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Meta-Analysis
. 2017 Jun 22;6(6):CD012691.
doi: 10.1002/14651858.CD012691.

Diet, physical activity and behavioural interventions for the treatment of overweight or obese adolescents aged 12 to 17 years

Lena Al-Khudairy  1 , Emma Loveman, Jill L Colquitt, Emma Mead, Rebecca E Johnson, Hannah Fraser, Joan Olajide, Marie Murphy, Rochelle Marian Velho, Claire O'Malley, Liane B Azevedo, Louisa J Ells, Maria-Inti Metzendorf, Karen Rees
Affiliations
Meta-Analysis

Diet, physical activity and behavioural interventions for the treatment of overweight or obese adolescents aged 12 to 17 years

Lena Al-Khudairy et al. Cochrane Database Syst Rev. .

Abstract

Background: Adolescent overweight and obesity has increased globally, and can be associated with short- and long-term health consequences. Modifying known dietary and behavioural risk factors through behaviour changing interventions (BCI) may help to reduce childhood overweight and obesity. This is an update of a review published in 2009.

Objectives: To assess the effects of diet, physical activity and behavioural interventions for the treatment of overweight or obese adolescents aged 12 to 17 years.

Search methods: We performed a systematic literature search in: CENTRAL, MEDLINE, Embase, PsycINFO, CINAHL, LILACS, and the trial registers ClinicalTrials.gov and ICTRP Search Portal. We checked references of identified studies and systematic reviews. There were no 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 for treating overweight or obesity in adolescents aged 12 to 17 years.

Data collection and analysis: Two review authors independently assessed risk of bias, evaluated the overall quality of the evidence using the GRADE instrument and extracted data following the guidelines of the Cochrane Handbook for Systematic Reviews of Interventions. We contacted trial authors for additional information.

Main results: We included 44 completed RCTs (4781 participants) and 50 ongoing studies. The number of participants in each trial varied (10 to 521) as did the length of follow-up (6 to 24 months). Participants ages ranged from 12 to 17.5 years in all trials that reported mean age at baseline. Most of the trials used a multidisciplinary intervention with a combination of diet, physical activity and behavioural components. The content and duration of the intervention, its delivery and the comparators varied across trials. The studies contributing most information to outcomes of weight and body mass index (BMI) were from studies at a low risk of bias, but studies with a high risk of bias provided data on adverse events and quality of life.The mean difference (MD) of the change in BMI at the longest follow-up period in favour of BCI was -1.18 kg/m2 (95% confidence interval (CI) -1.67 to -0.69); 2774 participants; 28 trials; low quality evidence. BCI lowered the change in BMI z score by -0.13 units (95% CI -0.21 to -0.05); 2399 participants; 20 trials; low quality evidence. BCI lowered body weight by -3.67 kg (95% CI -5.21 to -2.13); 1993 participants; 20 trials; moderate quality evidence. The effect on weight measures persisted in trials with 18 to 24 months' follow-up for both BMI (MD -1.49 kg/m2 (95% CI -2.56 to -0.41); 760 participants; 6 trials and BMI z score MD -0.34 (95% CI -0.66 to -0.02); 602 participants; 5 trials).There were subgroup differences showing larger effects for both BMI and BMI z score in studies comparing interventions with no intervention/wait list control or usual care, compared with those testing concomitant interventions delivered to both the intervention and control group. There were no subgroup differences between interventions with and without parental involvement or by intervention type or setting (health care, community, school) or mode of delivery (individual versus group).The rate of adverse events in intervention and control groups was unclear with only five trials reporting harms, and of these, details were provided in only one (low quality evidence). None of the included studies reported on all-cause mortality, morbidity or socioeconomic effects.BCIs at the longest follow-up moderately improved adolescent's health-related quality of life (standardised mean difference 0.44 ((95% CI 0.09 to 0.79); P = 0.01; 972 participants; 7 trials; 8 comparisons; low quality of evidence) but not self-esteem.Trials were inconsistent in how they measured dietary intake, dietary behaviours, physical activity and behaviour.

Authors' conclusions: We found low quality evidence that multidisciplinary interventions involving a combination of diet, physical activity and behavioural components reduce measures of BMI and moderate quality evidence that they reduce weight in overweight or obese adolescents, mainly when compared with no treatment or waiting list controls. Inconsistent results, risk of bias or indirectness of outcome measures used mean that the evidence should be interpreted with caution. We have identified a large number of ongoing trials (50) which we will include in future updates of this review.

PubMed Disclaimer

Conflict of interest statement

LA‐K: none known.

EL: none known.

JC: none known.

EM: none known.

RJ: none known.

HF: none known.

JO: none known.

MM: none known.

RV: none known.

CO: none known.

LA: none known.

LE: Louisa Ells is seconded to Public Health England two days per week but undertook this review within her role as Reader in Public Health and Obesity at Teesside University.

MIM: none known.

KR: none known.

Figures

1
1
Study flow diagram.
2
2
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies (blank cells indicate that the particular outcome was not investigated in some studies).
3
3
Risk of bias summary: review authors' judgements about each risk of bias item for each included study (blank cells indicate that the study did not report that particular outcome).
4
4
Funnel plot of comparison: 1 Interventions (all) versus controls, longest follow‐up, outcome: 1.1 BMI change (kg/m2)
1.1
1.1. Analysis
Comparison 1 Interventions (all) versus controls, longest follow‐up, Outcome 1 BMI change.
1.2
1.2. Analysis
Comparison 1 Interventions (all) versus controls, longest follow‐up, Outcome 2 BMI z score change.
1.3
1.3. Analysis
Comparison 1 Interventions (all) versus controls, longest follow‐up, Outcome 3 BMI percentile change.
1.4
1.4. Analysis
Comparison 1 Interventions (all) versus controls, longest follow‐up, Outcome 4 Weight change.
2.1
2.1. Analysis
Comparison 2 Interventions versus controls, by duration of intervention, less than 6 months, greater than 6 months, longest follow‐up, Outcome 1 Body mass index (BMI) change.
2.2
2.2. Analysis
Comparison 2 Interventions versus controls, by duration of intervention, less than 6 months, greater than 6 months, longest follow‐up, Outcome 2 BMI z score change.
3.1
3.1. Analysis
Comparison 3 Interventions (all) versus controls, other anthropometrics, longest follow‐up, Outcome 1 % body fat.
3.2
3.2. Analysis
Comparison 3 Interventions (all) versus controls, other anthropometrics, longest follow‐up, Outcome 2 % trunk fat.
3.3
3.3. Analysis
Comparison 3 Interventions (all) versus controls, other anthropometrics, longest follow‐up, Outcome 3 Waist circumference.
3.4
3.4. Analysis
Comparison 3 Interventions (all) versus controls, other anthropometrics, longest follow‐up, Outcome 4 Waist‐to‐height ratio.
3.5
3.5. Analysis
Comparison 3 Interventions (all) versus controls, other anthropometrics, longest follow‐up, Outcome 5 Waist‐to‐hip ratio.
3.6
3.6. Analysis
Comparison 3 Interventions (all) versus controls, other anthropometrics, longest follow‐up, Outcome 6 Fat mass.
3.7
3.7. Analysis
Comparison 3 Interventions (all) versus controls, other anthropometrics, longest follow‐up, Outcome 7 Trunk fat mass.
3.8
3.8. Analysis
Comparison 3 Interventions (all) versus controls, other anthropometrics, longest follow‐up, Outcome 8 Lean mass.
3.9
3.9. Analysis
Comparison 3 Interventions (all) versus controls, other anthropometrics, longest follow‐up, Outcome 9 % overweight.
4.1
4.1. Analysis
Comparison 4 Interventions (all) versus controls, quality of life, longest follow‐up, Outcome 1 Health‐related quality of life.
4.2
4.2. Analysis
Comparison 4 Interventions (all) versus controls, quality of life, longest follow‐up, Outcome 2 Health‐related quality of life by tool.
4.3
4.3. Analysis
Comparison 4 Interventions (all) versus controls, quality of life, longest follow‐up, Outcome 3 Self‐esteem.
4.4
4.4. Analysis
Comparison 4 Interventions (all) versus controls, quality of life, longest follow‐up, Outcome 4 Self‐esteem by outcome.
4.5
4.5. Analysis
Comparison 4 Interventions (all) versus controls, quality of life, longest follow‐up, Outcome 5 Self‐esteem by tool.
5.1
5.1. Analysis
Comparison 5 Interventions (all) versus controls, behavioural change, longest follow‐up, Outcome 1 Physical activity (mild ‐ vigorous physical activity).
5.2
5.2. Analysis
Comparison 5 Interventions (all) versus controls, behavioural change, longest follow‐up, Outcome 2 Physical activity length.
5.3
5.3. Analysis
Comparison 5 Interventions (all) versus controls, behavioural change, longest follow‐up, Outcome 3 Screen time.
6.1
6.1. Analysis
Comparison 6 Interventions versus control by duration of follow‐up, Outcome 1 Body mass index (BMI) change.
6.2
6.2. Analysis
Comparison 6 Interventions versus control by duration of follow‐up, Outcome 2 BMI z score change.
7.1
7.1. Analysis
Comparison 7 Interventions versus controls by duration of postintervention follow‐up, Outcome 1 Body mass index (BMI) change.
7.2
7.2. Analysis
Comparison 7 Interventions versus controls by duration of postintervention follow‐up, Outcome 2 BMI z score change.
8.1
8.1. Analysis
Comparison 8 Interventions by control type, longest follow‐up, Outcome 1 Body mass index (BMI) change.
8.2
8.2. Analysis
Comparison 8 Interventions by control type, longest follow‐up, Outcome 2 BMI z score change.
9.1
9.1. Analysis
Comparison 9 Interventions by mode, longest follow‐up, Outcome 1 Body mass index (BMI) change.
9.2
9.2. Analysis
Comparison 9 Interventions by mode, longest follow‐up, Outcome 2 BMI z score change.
10.1
10.1. Analysis
Comparison 10 Interventions by setting, longest follow‐up, Outcome 1 Body mass index (BMI) change.
10.2
10.2. Analysis
Comparison 10 Interventions by setting, longest follow‐up, Outcome 2 BMI z score change.
11.1
11.1. Analysis
Comparison 11 Interventions versus controls by intervention type, longest follow‐up, Outcome 1 Body mass index (BMI) change.
11.2
11.2. Analysis
Comparison 11 Interventions versus controls by intervention type, longest follow‐up, Outcome 2 BMI z score change.
12.1
12.1. Analysis
Comparison 12 Interventions versus controls by psychological approach, longest follow‐up, Outcome 1 Body mass index (BMI) change.
12.2
12.2. Analysis
Comparison 12 Interventions versus controls by psychological approach, longest follow‐up, Outcome 2 BMI z score change.
13.1
13.1. Analysis
Comparison 13 Interventions versus controls by parental involvement, longest follow‐up, Outcome 1 Body mass index (BMI) change.
13.2
13.2. Analysis
Comparison 13 Interventions versus controls by parental involvement, longest follow‐up, Outcome 2 BMI z score change.
See this image and copyright information in PMC

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Sigal 2014 {published data only}
    1. Alberga A, Goldfield G, Kenny G, Hadjiyannakis S, Phillips P, Prud'homme D, et al. Healthy Eating, Aerobic and Resistance Training in Youth (HEARTY): study rationale, design and methods. Contemporary Clinical Trials 2012;33:839‐47. - PubMed
    1. Goldfield G, Kenny G, Alberga A, Prud'homme D, Hadjiyannakis S, Gougeon R, et al. Effects of aerobic training, resistance training, or both on psychological health in adolescents with obesity: the HEARTY Rrandomized controlled trial. Journal of Consulting and Clinical Psychology 2015;83(6):1123. - PubMed
    1. NCT00195858. Healthy Eating Aerobic and Resistance Training in Youth (HEARTY) trial. clinicaltrials.gov/show/NCT00195858 Date first received: 12 September 2005.
    1. Sigal R, Alberga A, Goldfield G, Prud'homme D, Hadjiyannakis S, Gougeon R, et al. Effects of aerobic training, resistance training, or both on percentage body fat and cardiometabolic risk markers in obese adolescents: the Healthy Eating Aerobic and Resistance Training in Youth randomized clinical trial. JAMA Pediatrics 2014;168:1006‐14. - PubMed
Toulabi 2012 {published data only}
    1. Toulabi T, Nikoo M, Amini F, Nazari H, Mardani M. The influence of a behavior modification interventional program on body mass index in obese adolescents. Journal of the Formosan Medical Association / Taiwan Yi Zhi 2012;111(3):153‐9. - PubMed
van Egmond‐Frohlich 2006 {published data only}
    1. Egmond‐Frohlich A, Brauer W, Goldschmidt H, Hoff‐Emden H, Oepen J, Zimmermann E. Effects of a programme for structured outpatient follow‐up care after inpatient rehabilitation of obese children and adolescents ‐ a multicentre, randomized study. Rehabilitation 2006;45(1):40‐51. - PubMed
Vissers 2008 {published data only}
    1. Vissers D, Meulenaere A, Vanroy C, Vanherle K, Sompel A, Truijen S, et al. Effect of a multidisciplinary school‐based lifestyle intervention on body weight and metabolic variables in overweight and obese youth. E‐SPEN, the European E‐journal of Clinical Nutrition and Metabolism 2008;3(5):e196‐202.
Visuthranukul 2015 {published data only}
    1. NCT02049788. Effects of a low glycemic index in obese children. clinicaltrials.gov/show/NCT02049788 Date first received: 28 January 2014.
    1. Visuthranukul C, Sirimongkol P, Prachansuwan A, Pruksananonda C, Chomtho S. Low‐glycemic index diet may improve insulin sensitivity in obese children. Pediatric Research 2015;78(5):567‐73. - PubMed
Vos 2011 {published data only}
    1. ISRCTN36146436. The effect of lifestyle treatment on childhood obesity. www.isrctn.com/ISRCTN36146436 Date first assigned: 13 July 2010.
    1. Vos R, Huisman S, Houdijk E, Pijl H, Wit J. The effect of family‐based multidisciplinary cognitive behavioral treatment on health‐related quality of life in childhood obesity. Quality of Life Research 2012;21(9):1587‐94. - PubMed
    1. Vos R, Wit J, Pijl H, Houdijk E. Long‐term effect of lifestyle intervention on adiposity, metabolic parameters, inflammation and physical fitness in obese children: a randomized controlled trial. Nutrition & Diabetes 2011;1(10):e9. - PMC - PubMed
    1. Vos R, Wit J, Pijl H, Kruyff C, Houdijk, E. The effect of family‐based multidisciplinary cognitive behavioral treatment in children with obesity: study protocol for a randomized controlled trial. Trials 2011;12(1):110. - PMC - PubMed
Walpole 2013 {published data only}
    1. NCT01246349. Motivational interviewing for weight loss. clinicaltrials.gov/ct2/show/study/NCT01246349 Date first received: 11 November 2010.
    1. Walpole B, Dettmer E, Morrongiello B, McCrindle B, Hamilton J. Motivational interviewing as an intervention to increase adolescent self‐efficacy and promote weight loss: methodology and design. BMC Public Health 2011;11(1):459. - PMC - PubMed
    1. Walpole B, Dettmer E, Morrongiello B, McCrindle B, Hamilton J. Motivational interviewing to enhance self‐efficacy and promote weight loss in overweight and obese adolescents: a randomized controlled trial. Journal of Pediatric Psychology 2013;39(9):944‐53. - PubMed
Wengle 2011 {published data only}
    1. Wengle J, Hamilton J, Manlhiot C, Bradley T, Katzman D, Sananes R, et al. The 'Golden Keys' to health ‐ a healthy lifestyle intervention with randomized individual mentorship for overweight and obesity in adolescents. Paediatrics & Child Health 2011;16(18):473. - PMC - PubMed
Wong 2015 {published data only}
    1. Wong J, Ebbeling C, Robinson L, Feldman H, Ludwig D. Does the recommendation to drink 8 cups of water per day promote weight loss?. FASEB Journal 2015;29:747‐18.

References to studies excluded from this review

Balagopal 2005 {published data only}
    1. Balagopal P, George D, Patton N, Yarandi H, Roberts W, Bayne E, et al. Lifestyle‐only intervention attenuates the inflammatory state associated with obesity: a randomized controlled study in adolescents. Journal of Pediatrics 2005;146(3):342‐8. - PubMed
Belenchia 2013 {published data only}
    1. Belenchia A, Tosh A, Hillman L, Peterson C. Correcting vitamin D insufficiency improves insulin sensitivity in obese adolescents: a randomized controlled trial. American Journal of Clinical Nutrition 2013;97(4):774‐81. - PubMed
Braet 2004 {published data only}
    1. Braet C, Tanghe A, Decaluwé V, Moens E, Rosseel Y. Inpatient treatment for children with obesity: weight loss, psychological well‐being, and eating behavior. Journal of Pediatric Psychology 2004;29(7):519‐29. - PubMed
Carrel 2007 {published data only}
    1. Carrel A, Clark R, Peterson S, Eickhoff J, Allen D. School‐based fitness changes are lost during the summer vacation. Archives of Pediatrics & Adolescent Medicine 2007;161(6):561‐4. - PubMed
Crandall 2006 {published data only}
    1. Crandall M. The effectiveness of a program of comprehensive behavior modification therapy and sibutramine for obese adolescents. Thesis 2006; Vol. 69:3841.
Daly 2013 {published data only}
    1. Daly P. Obese Adolescent Females and Actual Behavioral Responses to a Mindful Eating Intervention [Doctoral dissertation]. Tucson (AZ): University of Arizona, 2013.
Dancy 2006 {published data only}
    1. Dancy B, Crittenden K, Talashek M. Effectiveness of the mother/daughter health promotion intervention in enhancing daughters' healthy eating behavior. APHA 134th Annual Meeting and Exposition; 2006 Nov 4‐8; Boston (MA). 2006.
De Jesus 2013 {published data only}
    1. Jesus S, Prapavessis H. The effects of a peer modeling intervention on cardiorespiratory fitness parameters and self‐efficacy in obese adolescents. Behavioral Medicine 2013;39(4):129‐37. - PubMed
DeVore 2013 {published data only}
    1. DeVore S, Kohli R, Lake K, Nicholas L, Dietrich K, Balistreri W, et al. A multidisciplinary clinical program is effective in stabilizing BMI and reducing transaminase levels in pediatric patients with NAFLD. Journal of Pediatric Gastroenterology and Nutrition 2013;57(1):119. - PMC - PubMed
Doyle 2008 {published data only}
    1. Doyle A, Goldschmidt A, Huang C, Winzelberg A, Taylor C, Wilfley D. Reduction of overweight and eating disorder symptoms via the internet in adolescents: a randomized controlled trial. Journal of Adolescent Health 2008;43(2):172‐9. - PMC - PubMed
Dreyer‐Gillette 2014 {published data only}
    1. Dreyer‐Gillette M, Odar Stough C, Best C, Beck A, Hampl S. Comparison of a condensed 12‐week version and a 24‐week version of a family‐based pediatric weight management program. Childhood Obesity 2014;10(5):375‐82. - PubMed
Faulkner 2013 {published data only}
    1. Faulkner M, Michaliszyn S, Hepworth J, Wheeler M. Personalized exercise for adolescents with diabetes or obesity. Biological Research for Nursing 2013;20:1099800413500064. - PMC - PubMed
Fonseca 2016 {published data only}
    1. Fonseca H, Prioste A, Sousa P, Gaspar P, do Céu Machado M. Effectiveness analysis of an internet‐based intervention for overweight adolescents: next steps for researchers and clinicians. BMC Obesity 2016;3(1):1. - PMC - PubMed
    1. NCT01904474. E‐therapeutic program for obese adolescents. clinicaltrials.gov/ct2/show/NCT01904474 Date first received: 9 July 2013.
Freire 2013 {published data only}
    1. Freire S, Fisberg M, Cozzolino S. Dietary intervention causes redistribution of zinc in obese adolescents. Biological Trace Element Research 2013;154(2):168‐77. - PubMed
Garnett 2014 {published data only}
    1. Garnett S, Gow M, Ho M, Baur L, Noakes M, Woodhead H, et al. Improved insulin sensitivity and body composition, irrespective of macronutrient intake, after a 12 month intervention in adolescents with pre‐diabetes; RESIST a randomised control trial. BMC Pediatrics 2014;14(1):289. - PMC - PubMed
Giel 2013 {published data only}
    1. Giel K, Zipfel S, Schweizer R, Braun R, Ranke M, Binder G, et al. Eating disorder pathology in adolescents participating in a lifestyle intervention for obesity: associations with weight change, general psychopathology and health‐related quality of life. Obesity Facts 2013;6(4):307‐16. - PMC - PubMed
Hay 2016 {published data only}
    1. Hay J, Wittmeier K, MacIntosh A, Wicklow B, Duhamel T, Sellers E, et al. Physical activity intensity and type 2 diabetes risk in overweight youth: a randomized trial. International Journal of Obesity 2016;40:607‐14. - PubMed
Jelalian 1999 {published data only}
    1. Jelalian E, Saelens B. Empirically supported treatments in pediatric psychology: pediatric obesity. Journal of Pediatric Psychology 1999;24(3):223‐48. - PubMed
Jelalian 2010 {published data only}
    1. Jelalian E, Lloyd‐Richardson EE, Mehlenbeck RS, Hart CN, Flynn‐O'Brien K, Kaplan J, et al. Behavioral weight control treatment with supervised exercise or peer‐enhanced adventure for overweight adolescents. Journal of Pediatrics 2010;157(6):923‐8. - PMC - PubMed
Jones 2008 {published data only}
    1. Jones M, Luce K, Osborne M, Taylor K, Cunning D, Doyle A, et al. Randomized, controlled trial of an internet‐facilitated intervention for reducing binge eating and overweight in adolescents. Pediatrics 2008;121(3):453‐62. - PubMed
Jones 2009 {published data only}
    1. Jones M. Reducing Binge Eating and Overweight in Adolescents via the Internet [Doctoral thesis]. Palo Alto (CA): Palo Alto University, 2009.
Lee 2013a {published data only}
    1. Lee S, Kuk J. Changes in fat and skeletal muscle with exercise training in obese adolescents: comparison of whole‐body MRI and dual energy X‐ray absorptiometry. Obesity 2013;21(10):2063‐71. - PMC - PubMed
Lee 2013b {published data only}
    1. Lee S, Deldin A, White D, Kim Y, Libman I, Rivera‐Vega M, et al. Aerobic exercise but not resistance exercise reduces intrahepatic lipid content and visceral fat and improves insulin sensitivity in obese adolescent girls: a randomized controlled trial. American Journal of Physiology. Endocrinology and Metabolism 2013;305(10):E1222‐9. - PMC - PubMed
Lee 2013c {published data only}
    1. Lee S, Burns S, White D, Kuk J, Arslanian S. Effects of acute exercise on postprandial triglyceride response after a high‐fat meal in overweight black and white adolescents. International Journal of Obesity 2013;37(7):966‐71. - PMC - PubMed
Lovely 2013 {published data only}
    1. Lovely R, Hossain J, Ramsey J, Komakula V, George D, Farrell D, et al. Obesity‐related increased γ' fibrinogen concentration in children and its reduction by a physical activity‐based lifestyle intervention: a randomized controlled study. Journal of Pediatrics 2013;163(2):333‐8. - PubMed
Lubans 2008 {published data only}
    1. Lubans D, Morgan P. Evaluation of an extra‐curricular school sport programme promoting lifestyle and lifetime activity for adolescents. Journal of Sports Sciences 2008;26(5):519‐29. - PubMed
NCT00863083 {published data only}
    1. NCT00863083. Reducing barriers to behavior change among youth with pediatric overweight and obesity. clinicaltrials.gov/ct2/show/NCT00863083 Date first received: 16 March 2009.
NCT01044134 {published data only}
    1. NCT01044134. Think AHEAD (a healthy eating and drinking) study. clinicaltrials.gov/ct2/show/NCT01044134 Date first received: 5 January 2010.
NCT02011646 {published data only}
    1. NCT02011646. Healthy body study. clinicaltrials.gov/ct2/show/NCT02011646 Date first received: 10 December 2013.
NCT02295761 {published data only}
    1. NCT02295761. Promoting overweight adolescents physical activity. clinicaltrials.gov/ct2/show/NCT02295761 Date first received: 18 February 2014.
Nunes 2016 {published data only}
    1. Nunes JE, Cunha HS, Freitas ZR, Nogueira AM, Dâmaso AR, Espindola FS, et al. Interdisciplinary therapy changes superoxide dismutase activity and adiponectin in obese adolescents: a randomised controlled trial. Journal of Sports Sciences 2016;34(10):945‐50. - PubMed
Parks 2014 {published data only}
    1. Parks E, Zemel B, Moore R, Berkowitz R. Change in body composition during a weight loss trial in obese adolescents. Pediatric Obesity 2014;9(1):26‐35. - PMC - PubMed
Racil 2013 {published data only}
    1. Racil G, Ounis O, Hammouda O, Kallel A, Zouhal H, Chamari K, et al. Effects of high vs. moderate exercise intensity during interval training on lipids and adiponectin levels in obese young females. European Journal of Applied Physiology 2013;113(10):2531‐40. - PubMed
Sabzghabaee 2013 {published data only}
    1. Sabzghabaee AM, Khayam I, Kelishadi R, Ghannadi A, Soltani R, Badri S, et al. Effect of Zizyphus jujuba fruits on dyslipidemia in obese adolescents: a triple‐masked randomized controlled clinical trial. Medical Archives 2013;67(3):156. - PubMed
Sarvestani 2009 {published data only}
    1. Sarvestani R, Jamalfard M, Kargar M, Kaveh M, Tabatabaee H. Effect of dietary behaviour modification on anthropometric indices and eating behaviour in obese adolescent girls. Journal of Advanced Nursing 2009;65(8):1670‐5. - PubMed
Shrewsbury 2011 {published data only}
    1. Shrewsbury V, Nguyen B, O'Connor J, Steinbeck K, Lee A, Hill A, et al. Short‐term outcomes of community‐based adolescent weight management: the Loozit® Study. BMC Pediatrics 2011;11(1):13. - PMC - PubMed
Sussman 2013 {published data only}
    1. Sussman A, Montoya C, Werder O, Davis S, Wallerstein N, Kong A. An adaptive CBPR approach to create weight management materials for a school‐based health center intervention. Journal of Obesity 2013;2013(978482):1‐9. - PMC - PubMed
Van 2013 {published data only}
    1. Vann L, Stanford F, Durkin M, Hanna A, Knight L, Stallworth J. "Moving and losing": a pilot study incorporating physical activity to decrease obesity in the pediatric population. Journal of the South Carolina Medical Association (1975) 2013;109(4):116‐20. - PubMed
Ventura 2009 {published data only}
    1. Ventura E, Davis J, Byrd‐Williams C, Toledo‐Corral C, Spruijt‐Metz D, Weigensberg M, et al. The effects of a randomized, controlled, modified‐carbohydrate nutrition intervention on the metabolic syndrome in overweight Latino adolescents. Obesity 2009;17:S183‐4.
Wadden 1990 {published data only}
    1. Wadden T, Stunkard A, Rich L, Rubin C, Sweidel G, McKinney S. Obesity in black adolescent girls: a controlled clinical trial of treatment by diet, behavior modification, and parental support. Pediatrics 1990;85(3):345‐52. - PubMed
Wiegand 2014 {published data only}
    1. Wiegand S, Bau A, Ernert A, Krude H. MAINTAIN: an intervention study of weight regain after weight loss in adolescents and children reveals an only minor role of leptin in weight regain. Hormone Research in Paediatrics 2014;82:1‐507.
Wilson 2012 {published data only}
    1. Wilson A, Jung M, Cramp A, Simatovic J, Prapavessis H, Clarson C. Effects of a group‐based exercise and self‐regulatory intervention on obese adolescents' physical activity, social cognitions, body composition and strength: a randomized feasibility study. Journal of Health Psychology 2012;17:1223‐37. - PubMed
Xanthopoulos 2013 {published data only}
    1. Xanthopoulos M, Moore R, Wadden T, Bishop‐Gilyard C, Gehrman C, Berkowitz R. The association between weight loss in caregivers and adolescents in a treatment trial of adolescents with obesity. Journal of Pediatric Psychology 2013;38(7):766‐74. - PMC - PubMed

References to studies awaiting assessment

Angerer 2015 {published data only}
    1. Angerer P, Niedermeier H, Graf T, Manthey A, Marten‐Mittag B, Schmidt H, et al. Fit4You ‐ a programme for prevention and reduction of overweight in apprentices in the workplace setting. Gesundheitswesen (Bundesverband der Arzte des Offentlichen Gesundheitsdienstes (Germany) 2015;77:S95‐6. [PUBMED: 23970389] - PubMed
Barbeau 2003 {published data only}
    1. Barbeau P, Gutin B, Litaker M, Ramsey L, Cannady W, Allison J, et al. Influence of physical training on plasma leptin in obese youths. Canadian Journal of Applied Physiology 2003;28(3):382‐96. - PubMed
Bohlin 2012 {published data only}
    1. Bohlin A, Klaesson S, Kowalski J. Can telephone consultations substitute visits in treatment of childhood obesity? Results from a randomized trial. Obesity Facts 2012;5(Suppl 1):237.
Campos 2017 {published data only}
    1. Campos R, Masquio D, Corgosinho F, Lima S, Piano A, Carnier J, et al. Homeostasis Model Assessment‐Adiponectin: the role of different types of physical exercise in obese adolescents. Journal of Sports Medicine and Physical Fitness 2017; Vol. 57, issue 6:831‐8. - PubMed
Cocca 2016 {published data only}
    1. Cocca A, Lomas R, Enríquez M, Cocca M, Ceballos O. Effects of a school‐based intervention program on metabolic syndrome parameters in school‐aged youth. Obesity Reviews 2016;17:131‐2.
Garrett 1979 {published data only}
    1. Garrett L. Group behavioral therapy versus family behavioral therapy in treatment of obese adolescent females [Doctor of Philosophy thesis]. University of Pennsylvania, 1979:1364‐5.
Gracianette 1982 {published data only}
    1. Gracianette C. The application of behavioral techniques to change eating habits and/or exercise habits to effect weight reduction and maintenance in adolescents: a year‐long study [Doctor of Philosophy thesis]. Baton Rouge (LA): Louisiana State University and Agricultural & Mechanical College, 1982.
Li 2006 {published data only}
    1. Li M. Anti‐obesity effect of comprehensive diet and sports in girl students with simple obesity or overweight. Chinese Journal of Clinical Rehabilitation 2006;10(32):44‐6.
Makkes 2015 {unpublished data only}
    1. Makkes S. Intensive inpatient treatment for severely obese children and adolescents: costs and effects [Doctoral Thesis]. Amsterdam (Netherlands): VU University Amsterdam, 2015.
    1. Makkes S, Halberstadt J, Renders C, Bosmans J, Baan‐Slootweg O, Seidell C. Health Effects of Lifestyle Interventions in Obese children and adolescents Study (HELIOS) ‐ a randomised controlled trial. Obesity Reviews 2011;12:58.
    1. Makkes S, Halberstadt J, Renders C, Bosmans J, Baan‐Slootweg O, Seidell J. Cost‐effectiveness of intensive inpatient treatments for severely obese children and adolescents in the Netherlands; a randomized controlled trial (HELIOS). BMC Public Health 2011;11(1):518. - PMC - PubMed
    1. NTR1678. Het HELIOS onderzoek naar behandeling van kinderen en adolescenten met ernstige obesitas. www.trialregister.nl/trialreg/admin/rctview.asp?TC=1678 Date first registered: 20 February 2009.
NCT00462267 {published data only}
    1. NCT00462267. Examining the feasibility of collaborative care treatment for overweight adolescents (SHINE‐Garfield). clinicaltrials.gov/ct2/show/NCT00462267 Date first received: 17 April 2007.
NCT00475163 {published data only}
    1. NCT00475163. Mentors in motion: a physical activity intervention for obese adolescents (MIM). clinicaltrials.gov/show/NCT00475163 Date first received: 17 May 2007.
Shapiro 1976 {published data only}
    1. Shapiro J. A comparison of various reward and monitoring procedures in the behavioral treatment of overweight children. Dissertation 1976; Vol. 36, issue 11‐B:5816‐7.

References to ongoing studies

ACTRN12607000632493 {published data only}
    1. ACTRN12607000632493. Active video games to improve body composition and physical activity in children. www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12607000632493 Date first registered: 12 December 2007.
    1. Maddison R, Foley L, Mhurchu CN, Jull A, Jiang Y, Prapavessis H, et al. Feasibility, design and conduct of a pragmatic randomized controlled trial to reduce overweight and obesity in children: the electronic games to aid motivation to exercise (eGAME) study. BMC Public Health 2009;9:146. [DOI: 10.1186/1471-2458-9-146] - DOI - PMC - PubMed
ACTRN12611000139976 {published data only}
    1. ACTRN12611000139976. Staying fit adolescent weight management study. www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12611000139976 Date first registered: 7 February 2011.
ACTRN12611000862943 {published data only}
    1. ACTRN12611000862943. Whanau Pakari: a multidisciplinary intervention for child and adolescent obesity. anzctr.org.au/Trial/Registration/TrialReview.aspx?id=343300 Date first registered: 15 August 2011.
ACTRN12613001037796 {published data only}
    1. ACTRN12613001037796. Effect of exercise intensity on cardiac and vascular function, and intra‐abdominal fat in obese children and adolescents. www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12613001037796 Date first registered: 18 September 2013.
ACTRN12615000558527 {published data only}
    1. ACTRN12615000558527. The effectiveness of a community weight management program with a behavioural incentive scheme compared to participation in a standard community weight management program in overweight children on relative weight loss and behaviour change. anzctr.org.au/Trial/Registration/TrialReview.aspx?id=368491 Date first registered: 29 May 2015.
Chew 2016 {published data only}
    1. Chew C, Kelly SM, Rajasegaran K, Oh JY, Lim M, Lim SC, et al. Three month outcome of a family based intervention program for adolescent obesity: the Lite randomised controlled trial. Obesity Reviews 2016;17:124. - PMC - PubMed
ChiCTR‐TRC‐13003501 {published data only}
    1. ChiCTR‐TRC‐13003501. Lifestyle intervention in obese Chinese adolescents with nonalcoholic fatty liver disease: a randomized controlled study. www.chictr.org.cn/showprojen.aspx?proj=6059 Date first registered: 21 August 2013.
DRKS00004583 {published data only}
    1. DRKS00004583. Feasibility and efficacy of a weight maintenance treatment approach for adolescent obesity via telephone counseling following an obesity treatment program: a randomized controlled trial. drks‐neu.uniklinik‐freiburg.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DR... Date first registered: 30 November 2012.
    1. Marked J, Herget S, Marschke S, Vogel M, Hilbert A, Bluher S. Weight maintenance treatment approach for adolescent obesity via telephone counseling following an inpatient obesity treatment program ‐ study concept. Obesity Facts Vol. 5:30.
    1. Markert J, Herget S, Marschke S, Lehnert T, Falkenberg C, Blüher S. Case management via telephone counseling and SMS for weight maintenance in adolescent obesity: study concept of the TeAM program. BMC Obesity 2014; Vol. 1, issue 1:8. - PMC - PubMed
    1. Markert J, Herget S, Vogel M, Gausche R, Hilbert A, Bluher S. After care treatment approach for adolescent obesity via telephone counseling following an obesity treatment program‐study concept. Hormone Research in Paediatrics Vol. 78:279.
DRKS00005299 {published data only}
    1. DRKS00005299. Impact of resistance versus endurance exercise on anthropometric and metabolic parameters within a standardized one year obesity treatment program for obese children and adolescents. drks‐neu.uniklinik‐freiburg.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DR... Date first registered: 13 September 2013.
DRKS00006781 {published data only}
    1. DRKS00006781. Feasibility of a media‐supported high‐intensity interval training program for overweight and obese adolescents. drks‐neu.uniklinik‐freiburg.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DR... Date first registered: 17 September 2014.
DRKS00007879 {published data only}
    1. DRKS00007879. Development and evaluation of a computer‐based self‐regulation training for obese children and adolescents. drks‐neu.uniklinik‐freiburg.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DR... Date first registered: 13 July 2015.
EUCTR2009‐016921‐32‐ES {published data only}
    1. EUCTR2009‐016921‐32‐ES. A phase II, randomized, double‐blind, placebo‐controlled, in parallel groups clinical trial to assess the safety and efficacy of dietary supplementation with tryptophan to achieve weight loss, and its neuropsychological effects in adolescents with obesity. www.clinicaltrialsregister.eu/ctr‐search/search?query=eudract_number:200... Date first registered: not available.
IRCT201012235440N1 {published data only}
    1. IRCT201012235440N1. Effectiveness of a theory‐based intervention on obesity‐related behaviors, laboratory indices, body composition, body mass index and health‐related quality of life in overweight adolescents. www.irct.ir/searchresult.php?id=5440&number=1 Date first registered: 18 February 2011.
IRCT2013103115211N1 {published data only}
    1. IRCT2013103115211N1. Study on the effect of nutrition education and physical activity intervention using social cognitive theory for overweight and obese student girls of middle school of Shahinshahr. www.irct.ir/searchresult.php?id=15211&number=1 Date first registered: 27 November 2013.
ISRCTN04152711 {published data only}
    1. ISRCTN04152711. Preventing obesity in young people attending primary dental care settings: an exploratory randomised controlled trial. www.isrctn.com/ISRCTN04152711 Date first assigned: 24 May 2012.
    1. Murphy M, Porter J, Yusuf H, Ntouva A, Newton T, Kolliakou A, et al. Considerations and lessons learned from designing a motivational interviewing obesity intervention for young people attending dental practices: a study protocol paper. Contemporary Clinical Trials 2013;36(1):126‐34. - PubMed
NCT00562263 {published data only}
    1. NCT00562263. Barriers to effective weight loss in overweight adolescents (TEENS). clinicaltrials.gov/ct2/show/NCT00562263 Date first received: 20 November 2007.
NCT00850629 {published data only}
    1. NCT00850629. Hormonal regulation of body weight maintenance. clinicaltrials.gov/ct2/show/NCT00850629 Date first received: 17 February 2009.
NCT00881478 {published data only}
    1. NCT00881478. Family intervention for obese children using portion control strategy for weight control (FOCUS). clinicaltrials.gov/ct2/show/NCT00881478 Date first received: 13 April 2009.
NCT00940966 {published data only}
    1. NCT00940966. A pilot study to determine the efficacy of a low carbohydrate diet in treatment of adolescents with metabolic syndrome. clinicaltrials.gov/ct2/show/NCT00940966 Date first received: 15 July 2009.
NCT00998413 {published data only}
    1. NCT00998413. Weight‐reduction intervention in asthmatic children with overweight/obesity. clinicaltrials.gov/ct2/show/NCT00998413 Date first received: 19 October 2009.
    1. Willeboordse M, Kant KD, Laat MN, Schayck OC, Mulkens S, Dompeling E. Multifactorial intervention for children with asthma and overweight (Mikado): study design of a randomised controlled trial. BMC Public Health 2013;13:494. [DOI: 10.1186/1471-2458-13-494] - DOI - PMC - PubMed
NCT01023139 {published data only}
    1. NCT01023139. Efficacy in adolescents of continued behavior modification following a six month sibutramine‐based weight management intervention (AOS). clinicaltrials.gov/ct2/show/NCT01023139 Date first received: 1 December 2009.
NCT01221220 {published data only}
    1. NCT01221220. Environmental strategies & behavior change to reduce overeating in obese children. clinicaltrials.gov/ct2/show/NCT01221220 Date first received: 13 October 2010.
NCT01350531 {published data only}
    1. NCT01350531. Interventionist procedures for adherence to weight loss recommendations in black adolescents. clinicaltrials.gov/ct2/show/NCT01350531 Date first received: 21 April 2011.
NCT01374386 {published data only}
    1. NCT01374386. Impact of Exergaming on adolescent youth. clinicaltrials.gov/ct2/show/NCT01374386 Date first received: 14 June 2011.
NCT01448551 {published data only}
    1. NCT01448551. MPOWERed messages: tailored mobile messages to enhance weight loss for teens. clinicaltrials.gov/ct2/show/NCT01448551 Date first received: 5 October 2011.
NCT01456221 {published data only}
    1. NCT01456221. Intervention study with omega‐3 fatty acids for weight loss and insulin resistance in adolescents (O3WLIRADOL). clinicaltrials.gov/ct2/show/NCT01456221 Date first received: 12 October 2011.
NCT01514279 {published data only}
    1. NCT01514279. Ideas moving parents and adolescents to change together (IMPACT). clinicaltrials.gov/ct2/show/NCT01514279 Date first received: 20 December 2011.
NCT01677923 {published data only}
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