***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background The prevalence of overweight and obesity in children has at least doubled in the past 25 years with a major impact on health . In 2005 a prevention protocol was developed applicable within Youth Health Care . This study aims to assess the effects of this protocol on prevalence of overweight and health behaviour among children . Methods and design A cluster r and omised controlled trial is conducted among 5-year-old children included by 44 Youth Health Care teams r and omised within 9 Municipal Health Services . The teams are r and omly allocated to the intervention or control group . The teams measure the weight and height of all children . When a child in the intervention group is detected with overweight according to the international age and gender specific cut-off points of BMI , the prevention protocol is applied . According to this protocol parents of overweight children are invited for up to three counselling sessions during which they receive personal advice about a healthy lifestyle , and are motivated for and assisted in behavioural change . The primary outcome measures are Body Mass Index and waist circumference of the children . Parents will complete question naires to assess secondary outcome measures : levels of overweight inducing/reducing behaviours ( i.e. being physically active , having breakfast , drinking sweet beverages and watching television/playing computer games ) , parenting styles , parenting practice s , and attitudes of parents regarding these behaviours , health-related quality of life of the children , and possible negative side effects of the prevention protocol . Data will be collected at baseline ( when the children are aged 5 years ) , and after 12 and 24 months of follow-up . Additionally , a process and a cost-effectiveness evaluation will be conducted . Discussion In this study called ' Be active , eat right ' we evaluate an overweight prevention protocol for use in the setting of Youth Health Care . It is hypothesized that the use of this protocol will result in a healthier lifestyle of the children and an improved BMI and waist circumference . Trial registration Current Controlled Trials IS RCT Background Childhood obesity is one of the most pressing health issues of our time . Key health organizations have recommended research be conducted on the effectiveness of well- design ed interventions to combat childhood obesity that can be translated into a variety of setting s. This paper describes the design and methods used in the Hunter Illawarra Kids Challenge Using Parent Support ( HIKCUPS ) trial , an ongoing multi-site r and omized controlled trial , in overweight/obese children comparing the efficacy of three interventions : 1 ) a parent-centered dietary modification program ; 2 ) a child-centered physical activity skill-development program ; and 3 ) a program combining both 1 and 2 above . Methods / Design Each intervention consists of three components : i ) 10-weekly face-to-face group sessions ; ii ) a weekly homework component , completed between each face-to-face session and iii ) three telephone calls at monthly intervals following completion of the 10-week program . Details of the programs ' method ological aspects of recruitment , r and omization and statistical analyses are described here a priori . Discussion Importantly this paper describes how HIKCUPS addresses some of the short falls in the current literature pertaining to the efficacy of child obesity interventions .The HIKCUPS trial is funded by the National Medical Research Council , Australia Objective To examine the prevalence of outcome reporting bias — the selection for publication of a subset of the original recorded outcome variables on the basis of the results — and its impact on Cochrane review s. Design A nine point classification system for missing outcome data in r and omised trials was developed and applied to the trials assessed in a large , unselected cohort of Cochrane systematic review s. Research ers who conducted the trials were contacted and the reason sought for the non-reporting of data . A sensitivity analysis was undertaken to assess the impact of outcome reporting bias on review s that included a single meta- analysis of the review primary outcome . Results More than half ( 157/283 ( 55 % ) ) the review s did not include full data for the review primary outcome of interest from all eligible trials . The median amount of review outcome data missing for any reason was 10 % , whereas 50 % or more of the potential data were missing in 70 ( 25 % ) review s. It was clear from the publications for 155 ( 6 % ) of the 2486 assessable trials that the research ers had measured and analysed the review primary outcome but did not report or only partially reported the results . For reports that did not mention the review primary outcome , our classification regarding the presence of outcome reporting bias was shown to have a sensitivity of 88 % ( 95 % CI 65 % to 100 % ) and specificity of 80 % ( 95 % CI 69 % to 90 % ) on the basis of responses from 62 trialists . A third of Cochrane review s ( 96/283 ( 34 % ) ) contained at least one trial with high suspicion of outcome reporting bias for the review primary outcome . In a sensitivity analysis undertaken for 81 review s with a single meta- analysis of the primary outcome of interest , the treatment effect estimate was reduced by 20 % or more in 19 ( 23 % ) . Of the 42 meta-analyses with a statistically significant result only , eight ( 19 % ) became non-significant after adjustment for outcome reporting bias and 11 ( 26 % ) would have overestimated the treatment effect by 20 % or more . Conclusions Outcome reporting bias is an under-recognised problem that affects the conclusions in a substantial proportion of Cochrane review s. Individuals conducting systematic review s need to address explicitly the issue of missing outcome data for their review to be considered a reliable source of evidence . Extra care is required during data extraction , review ers should identify when a trial reports that an outcome was measured but no results were reported or events observed , and contact with trialists should be encouraged This Scientific Statement addresses  Parents and Adult Caregivers ( PACs )  as ‘ agents of change ’ for obese children . Evidence is review ed to support the notion that PACs can leverage behavior change and reduce positive energy balance in obese youth , and research opportunities for the field are discussed . The Statement has three specific aims : First , the core behavior change strategies for PACs as used in family-based treatment programs are review ed . These strategies reduce childhood overweight compared to no treatment or nutrition education alone , although their limited potency is recognized . Second , the strength of evidence is evaluated for the hypothesis that greater parental ‘ involvement ’ in treatment is associated with greater reductions in child overweight . Drawing upon r and omized clinical trials that varied the degree/nature of parental involvement , and observational analyses that assessed parental adherence to behavioral strategies , we report limited and inconsistent support . For example , only 17 % of the intervention studies reported differential improvements in child overweight as function of parental involvement after treatment . On the other h and , greater parental adherence predicted better child weight outcomes after 2 and 5 years in certain studies . Third , research gaps identified throughout this review process are delineated and new opportunities for the field are proposed . For example , the assessment of refined parenting phenotypes , cultural tailoring of interventions , examination of family relationships , and incorporating new technologies in treatment represent topics needing further study . A conceptual model is proposed to guide research on underst and ing the determinants of parental feeding and physical-activity parenting practice s. The Statement strives to innovate the scope and potency of PAC treatments for childhood obesity Background : Treatment of childhood obesity is difficult , and successful management may differ in various areas with different cultural background s. The present study was conducted to assess the effect of lifestyle modification family-based intervention in young Iranian children . Methods : This field trial study was conducted in 2011 among 156 obese children in Tehran , Iran . They were r and omly assigned to intervention and control groups . At baseline , anthropometric measurements and biochemical analysis were performed . The second and third phases consisted of training sessions for parents of the intervention group . At the fourth phase , there was no training program . In all four phases , question naires on demographic characteristics , lifestyle and food frequency were completed by interviewing with mothers , and biochemical analysis was repeated at the end of the study . Results : During the second and third phases of the study , weight and height increased significantly in both groups , although weight increased more slowly , and waist and hip circumferences was decreased in the intervention group . Serum triglycerides and cholesterol decreased significantly in the intervention group ( P < 0.05 ) . Analysis of food group consumption showed that in the intervention group , not only consumption of milk , dairy and nuts group increased significantly but also the corresponding figure decreased for bread and cereals , sugar and confectionery ingredients ; moreover , the family 's oil and fat consumption decreased significantly ( P < 0.05 ) . Watching TV and playing on the computer decreased significantly in the intervention group ; however , walking time increased significantly in both groups ( P < 0.05 ) . Conclusions : The family-based lifestyle program had limited but desirable effects on anthropometric and metabolic outcomes of the obese children . We suggest that a longer period of intervention may have more favorable results BACKGROUND Excessive weight in childhood is a serious public health concern because of its costly health consequences and its increasing prevalence . OBJECTIVE Our objective was to compare the efficacy of a family-based approach for the treatment of  childhood obesity  , in which the parents served as the exclusive agents of change , with that of the conventional approach , in which the children served as the agents of change . DESIGN This study had a r and omized , longitudinal prospect i ve design and lasted 1 y. Sixty obese children aged 6 - 11 y were r and omly allocated to the experimental ( parents as agents of change ) or control ( children as agents of change ) group . Anthropometric and biochemical measurements were determined at the start and end of the study . A  sociodemographic question naire and a family eating and activity habits question naire were completed by both parents . Hour-long support and educational sessions were conducted by a clinical dietitian : 14 sessions for the parents in the experimental group and 30 sessions for the children in the control group . RESULTS The dropout rate was nine times greater in the control group ( n = 9 ) than in the experimental group ( n = 1 ) . Mean percentile weight reduction was significantly ( P < 0.03 ) higher in children in the experimental group ( 14.6 % ) than in the control group ( 8.1 % ) . CONCLUSIONS Treatment of childhood obesity with parents as the exclusive agents of change was superior to the conventional approach , as indicated by the dropout rate and the percentage weight loss of the children during the 1-y intervention There is a consensus that interventions to prevent and treat childhood obesity should involve the family ; however , the extent of the child 's involvement has received little attention . The goal of the present study was to evaluate the relative efficacy of treating childhood obesity via a family-based health-centred intervention , targeting parents alone  v.  parents and obese children together .  Thirty-two families with obese children of 6 - 11 years of age were r and omised into groups , in which participants were provided for 6 months a comprehensive educational and behavioural programme for a healthy lifestyle . These groups differed in their main agent of change : parents-only v. the parents and the obese child . In both groups , parents were encouraged to foster authoritative parenting styles ( parents are both firm and supportive ; assume a leadership role in the environmental change with appropriate granting of child 's autonomy ) . Only the intervention aim ed at parents-only result ed in a significant reduction in the percentage overweight at the end of the programme ( P=0.02 ) as well as at the 1-year follow-up meeting . The differences between groups at both times were significant ( P<0.05 ) . A greater reduction in food stimuli in the home ( P<0.05 ) was noted in the parents-only group . In both groups , the parents ' weight status did not change . Regression analysis shows that the level of attendance in sessions explained 28 % of the variability in the children 's weight status change , the treatment group explained another 10 % , and the improvement in the obesogenic load explained 11 % of the variability . These results suggest that omitting the obese child from active participation in the health-centred programme may be beneficial for weight loss and for the promotion of a healthy lifestyle among obese children Background With rates of childhood obesity increasing , physical activity ( PA ) promotion especially in young children has assumed greater importance . Given the limited effectiveness of most interventions to date , new approaches are needed . The General Systems theory suggests that involving parents as intervention targets may be effective in fostering healthier life styles in children . We describe the development of a parent-focused participatory intervention and the procedures used to evaluate its effectiveness in increasing daily PA in preschoolers . Methods / Design Thirty-seven South German preschools were identified for this study and agreed to participate . Using a two-armed , controlled cluster-r and omized trial design we test a participatory intervention with parents as the primary target group and potential agents of behavioural change . Specifically , the intervention is design ed to engage parents in the development , refinement and selection of project ideas to promote PA and in incorporating these ideas into daily routines within the preschool community , consisting of children , teachers and parents . Our study is embedded within an existing state-sponsored programme providing structured gym lessons to preschool children . Thus , child-based PA outcomes from the study arm with the parent-focused intervention and the state-sponsored programme are compared with those from the study arm with the state-sponsored programme alone . The evaluation entails baseline measurements of study outcomes as well as follow-up measurements at 6 and 12 months . Accelerometry measures PA intensity over a period of six days , with the mean over six days used as the primary outcome measure . Secondary outcomes include childrens ' BMI , a sum of averaged skin fold thickness measurements across multiple sites , and PA behaviour . Longitudinal multilevel models are used to assess within-subject change and between-group differences in study outcomes , adjusted for covariates at the preschool and individual levels . Teacher qualitative interviews monitor the intervention implementation process . Discussion Participatory approaches that actively involve parents have the potential to promote PA in ways that might be better tailored to local needs and more sustainable . Our mixed methods approach to assess the intervention efficacy and implementation employing both quantitative and qualitative measures within a cluster-r and om 
    Output:
    
Generally , these trials did not show substantial differences between their respective parent-only groups on BMI outcomes .Other outcomes such as behavioural measures , parent-child relationships and health-related quality of life were reported inconsistently .
Parent-only interventions may be an effective treatment option for overweight or obese children aged 5 to 11 years when compared with waiting list controls .
Parent-only interventions had similar effects compared with parent-child interventions and compared with those with minimal contact controls .