Children aged less than 18 years ; and ( iii ) Participants were defined as overweight or obese by relative weight or a measure of body weight status , studies that reported body weight per se were excluded . Data collection and analysis An experienced professional librarian search ed the data bases , and two trained research assistants independently identified studies for retrieval and assessed each article for inclusion . The included studies were critically appraised for method ological quality by two people independently . Data were extracted from the appropriate articles and when a discrepancy arose , a third party would arbitrate . Main results There were 116 articles that met the inclusion criteria . While 49 articles described r and omised controlled trials , they arose from 37 separate studies . There were 67 non-r and omised trials . Meta-analyses were performed on eight studies that included both a dietary intervention component and an adequate control group and on four studies that had follow-up data . There was a high degree of heterogeneity between studies and this made comparisons between studies problematic . Interventions that include diet therapy generally result in significant weight loss , at least in the short term . Many studies were poorly design ed and had no or only minimal follow up . The details of the dietary intervention were often inadequately described and dietary outcomes rarely reported , making repetition of the studies difficult . Review ers ' conclusions There is an urgent need for high quality studies investigating the optimal dietary approach to management of paediatric overweight and obesity . These studies require adequate follow up to ascertain if weight loss can be sustained in the long term . Details of the dietary prescription , adherence to the dietary intervention and diet-specific outcomes need to be reported in order to inform best practice Background Child and adolescent obesity predisposes individuals to an increased risk of morbidity and mortality from a range of lifestyle diseases . Although there is some evidence to suggest that rates of pediatric obesity have leveled off in recent years , this has not been the case among youth from low socioeconomic background s. The purpose of this paper is to report the rationale , study design and baseline findings of a school-based obesity prevention program for low-active adolescent girls from disadvantaged secondary schools . Methods / Design The Nutrition and Enjoyable Activity for Teen Girls ( NEAT Girls ) intervention will be evaluated using a group r and omized controlled trial . NEAT Girls is a 12-month multi-component school-based intervention developed in reference to Social Cognitive Theory and includes enhanced school sport sessions , interactive seminars , nutrition workshops , lunch-time physical activity ( PA ) sessions , PA and nutrition h and books , parent newsletters , pedometers for self-monitoring and text messaging for social support . The following variables were assessed at baseline and will be completed again at 12- and 24-months : adiposity , objective ly measured PA , muscular fitness , time spent in sedentary behaviors , dietary intake , PA and nutrition social-cognitive mediators , physical self-perception and global self-esteem . Statistical analyses will follow intention-to-treat principles and hypothesized mediators of PA and nutrition behavior change will be explored . Discussion NEAT Girls is an innovative intervention targeting low-active girls using evidence -based behavior change strategies and nutrition and PA messages and has the potential to prevent unhealthy weight gain and reduce the decline in physical activity and poor dietary habits associated with low socio-economic status . Few studies have reported the long-term effects of school-based obesity prevention programs and the current study has the potential to make an important contribution to the field . Trial registration Australian New Zeal and Clinical Trials Registry No : OBJECTIVE Successful weight management relies on at least two health behaviors , eating and exercise . However , little is known about their interaction on a motivational and behavioral level . Based on the Hierarchical Model of Motivation the authors examined whether exercise-specific motivation can transfer to eating regulation during a lifestyle weight control program . The authors further investigated whether general , treatment-related , and exercise motivation underlie the relation between increased exercise and improved eating regulation . DESIGN Overweight/obese women participated in a 1-year r and omized controlled trial ( N = 239 ) . The intervention focused on promoting physical activity and internal motivation for exercise and weight loss , following Self-Determination Theory . The control group received general health education . MAIN OUTCOME MEASURES General and exercise specific self-determination , eating self-regulation variables , and physical activity behavior . RESULTS General self-determination and more autonomous exercise motivation predicted eating self-regulation over 12 months . Additionally , general and exercise self-determination fully mediated the relation between physical activity and eating self-regulation . CONCLUSION Increased general self-determination and exercise motivation seem to facilitate improvements in eating self-regulation during weight control in women . These motivational mechanisms also underlie the relationship between improvements in exercise behavior and eating regulation Background Over 45 % of American women 20–39 years old are at risk for type 2 diabetes , cardiovascular disease , and other health conditions because they are overweight or obese . The prevalence of overweight and obesity is disproportionately high among low-income women . This paper describes the study design and rationale of a community based intervention ( Mothers In Motion , MIM ) aim ed to prevent weight gain among low-income overweight and obese mothers18 - 39 years old by promoting stress management , healthy eating , and physical activity . Methods / Design Peer recruiters approach participants from 5 Special Supplemental Nutrition Program for Women , Infants , and Children ( WIC ) in Michigan . The MIM delivers theory-based , culturally-sensitive intervention messages via a combination of DVDs and peer support group teleconferences ( PSGTs ) . The DVD features African American and white overweight and obese WIC mothers who participated in a healthy lifestyle intervention patterned after MIM . The PSGTs are led by paraprofessionals from Michigan State University Extension and WIC providers in Michigan who are trained in motivational interviewing and group facilitation skills . Participants are r and omly assigned to an intervention ( n = 350 ) or comparison group ( n = 175 ) . The intervention group receives a 16-week intervention on a weekly or bi-weekly basis . Participants are asked to watch 10 MIM DVD chapters at home and join 10 PSGT sessions by phone . The comparison group receives printed educational material s. The primary outcome is body weight . Secondary outcomes include dietary fat , fruit , and vegetable intake ; physical activity ; stress , and affect . Mediators are self-efficacy , emotional coping response , social support , and autonomous motivation . Telephone interviews and in-person data collection at WIC offices occur at 3 time points : baseline , immediately , and 3 months after the 16-week intervention . Discussion If MIM shows effectiveness , it could have a favorable impact on public health and community programs . The DVDs and PSGTs will be disseminated in WIC , Extension , clinical practice that promote healthy lifestyles for similar target audiences to make a broad contribution to the prevention of weight gain in low-income mothers . Also , our methodology can be adapted by research ers and community stakeholders to help other low-income population s prevent weight gain . Trial registration Clinical Trials Number : NCT01839708 Background To examine the effects of a 6 month lifestyle intervention on quality of life , depression , self-efficacy and eating behavior changes in overweight and obese endometrial cancer survivors . Methods Early stage endometrial cancer survivors were r and omized to intervention ( n = 23 ) or usual care ( n = 22 ) groups . Chi-square , Student 's t-test and repeated measures analysis of variance were used in intent-to-treat analyses . Outcomes were also examined according to weight loss . Results Morbidly obese patients had significantly lower self-efficacy , specifically when feeling physical discomfort . There was a significant improvement for self-efficacy related to social pressure ( p = .03 ) and restraint ( p = .02 ) in the LI group . There was a significant difference for emotional well-being quality of life ( p = .02 ) , self-efficacy related to negative emotions ( p < .01 ) , food availability ( p = .03 ) , and physical discomfort ( p = .01 ) in women who lost weight as compared to women who gained weight . Improvement in restraint was also reported in women who lost weight ( p < .01 ) . Conclusion This pilot lifestyle intervention had no effect on quality of life or depression but did improve self-efficacy and some eating behaviors . Trial Registration http://www . clinical trials.gov ; Objective To examine the behavioral processes through which lifestyle interventions impacted weight loss . Design and Methods We limited our analyses to overweight and obese Black and White adults r and omized to a PREMIER lifestyle intervention ( N = 501 ) . Structural equation modeling was conducted to test the direct and indirect relationships of session attendance , days of self-monitoring diet and exercise , change in diet composition and exercise , and six month weight change . Results Greater session attendance was associated with increased self-monitoring , which was in turn significantly related to reduction in percent energy from total fat consumed . Change in percent energy from fat and self-monitoring was associated with six-month percent change in weight . Both a decrease in fat intake and increase in self-monitoring are potential mediators of the relationship between attendance and weight change . Conclusions Our findings provide a reasonable model that suggests regular session attendance and use of behavioral strategies like self-monitoring are associated with improved behavioral outcomes that are associated with weight loss Background Obesity exerts an enormous health impact through its effect on coronary heart disease and its risk factors . Primary care-based and community-based intensive lifestyle counseling may effectively promote weight loss . There has been limited implementation and evaluation of these strategies , particularly the added benefit of community-based intervention , in low-income Latino population s. Design The Vivamos Activos Fair Oaks project is a r and omized clinical trial design ed to evaluate the clinical and cost-effectiveness of two obesity reduction lifestyle interventions : clinic-based intensive lifestyle counseling , either alone ( n = 80 ) or combined with community health worker support ( n = 80 ) , in comparison to usual primary care ( n = 40 ) . Clinic-based counseling consists of 15 group and four individual lifestyle counseling sessions provided by health educators targeting behavior change in physical activity and dietary practice s. Community health worker support includes seven home visits aim ed at practical implementation of weight loss strategies within the person 's home and neighborhood . The interventions use a framework based on Social Cognitive Theory , the Transtheoretical Model of behavior change , and techniques from previously tested lifestyle interventions . Application of the framework was culturally tailored based on past interventions in the same community and elsewhere , as well as a community needs and assets assessment . The interventions include a 12-month intensive phase followed by a 12-month maintenance phase . Participants are obese Spanish-speaking adults with at least one cardiovascular risk factor recruited from a community health center in a low-income neighborhood of San Mateo County , California . Follow-up assessment s occur at 6 , 12 , and 24 months for the primary outcome of percent change in body mass index at 24 months . Secondary outcomes include specific cardiovascular risk factors , particularly blood pressure and fasting glucose levels . Discussion and Conclusions If successful , this study will provide evidence for broad implementation of obesity interventions in minority population s and guidance about the selection of strategies involving clinic-based case management and community-based community health worker support . Clinical Trial Registration Clinical Trials.gov : Background The prevalence of childhood obesity has increased worldwide , which is a serious concern as obesity is associated with many negative immediate and long-term health consequences . Therefore , the treatment of overweight and obesity in children and adolescents is strongly recommended . Inpatient weight-loss programs have shown to be effective particularly regarding short-term weight-loss , whilst little is known both on the long-term effects of this treatment and the determinants of successful weight-loss and subsequent weight maintenance . The purpose of this study is to evaluate the short , middle and long-term effects of an inpatient weight-loss program for children and adolescents and to investigate the likely determinants of weight changes , whereby the primary focus lies on the potential role of differences in polymorphisms of adiposity-relevant genes . Methods / Design The study involves overweight and obese children and adolescents aged 6 to 19 years , who participate in an inpatient weight-loss program for 4 to 6 weeks . It started in 2006 and it is planned to include 1,500 participants by 2013 . The intervention focuses on diet , physical activity and behavior therapy . Measurements are taken at the start and the end of the intervention and comprise blood analyses ( DNA , lipid and glucose metabolism , adipokines and inflammatory markers ) , anthropometry ( body weight , height and waist circumference ) , blood pressure , pubertal stage , and exercise capacity . Physical activity , dietary habits , quality of life , and family background are assessed by question naires . Follow-up assessment s are performed 6 months , 1 , 2 , 5 and 10 years after the intervention : Children will complete the same question naires at all time points and visit their general practitioner for examination of anthropometric parameters , blood pressure and assessment of pubertal stage . At the 5 and 10 year follow-ups , blood parameters and exercise capacity will be additionally measured . Discussion Apart from illustrating the short , middle and long-term effects of an inpatient weight-loss program , this study will contribute to a better underst and ing of inter-individual differences in the regulation of body weight , taking into account the role of genetic predisposition and lifestyle factors . Trial Registration NCT01067157 Background The Weight Loss Maintenance Trial tested strategies for maintenance of weight loss .  Personal contact was superior to interactive technology and self-directed conditions . Purpose We aim ed to identify behavioral mediators of the superior effect of personal contact vs. interactive technology and of personal contact vs. self-directed arms . Methods Overweight/obese adults at risk for cardiovascular disease ( n = 1,032 ) who lost at least 4 kg were r and omized to personal contact , interactive technology , or self-directed . After 30 months , 880 participants had data on weight and behavioral strategies . Results Reported increase of intake of fruits and vegetables and physical activity and more frequent self-weighing met criteria as mediators of the better outcome of personal contact vs. interactive technology .  Increased intake of fruits and vegetables , more frequent self-weighing , and decreased dessert consumption were mediators of the difference between personal contact vs. self-directed . Conclusion Inducing changes in the identified behaviors might yield better outcomes in future weight loss maintenance trials . ( Clinical Trials.gov number NCT00054925 Background : Although exercise is related to weight loss , minimal energy expenditures typical in deconditioned persons explain only small portions of this reduction . Thus , it has been suggested that exercise-induced changes in psychological variables associated with appropriate eating may be mediators . Methods : Adults with obesity ( N = 106 ; Mean BMI = 42.0 ; SD = 6.0 kg/m2 ) , volunteering for a cognitive-behavioral exercise support program and group nutrition information , were assessed on overall mood , self-efficacy for controlled eating , self-regulation skills usage for appropriate eating , recalled volume of physical activity , body mass index ( BMI ) , and waist circumference at baseline and at month six . Results : All within-subject changes were significant ( P < 0.001 ) and as expected , changes in volumes of physical activity were significantly related to BMI ( & bgr ; = -0.52 ) and waist circumference ( & bgr ; = −0.63 ) changes . These relationships were partially mediated by changes in self-efficacy and self-regulation scores . Mediation of mood changes did not , however , reach statistical significance . Conclusion : In severely obese persons initiating behaviorally supported exercise , weight loss may be better accounted for by changes in psychological predictors of improved eating such as self-efficacy and self-regulation than by direct energy expenditure . Implication s for weight loss theory development and clinical applications were discussed OBJECTIVES Veterans with serious mental illness are at increased risk of obesity , sedentary lifestyle , and a host of related chronic diseases . Although evidence suggests that lifestyle interventions can help mental health consumers achieve modest weight loss , several studies have failed to show a benefit and most have concluded that significant challenges remain in delivering effective interventions . In 2006 , the Veterans Health Administration introduced MOVE ! , a weight management program that includes behaviorally based dietary and physical activity self-management support . This article describes modifications used to manualize MOVE ! for veterans with serious mental illness and reports findings from a r and omized controlled trial of the new intervention . METHODS Between January 2007 and June 2009 , overweight or obese veterans with serious mental illness were r and omly assigned to a six-month trial of MOVE ! ( N=53 ) , which includes both individual and group sessions , or to a control condition that offered basic information about diet and exercise every month ( N=56 ) . Weight and metabolic , attitudinal , behavioral , and functional variables were measured at baseline and six months , and weight was also measured monthly . RESULTS Thirty participants in MOVE ! and 41 participants in the control group completed the six-month assessment , and only seven lost 5 % of their baseline weight ; there was no effect of group assignment on weight loss . There were no significant group × time differences in any metabolic , dietary , physical activity , attitudinal , or functional measure . CONCLUSIONS Despite the negative findings of this study , research is crucial to identify lifestyle interventions and related supports and services to help veterans with mental illness reduce overweight and obesity There are few effective obesity interventions directed towards younger children , particularly young minority children . This paper describes the design , intervention , recruitment methods , and baseline data of the ongoing Positive Lifestyles for Active Youngsters ( Team PLAY ) study . This r and omized controlled trial is design ed to test the efficacy of a 6-month , moderately intense , primary care feasible , family-based behavioral intervention , targeting both young children and their parent , in promoting healthy weight change .  Participants are 270 overweight and obese children ( ages 4 to 7 years ) and their parents , who were recruited from a primarily African American urban population . Parents and children were instructed in proven cognitive behavioral techniques ( e.g. goal setting , self-talk , stimulus control and reinforcement ) design ed to encourage healthier food choices ( more whole grains , fruits and vegetables , and less concentrated fats and sugar ) , reduce portion sizes , decrease sweetened beverages and increase moderate to vigorous physical activity engagement . The main outcome of this study is change in BMI at two year post enrollment . Recruitment using reactive methods ( mailings , TV ads , pamphlets ) was found to be more successful than using only a proactive approach ( referral through physicians ) . At baseline , most children were very obese with an average BMI z-score  of 2.6 . Reported intake of fruits and vegetables and minutes of moderate to vigorous physical activity engagement did not meet national recommendations . If efficacious , Team PLAY would offer a model for obesity treatment directed at families with young children that could be tested and translated to both community and primary care setting
Identified mediators for medium-/long-term weight control were higher levels of autonomous motivation , self-efficacy/barriers , self-regulation skills ( such as self-monitoring ) , flexible eating restraint , and positive body image .
For physical activity , significant putative mediators were high autonomous motivation , self-efficacy , and use of self-regulation skills .
For dietary intake , the evidence was much less clear , and no consistent mediators were identified .
Conclusions This is the first systematic review of mediational psychological mechanisms of successful outcomes in obesity-related lifestyle change interventions .
Despite limited evidence , higher autonomous motivation , self-efficacy , and self-regulation skills emerged as the best predictors of beneficial weight and physical activity outcomes ; for weight control , positive body image and flexible eating restraint may additionally improve outcomes .
These variables represent possible targets for future lifestyle interventions in overweight/obese population
Background Relapse is high in lifestyle obesity interventions involving behavior and weight change .
Identifying mediators of successful outcomes in these interventions is critical to improve effectiveness and to guide approaches to obesity treatment , including re source allocation .
This article review s the most consistent self-regulation mediators of medium- and long-term weight control , physical activity , and dietary intake in clinical and community behavior change interventions targeting overweight/obese adults .