***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 assess the process variables involved in a weight loss program for African-American adolescent girls . Several process variables have been identified as affecting success in in vivo weight loss programs for adults and children , including program adherence , self-efficacy , and social support . The current study sought to broaden the underst and ing of these process variables as they pertain to an intervention program that is presented using the Internet . It was hypothesized that variables such as program adherence , dietary self-efficacy , psychological factors , and family environment factors would mediate the effect of the experimental condition on weight loss . RESEARCH METHODS AND PROCEDURES Participants were 57 adolescent African-American girls who joined the program with one obese parent ; family pairs were r and omized to either a behavioral or control condition in an Internet-based weight loss program .  Outcome data ( weight loss ) are reported for the first 6 months of the intervention . RESULTS Results partially supported the hypotheses . For weight loss among adolescents , parent variables pertaining to life and family satisfaction were the strongest mediating variables . For parental weight loss , changes in dietary practice s over the course of 6 months were the strongest mediators . DISCUSSION The identification of factors that enhance or impede weight loss for adolescents is an important step in improving weight loss programs for this group . The current findings suggest that family/parental variables exert a strong influence on weight loss efforts for adolescents and should be considered in developing future programs 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 We report 10-year treatment outcomes for obese children in 4 r and omized treatment studies . At 10 years , 34 % decreased percentage overweight by 20 % or more , and 30 % were not obese . Significant effects were observed when parents and children were targeted and reinforced for weight loss in comparison with nontargeted controls and for children given lifestyle or aerobic exercise in comparison with a calisthenics control . Thirty-four percent of the variance in change in percentage overweight was predicted from sex , baseline percentage overweight , self-monitoring weight , meals eaten at home , and family and friends ' support for eating and exercise . Results show long-term changes in children depend on the treatment , and evidence converges on the importance of the family and other sources of support for eating and activity change Background : Childhood obesity has become a nutritional problem in China since the 1990s . Aims : A family based behavioural treatment was developed and tested , to see if its use was feasible in China and to evaluate its impact on obese schoolchildren . Methods : In a single school in Beijing , 33 obese children were r and omly assigned to a treatment group and 35 to a control group . The treatment group participated in a family based behavioural treatment programme for two years . Height and weight were measured every six months for all participants . Blood pressure , cholesterol , and triglyceride levels were measured at baseline and after two years of programme implementation . Results : Body mass index ( BMI , kg/m2 ) was significantly reduced in the treatment group ( from 26.6 ( 1.7 ) to 24.0 ( 0.9 ) , 95 % CI 2.06 to 3.18 ) but not in the control group ( from 26.1 ( 1.5 ) to 26.0 ( 1.6 ) ) . Total cholesterol decreased 5.5 % and triglycerides 9.7 % in the treatment group . There was a significant correlation between change in BMI and change in triglycerides . There were no significant changes in plasma lipids in the controls . Blood pressure values also decreased significantly in the treatment , but not the control group . Conclusions : A family based behavioural intervention was feasible to use in treating obesity in schoolchildren in Beijing , China . After two years of implementation , it successfully decreased the degree of obesity , reduced levels of blood pressure , and decreased serum lipids in treatment ; there were no significant changes among control children Weight and blood pressure changes were evaluated in a 16-month controlled trial comparing three methods of involving mothers in the treatment of their obese adolescents ( aged 12 to 16 years ) . The treatments were : ( 1 )  Mother-Child Separately -- children and mothers attended separate groups ; ( 2 ) Mother-Child Together -- the children and mothers met together in the same group ; and ( 3 ) Child Alone -- the children met in groups and mothers were not involved . The program consisted of behavior modification , social support , nutrition , and exercise . The Mother-Child Separately group lost more weight ( 8.4 kg ) during treatment than did the other two groups ( 5.3 and 3.3 kg ) . Differences between the groups increased at the 1-year follow-up : compared to pretreatment weight , the Mother-Child Separately group lost 7.7 kg compared with gains of approximately 3 kg in the other two groups . Blood pressures of children with the highest initial pressures decreased by 16/9 mm Hg at the end of treatment and by 16/5 mm Hg at the 1-year follow-up . These results suggest that a program of behavior modification and parent involvement can lead to significant weight losses in obese children , and that the nature of parent involvement may be important Family variables such as cohesion and nurturance have been associated with adolescent weight-related health behaviors . Integrating family variables that improve family functioning into traditional weight-loss programs can provide health-related benefits . The current study evaluated a family-based psychoeducational and behavioral skill-building weight-loss program for adolescent girls that integrated Family Systems and Social Cognitive Theories . Forty-two overweight ( > or = 95th percentile ) female adolescent participants and parents participated in a 16-week r and omized controlled trial comparing three groups : multifamily therapy plus psychoeducation ( n=15 ) , psychoeducation-only ( n=16 ) , or wait list ( control ; n=11 ) group . Body mass index , energy intake , and family measures were assessed at baseline and posttreatment . Adolescents in the psychoeducation-only group demonstrated a greater decrease in energy intake compared to the multifamily therapy plus psychoeducation and control groups ( P<0.01 ) . Positive changes in family nurturance were associated with lower levels of adolescent energy intake ( P<0.05 ) . No significant effects were found for body mass index . Results provide preliminary support for a psychoeducational program that integrates family variables to reduce energy intake in overweight adolescent girls . Results indicate that nurturance can be an important family variable to target in future adolescent weight-loss and dietary programs STUDY OBJECTIVE To evaluate the effect of family therapy on  childhood obesity .  DESIGN Clinical trial . One year follow-up . SETTING Referral from school after screening . PARTICIPANTS Of 1774 children ( aged 10 to 11 ) , screened for obesity , 44 obese children were divided into two treatment groups . In an untreated control group of 50 obese children , screened in the same manner , body mass index ( BMI ) values were recorded twice , at 10 to 11 and at 14 years of age . INTERVENTION Both treatment groups received comparable dietary counseling and medical checkups for a period of 14 to 18 months , while one of the groups also received family therapy . RESULTS At the 1-year follow-up , when the children were 14 years of age , intention-to-treat analyses were made of the weight and height data for 39 of 44 children in the two treatment groups and for 48 of the 50 control children . The increase of BMI in the family therapy group was less than in the conventional treatment group at the end of treatment , and less than in the control group ( P = .04 and P = .02 , respectively ) . Moreover , mean BMI was significantly lower in the family therapy group than in the control group ( P < .05 ) , and the family therapy group also had fewer children with BMI > 30 than the control group ( P = .02 ) . The reduction of triceps , subscapular , and suprailiac skinfold thicknesses , expressed as percentages of the initial values , was significantly greater in the family therapy group than in the conventional treatment group ( P = .03 , P = .005 and P = .002 , respectively ) , and their physical fitness was significantly better ( P < .05 ) . CONCLUSIONS Family therapy seems to be effective in preventing progression to severe obesity during adolescence if the treatment starts at 10 to 11 years of age BACKGROUND . Parenting-skills training may be an effective age-appropriate child behavior-modification strategy to assist parents in addressing childhood overweight . OBJECTIVE . Our goal was to evaluate the relative effectiveness of parenting-skills training as a key strategy for the treatment of overweight children . DESIGN . The design consisted of an assessor-blinded , r and omized , controlled trial involving 111 ( 64 % female ) overweight , prepubertal children 6 to 9 years of age r and omly assigned to  parenting-skills training plus intensive lifestyle education , parenting-skills training alone , or a 12-month wait-listed control . Height , BMI , and waist-circumference z score and metabolic profile were assessed at baseline , 6 months , and 12 months ( intention to treat ) . RESULTS . After 12 months , the BMI z score was reduced by ∼10 % with parenting-skills training plus intensive lifestyle education versus ∼5 % with parenting-skills training alone or wait-listing for intervention . Waist-circumference z score fell over 12 months in both intervention groups but not in the control group . There was a significant gender effect , with greater reduction in BMI and waist-circumference z scores in boys compared with girls . CONCLUSION . Parenting-skills training combined with promoting a healthy family lifestyle may be an effective approach to weight management in prepubertal children , particularly boys . Future studies should be powered to allow gender sub analysis OBJECTIVE We conducted a study to determine if wearing a pedometer affects weight , body mass index ( BMI ) , or mediators of physical activity among families . METHODS Eighty-seven families were r and omized to 1 of 3 treatments :  pedometer plus education ( PE ) , pedometer ( P ) , or control ( C ) . Participants in the PE and P groups wore pedometers and were encouraged to walk 10,000 steps daily for 12 weeks . PE group participants attended 6 sessions on healthy eating and exercise . Participants were surveyed about their knowledge and attitudes about healthy eating and physical activity prior to r and omization , at the end of the intervention , and 9 months later . Their heights and weights were measured and BMI calculated . RESULTS  Children 's BMI percentile decreased from baseline to end of intervention ( -0.18 % ) and at 9-month follow-up ( -0.08 % ) but did not differ by treatment . Children 's  BMI percentile varied by parental obesity status ( average BMI percentile was 88.7 % for children of obese parents and 78.5 % for children of non-obese parents ) . Parents ' weight decreased slightly by intervention 's end ( 0.6 pounds ) and at 9 months ( 1.2 pounds ) , but change was similar among groups . Attitudes about their physical activity level relative to their peers improved significantly among children and parents wearing the pedometer . Self-efficacy improved for parents wearing the pedometer . Both children and parents felt the pedometer increased their activity level , but most were unlikely to wear it beyond the intervention . CONCLUSIONS The pedometer had little impact on the activity level , weight , or BMI of participants Using a prospect i ve , r and omized , controlled design , we examined the effects of behavioral family-based treatment on percent overweight and growth over 10 years in obese 6- to 12-year-old children . Obese children and their parents were r and omized to three groups that were provided similar diet , exercise , and behavior management training but differed in the reinforcement for weight loss and behavior change . The child and parent group reinforced parent and child behavior change and weight loss , the child group reinforced child behavior change and weight loss  , and the nonspecific control group reinforced families for attendance .  Children in the child and parent group showed significantly greater decreases in percent overweight after 5 and 10 years ( -11.2 % and -7.5 % , respectively ) than children in the nonspecific control group ( + 7.9 % and + 14.3 % , respectively ) . Children in the child group showed increases in percent overweight after 5 and 10 years ( + 2.7 % and + 4.5 % 
    Output:
    
Family-based interventions rooted in behaviour theory achieved better results than those theoretically connected to family systems theory in terms of treatment effectiveness .