Diet, physical activity and behavioural interventions for the treatment of overweight or obese children from the age of 6 to 11 years
- PMID: 28639319
- PMCID: PMC6481885
- DOI: 10.1002/14651858.CD012651
Diet, physical activity and behavioural interventions for the treatment of overweight or obese children from the age of 6 to 11 years
Abstract
Background: Child and adolescent overweight and obesity has increased globally, and can be associated with significant short- and long-term health consequences. This is an update of a Cochrane review published first in 2003, and updated previously in 2009. However, the update has now been split into six reviews addressing different childhood obesity treatments at different ages.
Objectives: To assess the effects of diet, physical activity and behavioural interventions (behaviour-changing interventions) for the treatment of overweight or obese children aged 6 to 11 years.
Search methods: We searched CENTRAL, MEDLINE, Embase, PsycINFO, CINAHL, LILACS as well as trial registers ClinicalTrials.gov and ICTRP Search Portal. We checked references of studies and systematic reviews. We did not apply any language restrictions. The date of the last search was July 2016 for all databases.
Selection criteria: We selected randomised controlled trials (RCTs) of diet, physical activity, and behavioural interventions (behaviour-changing interventions) for treating overweight or obese children aged 6 to 11 years, with a minimum of six months' follow-up. We excluded interventions that specifically dealt with the treatment of eating disorders or type 2 diabetes, or included participants with a secondary or syndromic cause of obesity.
Data collection and analysis: Two review authors independently screened references, extracted data, assessed risk of bias, and evaluated the quality of the evidence using the GRADE instrument. We contacted study authors for additional information. We carried out meta-analyses according to the statistical guidelines in the Cochrane Handbook for Systematic Reviews of Interventions.
Main results: We included 70 RCTs with a total of 8461 participants randomised to either the intervention or control groups. The number of participants per trial ranged from 16 to 686. Fifty-five trials compared a behaviour-changing intervention with no treatment/usual care control and 15 evaluated the effectiveness of adding an additional component to a behaviour-changing intervention. Sixty-four trials were parallel RCTs, and four were cluster RCTs. Sixty-four trials were multicomponent, two were diet only and four were physical activity only interventions. Ten trials had more than two arms. The overall quality of the evidence was low or very low and 62 trials had a high risk of bias for at least one criterion. Total duration of trials ranged from six months to three years. The median age of participants was 10 years old and the median BMI z score was 2.2.Primary analyses demonstrated that behaviour-changing interventions compared to no treatment/usual care control at longest follow-up reduced BMI, BMI z score and weight. Mean difference (MD) in BMI was -0.53 kg/m2 (95% confidence interval (CI) -0.82 to -0.24); P < 0.00001; 24 trials; 2785 participants; low-quality evidence. MD in BMI z score was -0.06 units (95% CI -0.10 to -0.02); P = 0.001; 37 trials; 4019 participants; low-quality evidence and MD in weight was -1.45 kg (95% CI -1.88 to -1.02); P < 0.00001; 17 trials; 1774 participants; low-quality evidence.Thirty-one trials reported on serious adverse events, with 29 trials reporting zero occurrences RR 0.57 (95% CI 0.17 to 1.93); P = 0.37; 4/2105 participants in the behaviour-changing intervention groups compared with 7/1991 participants in the comparator groups). Few trials reported health-related quality of life or behaviour change outcomes, and none of the analyses demonstrated a substantial difference in these outcomes between intervention and control. In two trials reporting on minutes per day of TV viewing, a small reduction of 6.6 minutes per day (95% CI -12.88 to -0.31), P = 0.04; 2 trials; 55 participants) was found in favour of the intervention. No trials reported on all-cause mortality, morbidity or socioeconomic effects, and few trials reported on participant views; none of which could be meta-analysed.As the meta-analyses revealed substantial heterogeneity, we conducted subgroup analyses to examine the impact of type of comparator, type of intervention, risk of attrition bias, setting, duration of post-intervention follow-up period, parental involvement and baseline BMI z score. No subgroup effects were shown for any of the subgroups on any of the outcomes. Some data indicated that a reduction in BMI immediately post-intervention was no longer evident at follow-up at less than six months, which has to be investigated in further trials.
Authors' conclusions: Multi-component behaviour-changing interventions that incorporate diet, physical activity and behaviour change may be beneficial in achieving small, short-term reductions in BMI, BMI z score and weight in children aged 6 to 11 years. The evidence suggests a very low occurrence of adverse events. The quality of the evidence was low or very low. The heterogeneity observed across all outcomes was not explained by subgrouping. Further research is required of behaviour-changing interventions in lower income countries and in children from different ethnic groups; also on the impact of behaviour-changing interventions on health-related quality of life and comorbidities. The sustainability of reduction in BMI/BMI z score and weight is a key consideration and there is a need for longer-term follow-up and further research on the most appropriate forms of post-intervention maintenance in order to ensure intervention benefits are sustained over the longer term.
Conflict of interest statement
EM: none known.
TB: none known.
KR: none known.
LA: none known.
VW: none known.
DJ: none known.
JO: none known.
GM: none known.
EC: none known.
CM: none known.
EB: none known.
LA‐K: none known.
LB: is a co‐author on two of the included studies (McCallum 2007; Wake 2009).
MIM: none known.
Disclaimer: Alessandro Demaio is currently a staff member of the World Health Organization. The author alone is responsible for the views expressed in this publication and they do not necessarily represent the decisions, policy or views of the World Health Organization.
LE: is seconded to Public Health England part‐time as a specialist obesity advisor. The author received funding from WHO to complete this review. Louisa Ells also has a part time secondment to Public Health England, but undertook this review within her role at Teesside University.
Figures
References
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- Taveras EM, Marshall R, Kleinman KP, Gillman MW, Hacker K, Horan CM, et al. Comparative effectiveness of childhood obesity interventions in pediatric primary care: a cluster‐randomized clinical trial. JAMA pediatrics 2015;169(6):535‐42. - PubMed
Taylor 2015 {published data only}
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- ACTRN12609000749202. Screening, feedback and treatment in overweight 4‐8 year old children: the MInT study. www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=308336 (last accessed 6 December 2016).
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- Dawson AM, Brown DA, Cox A, Williams SM, Treacy L, Haszard J, et al. Using motivational interviewing for weight feedback to parents of young children. Journal of Paediatrics and Child Health 2014;50(6):461‐70. - PubMed
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- Haszard JJ, Williams SM, Dawson AM, Skidmore PML, Taylor RW. Factor analysis of the comprehensive feeding practices questionnaire in a large sample of children. Appetite 2013;62:110‐8. - PubMed
Vann 2013 {published data only}
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- Vann LH, Stanford FC, Durkin MW, Hanna A, Knight LM, Stallworth JR. "Moving and losing": a pilot study incorporating physical activity to decrease obesity in the pediatric population. Journal of the South Carolina Medical Association 2013;109(4):116‐20. - PubMed
Wafa 2011 {published data only}
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- Hamzaid H, Talib RA, Azizi NH, Maamor N, Reilly JJ, Wafa SW. Quality of life of obese children in Malaysia. International Journal of Pediatric Obesity 2011;6(5‐6):450‐4. - PubMed
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- ISRCTN14241825. Malaysian childhood obesity treatment trial (MASCOT). www.isrctn.com/ISRCTN14241825 (last accessed 6 December 2016).
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- Sharifah WW, Nur HH, Ruzita AT, Roslee R, Reilly JJ. The Malaysian Childhood Obesity Treatment Trial (MASCOT). Malaysian Journal of Nutrition 2011;17(2):229‐36. - PubMed
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- Wafa SW, Ruzita AT, Nur Hana H, Roslee R, Ng LO, Ayiesah R, et al. Family‐focused weight management programme for childhood obesity in Malaysia: randomised controlled trial. Obesity Reviews 2010;11:85‐6.
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- Wafa SW, Talib RA, Hamzaid NH, McColl JH, Rajikan R, Ng LO, et al. Randomized controlled trial of a good practice approach to treatment of childhood obesity in Malaysia: Malaysian Childhood Obesity Treatment Trial (MASCOT). International Journal of Pediatric Obesity 2011;6(2‐2):e62‐9. - PubMed
Wake 2009 {published data only}
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- ISRCTN52511065. Randomised controlled trial of a brief GP intervention to reduce overweight in Victorian primary school children ‐ live, eat and play (LEAP 2). www.isrctn.com/ISRCTN52511065 (last accessed 6 December 2016).
Wake 2013 {published data only}
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- ACTRN12608000055303. Better outcomes for obese children in general practice: randomized controlled trial of a new shared‐care model vs usual care. www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=82549 (last accessed 6 December 2016).
Waling 2012 {published data only}
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- Backlund C, Sundelin G, Larsson C. Effect of a 1‐year lifestyle intervention on physical activity in overweight and obese children. Advances in Physiotherapy 2011;13(3):87‐96.
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- Backlund C, Sundelin G, Larsson C. Effects of a 2‐year lifestyle intervention on physical activity in overweight and obese children. Advances in Physiotherapy 2011;13(3):97‐109.
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- NCT01012206. Overweighed children's health ‐ studies of the effect of lifestyle and food habits (SELFH). clinicaltrials.gov/ct2/show/NCT01012206 (last accessed 6 December 2016).
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- Waling M, Lind T, Hernell O, Larsson C. A one‐year intervention has modest effects on energy and macronutrient intakes of overweight and obese Swedish children. Journal of Nutrition 2010;140(10):1793‐8. - PubMed
Warschburger 2016 {published data only}
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- ISRCTN24655766. Empowering parents of obese children: development and controlled evaluation of an obesity‐specific parenting skills training. www.isrctn.com/ISRCTN24655766 (last accessed 6 December 2016).
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- Warschburger P, Kroeller K, Haerting J, Unverzagt S, Egmond‐Fröhlich A. Empowering Parents of Obese Children (EPOC): a randomized controlled trial on additional long‐term weight effects of parent training. Appetite 2016;103:148‐56. - PubMed
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- Warschburger P, Kroller K, Unverzagt S, Haerting J. What is the parents' part in long‐term weight management of their obese child? Results from the EPOC study. Obesity Facts 2013;6:230.
Weigel 2008 {published data only}
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- Weigel C, Kokocinski K, Lederer P, Dotsch J, Rascher W, Knerr I. Childhood obesity: concept, feasibility, and interim results of a local group‐based, long‐term treatment program. Journal of Nutrition Education & Behavior 2008;40(6):369‐73. - PubMed
Weintraub 2008 {published data only}
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- NCT00186173. Sports to prevent obesity: feasibility and pilot RCT. clinicaltrials.gov/ct2/show/NCT00186173 (last accessed 6 December 2016).
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- Weintraub DL, Tirumalai EC, Haydel KF, Fujimoto M, Fulton JE, Robinson TN. Team sports for overweight children: the Stanford Sports to Prevent Obesity Randomized Trial (SPORT). Archives of Pediatrics & Adolescent Medicine 2008;162(3):232‐7. - PubMed
Wilfley 2007 {published data only}
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- NCT00301197. Childhood obesity treatment: a maintenance approach. clinicaltrials.gov/ct2/show/NCT00301197 (last accessed 6 December 2016).
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- Wilfley DE, Stein RI, Saelens BE, Mockus DS, Matt GE, Hayden‐Wade HA, et al. Efficacy of maintenance treatment approaches for childhood overweight: a randomized controlled trial. JAMA 2007;298(14):1661‐73. - PubMed
Woo 2004 {published data only}
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- Woo KS, Chook P, Yu CW, Sung RY, Qiao M, Leung SS, et al. Effects of diet and exercise on obesity‐related vascular dysfunction in children. Circulation 2004;109(16):1981‐6. - PubMed
Wright 2012 {published data only}
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- Wright K, Giger JN, Norris K, Suro Z. Impact of a nurse‐directed, coordinated school health program to enhance physical activity behaviors and reduce body mass index among minority children: a parallel‐group, randomized control trial. International Journal of Nursing Studies 2013;50(6):727‐37. - PMC - PubMed
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- Wright K, Norris K, Newman Giger J, Suro Z. Improving healthy dietary behaviors, nutrition knowledge, and self‐efficacy among underserved school children with parent and community involvement. Childhood Obesity 2012;8(4):347‐56. - PubMed
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- Wright K, Suro Z. Using community‐academic partnerships and a comprehensive school‐based program to decrease health disparities in activity in school‐aged children. Journal of Prevention & Intervention in the Community 2014;42(2):125‐39. - PubMed
References to studies excluded from this review
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Albala 2008 {published data only}
Alberga 2013 {published data only}
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Alexander 2014 {published data only}
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Baker 2012 {published data only}
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Ball 2012 {published data only}
Banks 2011 {published data only}
Banks 2012a {published data only}
Banks 2012b {published data only}
Banks 2014 {published data only}
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Banos 2009 {published data only}
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Barbeau 2007 {published data only}
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Bau 2016 {published data only}
Bauer 2010 {published data only}
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Bean 2012 {published data only}
Bean 2014 {published data only}
Benestad 2014 {published data only}
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Benson 2008 {published data only}
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Bernstein 2015 {published data only}
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- Bernstein HM. An ecological systems approach to pediatric weight management: a psychoeducational group manual for caregivers [Dissertation]. Vol. 75, Available from gradworks.umi.com/36/30/3630291.html, 2015.
Best 2016 {published data only}
Bloom 2013 {published data only}
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Bocca 2014 {published data only}
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Bohnert 2013 {published data only}
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Boutelle 2011 {published data only}
Boutelle 2013 {published data only}
Braden 2014 {published data only}
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Braet 1997a {published data only}
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- Braet C, Mervielde I, Vandereycken W. Psychological aspects of childhood obesity: a controlled study in a clinical and nonclinical sample. Journal of Pediatric Psychology 1997;22:59‐71. - PubMed
Braet 1997b {published data only}
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- Braet C, Winckel M, Leeuwen K. Follow‐up results of different treatment programs for obese children. Acta Paediatrica 1997;86:397‐402. - PubMed
Braet 2000 {published data only}
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- Braet C, Winckel M. Long‐term follow‐up of a cognitive behavioral treatment program for obese children. Behavior Therapy 2000;31:55‐74.
Buhari 2014 {published data only}
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- Buhari SSS, Talib RA, Koon PB. The HEBAT! program: an obesity prevention exploratory cluster randomized controlled trial. Obesity Reviews 2014;15:153.
Burrows 2008 {published data only}
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- Burrows T, Warren JM, Baur LA, Collins CE. Impact of a child obesity intervention on dietary intake and behaviors. International Journal of Obesity 2008;32:1481‐8. - PubMed
Burrows 2010a {published data only}
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- Burrows T, Berthton B, Garg M, Collins C. A novel approach to validating dietary change in children participating in the HIKCUPS (Hunter Illawarra Kids Challenge Using Parent Support) obesity intervention. Obesity Reviews 2010;11:374.
Burrows 2010b {published data only}
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- Burrows T, Warren JM, Collins CE. The impact of a child obesity treatment intervention on parent child‐feeding practices. International Journal of Pediatric Obesity 2010;5:43‐50. - PubMed
Burrows 2011 {published data only}
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- Burrows T, Janet WM, Collins CE. Long‐term changes in food consumption trends in overweight children in the HIKCUPS intervention. Journal of Pediatric Gastroenterology & Nutrition 2011;53:543‐7. - PubMed
Bush 2007 {published data only}
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- Bush CL, Pittman S, McKay S, Ortiz T, Wong WW, Klish WJ. Park‐based obesity intervention program for inner‐city minority children. The Journal of Pediatrics 2007;151:513‐7. - PubMed
Bustos 1997 {published data only}
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- Bustos LG, Moreno MF, Calderin MMA, Martinez QJJ, Diaz ME, Arana CC. Comparative study of medical advice and cognitive‐behavioral group therapy in the treatment of child‐adolescent obesity. Anales Espanoles de Pediatria 1997;47:135‐43. - PubMed
Caballero 2003a {published data only}
Caballero 2003b {published data only}
Canas 2012a {published data only}
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- Canas JA, Damaso L, Altomare A, Killen K, Hossain J, Balagopal PB. Insulin resistance and adiposity in relation to serum beta‐carotene levels. Journal of Pediatrics 2012;161:58‐64.e1‐2. - PubMed
Canas 2012b {published data only}
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- Canas JA, Damaso L, Mann KJ, Sweeten S, Balagopa P. Fatty acid binding proteins (FABP4 and FABP5), beta‐carotene and insulin resistance (IR): a 6‐month double blind placebo‐controlled study on the effect of a fruit and vegetable juice concentrate (FVJC) in boys. Endocrine Reviews 2012;33 (3 Meeting Abstracts):No pagination.
Canas 2014 {published data only}
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- Canas J, Lochrie A, McGowan AG, Schettino C, Hossain J, Balagopal P. Effect of a 2‐week intense life‐style intervention followed by 6‐month carotenoid supplementation on fat depots, aditonectin and palmitoleate: a 6‐month double blind placebo‐controlled pilot study in obese children. FASEB Journal 2014;1:645.6.
Carrel 2005 {published data only}
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- Carrel AL, Clark RR, Peterson SE, Nemeth BA, Sullivan J, Allen DB. Improvement of fitness, body composition, and insulin sensitivity in overweight children in a school‐based exercise program: a randomized, controlled study. Archives of Pediatrics & Adolescent Medicine 2005;159:963‐8. - PubMed
Carrel 2007 {published data only}
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- Carrel AL, Clark RR, Peterson S, Eickhoff J, Allen DB. School‐based fitness changes are lost during the summer vacation. Archives of Pediatrics & Adolescent Medicine 2007;161:561‐4. - PubMed
Cash 2009 {published data only}
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- Cash AJ. Evaluation of a multi‐faceted intervention to prevent obesity in elementary school children. Dissertation Abstracts International: Section B: The Sciences and Engineering. 2009; Vol. 69:7446.
Catenacci 2014 {published data only}
Cespedes 2014 {published data only}
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- Cespedes EM, Horan CM, Gillman MW, Gortmaker SL, Price S, Rifas‐Shiman SL, et al. Participant characteristics and intervention processes associated with reductions in television viewing in the High Five for Kids study. Preventive Medicine: An International Journal Devoted to Practice and Theory 2014;62:64‐70. - PMC - PubMed
Chen 2013 {published data only}
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- Chen JL, Kwan M, Mac A, Chin NC, Liu K. iStart smart: a primary‐care based and community partnered childhood obesity management program for Chinese‐American children: feasibility study. Journal of Immigrant & Minority Health 2013;15:1125‐8. - PubMed
Chen 2015 {published data only}
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- Chen J, Kwan M, Liu K, Yu F. The feasibility and efficacy of healthy weight management program for low income Chinese American overweight and obese children in a primary care clinic. Journal of Pediatric Nursing 2015;30:821‐8. - PubMed
Chen 2016 {published data only}
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- Chen J, Kwan M. Short‐term efficacy and correlates of change in health weight management program for Chinese American children. Clinical Pediatrics 2016;55:463‐9. - PubMed
Chirita‐Emandi 2014 {published data only}
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- Chirita‐Emandi A, Puiu M. Outcomes of neurofeedback training in childhood obesity management: a pilot study. Journal of Alternative & Complementary Medicine 2014;20:831‐7. - PubMed
Chongviriyaphan 2010 {published data only}
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- Chongviriyaphan N, Sangthien N, Suthutvoravut U. The nutrition counselling with a behavior modification is effective in obese school‐aged children. Obesity Reviews 2010;11:292‐3.
Cohen 2012 {published data only}
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- Cohen TR, Hazell T, Vanstone CA, Moore M, Plourde H, Rodd C, et al. Body composition of 6 to 8.5 year old overweight and obese children: 12‐week follow‐up from an eating and exercise behaviour family‐centered lifestyle intervention in Quebec (Canada). FASEB Journal 2012;26:811‐2.
Collins 2010 {published data only}
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- Collins CE, Morgan PJ, Okely AD, Burrows TL, Cliff DP, Jones RA, et al. HIKCUPS (Hunter Illawarra Kids Challenge Using Parent Support) reduces BMI z‐score up to 2 years: results of a multi‐site randomized trial for overweight children. Obesity Reviews 2010;11:280.
Cooperberg 2014 {published data only}
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- Cooperberg J. Food for thought: a parental internet‐based intervention to treat childhood obesity in preschool‐aged children. Dissertation Abstracts International: Section B: The Sciences and Engineering. 2014; Vol. 74.
Coppinger 2016 {published data only}
Cradock 2016 {published data only}
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- Cradock AL, Barrett JL, Giles CM, Lee RM, Kenney EL, deBlois ME, et al. Promoting physical activity with the Out of School Nutrition and Physical Activity (OSNAP) initiative a cluster‐randomized controlled trial. JAMA Pediatrics 2016;170:155‐62. - PubMed
Crova 2014 {published data only}
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- Crova C, Struzzolino I, Marchetti R, Masci I, Vannozzi G, Forte R, et al. Cognitively challenging physical activity benefits executive function in overweight children. Journal of Sports Sciences 2014;32:201‐11. - PubMed
Cunningham‐Sabo 2016 {published data only}
Dahiya 2012 {published data only}
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- Dahiya R, Cowin GJ, Yang Z, Almestehi M, Leong GM. Effect of a 12‐month lifestyle behavioral modification intervention on fat compartmentation in overweight and obese prepubertal children. Endocrine Reviews 2012;33(3 Meeting Abstracts):OR18‐4.
Dai 2006 {published data only}
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- Dai J, Jiang Z, Zhang B. Exercise and nutrition therapy for simple obesity in children. Chinese Journal of Clinical Rehabilitation 2006;10:20‐2.
Dalton 2013 {published data only}
Daniels 2009a {published data only}
Danielsen 2013 {published data only}
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- Danielsen YS, Nordhus IH, Juliusson PB, Maehle M, Pallesen S. Effect of a family‐based cognitive behavioural intervention on body mass index, self‐esteem and symptoms of depression in children with obesity (aged 7‐13): a randomised waiting list controlled trial. Obesity Research & Clinical Practice 2013;7:e116‐28. - PubMed
Danielzik 2007 {published data only}
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- Danielzik S, Pust S, Muller MJ. School‐based interventions to prevent overweight and obesity in prepubertal children: process and 4‐years outcome evaluation of the Kiel Obesity Prevention Study (KOPS). Acta Paediatrica, International Journal of Paediatrics 2007;96:19‐25. - PubMed
da Silva 2015 {published data only}
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- Silva DF, Bianchini JA, Lopera CA, Capelato DA, Hintze LJ, Nardo CC, et al. Impact of readiness to change behavior on the effects of a multidisciplinary intervention in obese Brazilian children and adolescents. Appetite 2015;87:229‐35. - PubMed
Davis 1999 {published data only}
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- Davis CE, Hunsberger S, Murray DM, Fabsitz RR, Himes JH, Stephenson LK, et al. Design and statistical analysis for the Pathways study. American Journal of Clinical Nutrition 1999;69:760S‐763S. - PubMed
Davis 2011a {published data only}
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- Davis AM, Blackburn KS, Dreyer M, Hampl S, Sampilo M. Treatment outcomes across three family‐based behavioral pediatric obesity group treatment programs: Healthy Hawks, Zoom to Health and PHIT kids. Obesity 2011;19:S106.
Davis 2011b {published data only}
Davis 2014 {published data only}
Davis 2016a {published data only}
Davis 2016b {published data only}
de Mello 2004 {published data only}
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- Mello ED, Luft VC, Meyer F. Individual outpatient care versus group education programs. Which leads to greater change in dietary and physical activity habits for obese children?. Jornal de Pediatria 2004;80:468‐74. - PubMed
Dennis 2013 {published data only}
De Ruyter 2013 {published data only}
DeVault 2009 {published data only}
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- Vault N, Kennedy T, Hermann J, Mwavita M, Rask P, Jaworsky A. It's all about kids: preventing overweight in elementary school children in Tulsa, OK. Journal of the American Dietetic Association 2009;109:680‐7. - PubMed
Dias 2016 {published data only}
Dodds 2014 {published data only}
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- Dodds P, Wolfenden L, Chapman K, Wellard L, Hughes C, Wiggers J. The effect of energy and traffic light labelling on parent and child fast food selection: a randomised controlled trial. Appetite 2014;73:23‐30. - PubMed
Donnelly 2009 {published data only}
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- Donnelly JE, Greene JL, Gibson CA, Smith BK, Washburn RA, Sullivan DK, et al. Physical Activity Across the Curriculum (PAAC): a randomized controlled trial to promote physical activity and diminish overweight and obesity in elementary school children. Preventive Medicine 2009;49:336‐41. - PMC - PubMed
Doyle‐Baker 2011 {published data only}
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- Doyle‐Baker PK, Venner AA, Lyon ME, Fung T. Impact of a combined diet and progressive exercise intervention for overweight and obese children: the B.E. H.I.P. study. Applied Physiology, Nutrition, & Metabolism 2011;36:515‐25. - PubMed
Dreyer 2014 {published data only}
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- Dreyer Gillette ML, Odar Stough C, Best CM, Beck AR, Hampl SE. Comparison of a condensed 12‐week version and a 24‐week version of a family‐based pediatric weight management program. Childhood obesity 2014;10:375‐82. - PubMed
DuBose 2008 {published data only}
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- DuBose KD, Mayo MS, Gibson CA, Green JL, Hill JO, Jacobsen DJ, et al. Physical activity across the curriculum (PAAC): rationale and design. Contemporary Clinical Trials 2008;29:83‐93. - PubMed
Duckworth 2009 {published data only}
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- Duckworth LC, Gately PJ, Radley D, Cooke CB, King RF, Hill AJ. RCT of a high‐protein diet on hunger motivation and weight‐loss in obese children: an extension and replication. Obesity 2009;17:1808‐10. - PubMed
Duncan 2009 {published data only}
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- Duncan MJ, Al‐Nakeeb Y, Nevill AM. Effects of a 6‐week circuit training intervention on body esteem and body mass index in British primary school children. Body Image 2009;6:216‐20. - PubMed
Dura 2006 {published data only}
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- Dura Trave T. Treatment of childhood obesity: nutrition education, self‐management and intensive follow‐up. Acta Pediatrica Espanola 2006;64:328‐34.
Economos 2007 {published data only}
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- Economos CD, Hyatt RR, Goldberg JP, Must A, Naumova EN, Collins JJ, et al. A community intervention reduces BMI z‐score in children: Shape Up Somerville first year results. Obesity 2007;15:1325‐36. - PubMed
El Hage 2012 {published data only}
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- Hage R, Rocher E, Chappard C, Portier H, Rochefort GY, Benhamou CL. Effect of a 6‐month physical training program on hip structure analysis in obese children. Osteoporosis International 2012;23:S686.
Endevelt 2014 {published data only}
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- Endevelt R, Elkayam O, Cohen R, Peled R, Tal‐Pony L, Grunwald RM, et al. An intensive family intervention clinic for reducing childhood obesity. Journal of the American Board of Family Medicine: JABFM 2014;27:321‐8. - PubMed
Epstein 1981 {published data only}
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- Epstein LH, Wing RR, Koeske R, Andrasik F, Ossip DJ. Child and parent weight loss in family‐based behavior modification programs. Journal of Consulting & Clinical Psychology 1981;49:674‐85. - PubMed
Epstein 1984b {published data only}
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- Epstein LH, Woodall K, Goreczny AJ, Wing RR, Robertson RJ. The modification of activity patterns and energy expenditure in obese young girls. Behavior Therapy 1984;15:101‐8.
Epstein 1986 {published data only}
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- Epstein LH, Wing RR, Koeske R, Valoski A. Effect of parent weight on weight loss in obese children. Journal of Consulting and Clinical Psychology 1986;54:400‐1. - PubMed
Epstein 1987a {published data only}
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- Epstein LH, Nudelman S, Wing RR. Long‐term effects of family‐based treatment for obesity on nontreated family members. Behavior Therapy 1987;18:147‐52.
Epstein 1987b {published data only}
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- Epstein LH, Wing RR, Koeske R, Valoski A. Long‐term effects of family‐based treatment of childhood obesity. Journal of Consulting and Clinical Psychology 1987;55:91‐5. - PubMed
Epstein 1987c {published data only}
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- Epstein LH, Wing RR, Valoski A, Gooding W. Long‐term effects of parent weight on child weight loss. Behavior Therapy 1987;18:219‐26.
Epstein 1987d {published data only}
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- Epstein LH, Wing RR, Valoski A, Penner BC. Stability of food preferences during weight control: a study with 8‐ to 12‐year‐old children and their parents. Behavior Modification 1987;11:87‐101. - PubMed
Epstein 1990 {published data only}
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- Epstein LH, Valoski A, Wing RR, McCurley J. Ten‐year follow‐up of behavioral, family‐based treatment for obese children. JAMA 1990;264:2519‐23. - PubMed
Epstein 1993 {published data only}
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- Epstein LH, Valoski A, McCurley J. Effect of weight loss by obese children on long‐term growth. American Journal of Diseases of Children 1993;147:1076‐80. - PubMed
Epstein 1994a {published data only}
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- Epstein LH, McKenzie SJ, Valoski A, Klein KR, Wing RR. Effects of mastery criteria and contingent reinforcement for family‐based child weight control. Addictive Behaviors 1994;19:135‐45. - PubMed
Epstein 1994b {published data only}
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- Epstein LH, Valoski A, Wing RR, McCurley J. Ten‐year outcomes of behavioral family‐based treatment for childhood obesity. Health Psychology 1994;13(5):373‐83. - PubMed
Epstein 1995 {published data only}
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- Epstein LH, Valoski AM, Vara LS, McCurley J, Wisniewski L, Kalarchian MA, et al. Effects of decreasing sedentary behavior and increasing activity on weight change in obese children. Health Psychology 1995;14:109‐15. - PubMed
Epstein 2000b {published data only}
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- Epstein LH, Paluch RA, Gordy CC, Saelens BE, Ernst MM. Problem solving in the treatment of childhood obesity. Journal of Consulting & Clinical Psychology 2000;68:717‐21. - PubMed
Epstein 2004 {published data only}
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- Epstein LH, Paluch RA, Kilanowski CK, Raynor HA. The effect of reinforcement or stimulus control to reduce sedentary behavior in the treatment of pediatric obesity. Health Psychology 2004;23:371‐80. - PubMed
Epstein 2007 {published data only}
Epstein 2008a {published data only}
Epstein 2008b {published data only}
Epstein 2012 {published data only}
Erceg 2012 {published data only}
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- Erceg DNJ. The effects of whole body vibration exercise on metabolic systems in overweight Latino boys. Dissertation Abstracts International: Section B: The Sciences and Engineering. 2012; Vol. 73:274.
Escobedo 2014 {published data only}
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- Escobedo S, Garca O, Ronquillo D, Caamao M, Rosado J. Supplementation with multiple micronutrients and polyunsaturated fatty acids does not improve school performance of obese children in a rural area of Mexico. FASEB Journal 2014;1:811.23.
Escoto 2008 {published data only}
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