***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: Objective To determine whether modifying eating behaviour with use of a feedback device facilitates weight loss in obese adolescents . Design R and omised controlled trial with 12 month intervention . Setting Hospital based obesity clinic . Participants 106 newly referred obese young people aged 9 - 17 . Interventions A computerised device , M and ometer , providing real time feedback to participants during meals to slow down speed of eating and reduce total intake ; st and ard lifestyle modification therapy . Main outcome measures Change in body mass index ( BMI ) st and ard deviation score ( SDS ) over 12 months with assessment 18 months after the start of the intervention . Secondary outcomes were body fat SDS , metabolic status , quality of life evaluation , change in portion size , and eating speed . Results Using the last available data on all participants ( n=106 ) , those in the M and ometer group had significantly lower mean BMI SDS at 12 months compared with st and ard care ( baseline adjusted mean difference 0.24 , 95 % confidence interval 0.11 to 0.36 ) . Similar results were obtained when analyses included only the 91 who attended per protocol ( baseline adjusted mean difference 0.27 , 0.14 to 0.41 ; P<0.001 ) , with the difference maintained at 18 months ( 0.27 , 0.11 to 0.43 ; P=0.001 ) ( n=87 ) . The mean meal size in the M and ometer group fell by 45 g ( 7 to 84 g ) . Mean body fat SDS adjusted for baseline levels was significantly lower at 12 months ( 0.24 , 0.10 to 0.39 ; P=0.001 ) . Those in the M and ometer group also had greater improvement in concentration of high density lipoprotein cholesterol ( P=0.043 ) . Conclusions Retraining eating behaviour with a feedback device is a useful adjunct to st and ard lifestyle modification in treating obesity among adolescents . Trial registration Clinical Trials.gov NCT00407420 BACKGROUND AND OBJECTIVE : Most clinic-based weight control treatments for youth have been design ed for preadolescent children by using family-based care . However , as adolescents become more autonomous and less motivated by parental influence , this strategy may be less appropriate . This study evaluated a primary care – based , multicomponent lifestyle intervention specifically tailored for overweight adolescent females . METHODS : Adolescent girls ( N = 208 ) 12 to 17 years of age ( mean ± SD : 14.1 ± 1.4 years ) , with a mean ± SD BMI percentile of 97.09 ± 2.27 , were assigned r and omly to the intervention or usual care control group . The gender and developmentally tailored intervention included a focus on adoptable healthy lifestyle behaviors and was reinforced by ongoing feedback from the teen ’s primary care physician . Of those r and omized , 195 ( 94 % ) completed the 6-month posttreatment assessment , and 173 ( 83 % ) completed the 12-month follow-up . The primary outcome was reduction in BMI z score . RESULTS : The decrease in BMI z score over time was significantly greater for intervention participants compared with usual care participants ( −0.15 in BMI z score among intervention participants compared with −0.08 among usual care participants ; P = .012 ) . The 2 groups did not differ in secondary metabolic or psychosocial outcomes . Compared with usual care , intervention participants reported less reduction in frequency of family meals and less fast-food intake . CONCLUSIONS : A 5-month , medium-intensity , primary care – based , multicomponent behavioral intervention was associated with significant and sustained decreases in BMI z scores  among obese adolescent girls compared with those receiving usual care OBJECTIVE . The objective of this study was to determine whether a generalizable best- practice individualized behavioral intervention  reduced BMI z score relative to st and ard dietetic care among overweight children . METHODS . The design consisted of an assessor-blinded , r and omized , controlled trial involving 134 overweight children ( 59 boys , 75 girls ; BMI ≥ 98th centile relative to United Kingdom 1990 reference data for children aged 5–11 years ) who were r and omly assigned to a best- practice behavioral program ( intervention ) or st and ard care ( control ) .  The intervention used family-centered counseling and behavioral strategies to modify diet , physical activity , and sedentary behavior . BMI z score , weight , objective ly measured physical activity and sedentary behavior , fat distribution , quality of life , and height z score were recorded at baseline and at 6 and 12 months . RESULTS . The intervention had no significant effect relative to st and ard care on BMI z score from baseline to 6 months and 12 months . BMI z score decreased significantly in both groups from baseline to 6 and 12 months . For those who complied with treatment , there was a significantly smaller weight increase in those in the intervention group compared with control subjects from baseline to 6 months . There were significant between-group differences in favor of the intervention for changes in total physical activity , percentage of time spent in sedentary behavior , and light-intensity physical activity . CONCLUSIONS . A generalizable , best- practice individualized behavioral intervention had modest benefits on objective ly measured physical activity and sedentary behavior but no significant effect on BMI z score compared with st and ard care among overweight children . The modest magnitude of the benefits observed perhaps argues for a longer-term and more intense intervention , although such treatments may not be realistic for many health care systems As described in the manuscripts in this special issue , pediatric obesity is an epidemic that challenges the health of children in the United States and globally , and places considerable burden on all levels of our health care system . During the past decade , pediatric psychologists have actively pursued an underst and ing of the psychosocial correlates of pediatric obesity and developed effective interventions based on this knowledge . This special issue is a reflection of the considerable progress that has been made in this arena , while simultaneously paving the way for the work that remains to be done . Treatment Models Several of the manuscripts in this special issue outline novel approaches for intervening with obese children and adolescents . Overweight/obese adolescents present a particular challenge for intervention stemming from developmentally normative striving for autonomy , the ambiguous role of parents in initiating and supporting weight control , and decreased body satisfaction ( Jelalian et al. , 2010 ) . Walpole , Dettmer , Morrongiello , McCrindle , and Hamilton ( 2013 ) r and omized youth with a mean age of 13.9 years to six sessions of motivational interviewing ( MI ) or social skills training combined with st and ard care . There was no advantage to MI over social skills training with regard to change in body mass index z-score ( z BMI ) or self-efficacy . When groups were combined , adolescents demonstrated significant increases in self-efficacy related to weight-control behaviors and a trend toward decrease in weight status . Of interest , attendance at MI sessions was superior to that for social skills sessions , suggesting that MI may be an effective strategy for engaging adolescents . MI may serve as an initial engagement strategy or an adjunctive treatment to support weight control in adolescents . In a study with adults ( West , DiLillo , Bursac , Gore , & Greene , 2007 ) , participants r and omized to st and ard group-based behavioral obesity treatment combined with adjunctive motivational sessions demonstrated superior weight loss compared with those r and omized to behavioral weight loss treatment and attention control sessions . In the area of weight control for adolescents , we may need to combine MI with more intensive lifestyle interventions to see incremental benefits in body mass index ( BMI ) decrease . A second strategy for enhancing motivation to facilitate weight change is seen in the study by Saelens , Lozano , and Scholz ( 2013 ) . This study , which was conducted with school-age children rather than adolescents , presents another model for incorporating motivational factors into intervention development . These investigators r and omized children between the ages of 7 and 11 years to a 20-week behavioral weight-control intervention with a st and ard untailored prescription of weekly goals by the interventionist or a ‘ ‘ self-directed ’ ’ approach in which parent – child dyads were encouraged to increase autonomy in selection of weekly goals based on their own motivation . Interestingly , children and parents in both treatment conditions showed significant reductions in z BMI and BMI , respectively , with no added benefit associated with the enhanced motivational approach . As noted by the authors , there may be alternative models for more explicitly enhancing motivation that would result in stronger outcomes OBJECTIVE : To test the efficacy of an innovative family-based intervention for overweight preschool-aged children and overweight parents conducted in the primary care setting . METHODS : Children with BMI ≥85th percentile and an overweight parent were r and omized to intervention or information control ( IC ) . Trained staff delivered dietary and physical/sedentary activities education to parents  over 6 months ( 10 group meetings and 8 calls ) . Parents in the intervention received also behavioral modification . An intention-to-treat analysis was performed by using mixed analysis of variance models to test changes in child percent over BMI ( % O BMI ) and z- BMI and to explore potential moderators of group differences in treatment response . RESULTS : Ninety-six of 105 r and omized families started the program : 46 children ( 31 girls/15 boys ) in the intervention and 50 ( 33 girls/17 boys ) in the IC , with 33 and 39 mothers and 13 and 11 fathers in intervention and IC , respectively . Baseline characteristics did not differ between groups . Children in the intervention group had greater % O BMI and z- BMI decreases at 3 and 6 months compared with those assigned to IC ( P < .0021 ) . A greater BMI reduction over time was also observed in parents in the intervention compared with parents assigned to IC ( P < .0001 ) . Child % O BMI and parent BMI changes were correlated ( r = .31 ; P = .003 ) . Children with greater baseline % O BMI were more likely to have a greater % O BMI decrease over time ( P = .02 ) . CONCLUSIONS : Concurrently targeting preschool-aged overweight youth and their overweight parents for behavioral weight control in a primary care setting reduced child % O BMI and parent BMI , with parent and child weight changes correlating Background : The best outcomes for treating childhood obesity have come from comprehensive family-based programmes . However there are questions over their generalizability . Objective : To examine the acceptability and effectiveness of ‘ family-based behavioural treatment ’ ( FBBT ) for childhood obesity in an ethnically and socially diverse sample of families in a UK National Health Service ( NHS ) setting . Methods : In this parallel group , r and omized controlled trial , 72 obese children were r and omized to  FBBT  or a waiting-list control . Primary outcomes were body mass index ( BMI ) and BMI s.d . scores ( SDSs ) . Secondary outcomes were weight , weight SDSs , height , height SDSs , waist , waist SDSs , FM index , FFM index , blood pressure ( BP ) and psychosocial measures . The outcomes were assessed at baseline and after treatment , with analyses of 6-month data performed on an intent-to-treat ( ITT ) basis . Follow-up anthropometric data were collected at 12 months for the treatment group . Results : ITT analyses included all children with baseline data ( n=60 ) . There were significant BMI SDS changes ( P<0.01 ) for the treatment and control groups of −0.11 ( 0.16 ) and −0.10 ( 1.6 ) . The treatment group showed a significant reduction in systolic BP ( −0.24 ( 0.7 ) , P<0.05 ) and improvements in quality of life and eating attitudes ( P<0.05 ) , with no significant changes for the control group . However the between-group treatment effects for BMI , body composition , BP and psychosocial outcomes were not significant . There was no overall change in BMI or BMI SDSs from 0–12 months for the treatment group . No adverse effects were reported . Conclusions : Both treatment and control groups experienced significant reductions in the level of overweight , but with no significant difference between them . There were no significant group differences for any of the secondary outcomes . This trial was registered at http://www.controlled-trials.com/ under IS RCT N 51382628 Using self-determination theory ( SDT ) as an explanatory framework , this r and omised-controlled study evaluates the effect of a motivational interviewing (MI)-based intervention as an addition to a st and ard weight loss programme ( SWLP ) on physical activity ( PA ) practice in obese adolescents over a six-month period . Fifty-four obese adolescents ( mean age = 13 years , mean BMI = 29.57 kg/m² ) were r and omly assigned to an  SWLP group ( n = 28 ) or SWLP + MI group ( n = 26 ) . Both groups received two SWLP sessions , supplemented for the SWLP + MI group , by six MI sessions . Perceived autonomy support , perceived competence , motivational regulations , PA and BMI were assessed at baseline , three and six months ( i.e. the end of the programme ) . MLM analyses revealed that compared to SWLP , the SWLP + MI group had a greater BMI decrease and a greater PA practice increase over time . Moreover , the SWLP + MI group reported greater autonomy support from medical staff at the end of the programme , greater increase in integrated and identified regulations and a stronger decrease in amotivation . MI appears as an efficient counselling method as an addition to an SWLP to promote PA in the context of pediat 
    Output:
    
Subgroup analyses suggested an increased effect in specialist health care with a group treatment component included in the intervention .
Conclusion Multicomponent lifestyle interventions have a moderate effect on change in BMI and BMI Z score after 6 , 12 , and 24 months compared with st and ard , minimal , and no treatment