***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 : Exergames ( i.e. , video games that require gross motor activity ) may provide intrinsically motivating experiences that engage youth in sustained physical activity . Method : Thirty-one low-income 15– to 19-year-old overweight and obese African American adolescents were r and omly assigned to a competitive exergame ( n = 17 ) or a cooperative exergame ( n = 14 ) condition . Participants played a preassigned Wii Active exergame routine that took between 30 and 60 min each school day , and sessions occurred during lunch time or an after-school program over a 6 month period . Participation was voluntary , so students decided whether to come or not on a given day . Cooperative exergame players worked together with a peer to expend calories and earn points , while competitive exergame players competed individually against a peer to expend calories and earn points . Motivation was measured through surveys and interviews at the end of the intervention , and energy expenditure was measured by accelerometry during game play . Results : Compared with the competitive group , the cooperative players were significantly more intrinsically motivated to play ( p = .034 , partial eta-squared = 0.366 ) and more psychologically attracted to the design of the exergame ( p = .034 , partial eta-squared = 0.320 ) . Intrinsic motivation was significantly positively correlated with energy expenditure during game play : Individuals who were motivated by control/choice had higher energy expenditure ( p = .026 ) , and those who were more goal motivated ( p = .004 ) and more immersed in game play ( p = .024 ) had lower energy expenditure during game play . Conclusions : Cooperative exergame play produced higher intrinsic motivation to play the exergame than competitive exergame play did . Intrinsic motivation that came from a desire for control/choice was related to higher energy expenditure during game play . Cooperative exergame play holds promise as a method for engaging overweight and obese youth in physical activity Process evaluation is valuable in guiding development of effective intervention programmes but rare in adolescent weight management . This paper presents a process evaluation of the Loozit ( ® ) r and omized controlled trial , a community-based behavioural lifestyle intervention for obese 13 - 16 year olds . Adolescents were r and omized to receive the two-phase Loozit ( ® ) group programme  , with  ( n = 73 ) or without ( n = 78 )  , additional therapeutic contact ( telephone coaching , short message service and /or emails ) in Phase 2 . Quantitative and qualitative process data were collected . Facilitators used a st and ardized evaluation form to document participant attendance , and comment on lesson adherence and process delivery . Adolescents and parents completed satisfaction question naires at 2- , 12- and 24-month follow-ups . Following the intervention , 14 adolescents who provided informed written consent were interviewed about their experience with additional therapeutic contact . Data were analysed using descriptive statistics , parametric and non-parametric tests to compare group means , and thematic analyses . Group attendance rates averaged 85 and 47 % during Phases 1 ( 0 - 2 months ) and 2 ( 3 - 24 months ) , respectively . Facilitators frequently noted that participants reported making healthy lifestyle changes . Elements enjoyed in the sessions included practical activities , fun active games , resistance training and forming new friendships . Adolescents struggled with setting specific , measurable , achievable , realistic and timely ( SMART ) goals . Overall , participants were satisfied with the help received including the telephone and electronic contact . More than 80 % of participants found the programme changed adolescents ' eating and physical activity habits , and 89 % of parents reported changing parenting strategies . Future adolescent group-based programmes may enhance participant engagement and programme effectiveness by including more interactive and frequent telephone and electronic contact Background : The WATCH IT programme was developed to address the needs of obese children from disadvantaged communities in Leeds and has been running since January 2004 . Results of the pilot phase , prior to a r and omised controlled trial , are presented . Methods : A process evaluation to assess success of implementation was conducted in December 2004 . User views ( parent and child ) were obtained by semi-structured interviews and focus groups . Change in BMI SD score was calculated for children attending between January 2004 and November 2005 . Results : A total of 94 children ( 49 girls , 45 boys ) , mean age ( SD ) 12.2 ( 2.0 ) years attended . They were moderately to severely obese ( mean BMI SDS 3.09 ( 0.45 ) , with low quality of life and self-image scores . There was a significant reduction in overweight at 6 months ( Δ BMI SD −0.07 ) , especially for teenagers ( Δ BMI SD −0.13 ) and girls ( Δ BMI SD −0.07 ) . The programme was successfully implemented . By December 2004 mean attendance was 2.1 ( 0.7 ) clinics per month , and sports sessions 3.3 ( 1.7 ) sessions per month . Fourteen children dropped out and non-attendance was low ( only 7.5 % sessions missed in 12 months ) . Qualitative research indicated significant appreciation of the service , with reported increase in self-confidence and friendships , and reduction in self-harm . Conclusion : WATCH IT offers a model for a community based service for obese children . The programme suggests that effective care can be delivered by health trainers supervised by health professionals , and so potentially provides a cost effective programme within children ’s communities . These findings are encouraging , and need to be substantiated by extension to other locations and evaluation by r and omised controlled trial BACKGROUND Purpose was to examine experiences of obese youth aged 14 to 18 years during their participation in the Healthy Eating , Aerobic , and Resistance Exercise in Youth ( HEARTY ) r and omized controlled exercise trial . METHODS A longitudinal qualitative approach was used to investigate youths ' experiences across time points in the trial : 3-weeks ( run-in phase ; n = 44 , 52 % males ) , 3-months ( midpoint ; n = 25 ) , and 6-months ( end of intervention ; n = 24 ) . Participants completed telephone interviews on perceived exercise facilitators , barriers , outcomes , and program preferences . Responses were subject to content analyses and are reported as frequencies . RESULTS Participants joined the trial initially to lose weight , but focused more on fitness over time . Exercise behavior was influenced by a sense of achieving results , and by family and peers ( ie , supportive comments , transportation ) . At 6-months , the most commonly perceived changes were improved fitness ( 50 % ) and appearance ( 46 % ) . Suggested changes to the HEARTY trial included initial guidance by a trainer , and more varied and group-based activity . CONCLUSIONS Exercise facilitators , barriers and perceived changes in an exercise trial are reported . Access to a gym , initial direction by a trainer , variety , and group-based activities were reported as desired components of an exercise intervention . Findings also point to the importance of involving family and peer supports OBJECTIVES To assess changes in overweight and obesity between adolescence and young adulthood . DESIGN Prospect i ve 8-wave cohort study in Victoria , Australia , with 1,520 adolescents tracked from the age of 14 for a period of 10 years . MAIN OUTCOME MEASURES Participants aged < 18 years were classified as non-overweight , overweight , or obese according to International Obesity Taskforce cutoff points . In those aged > 18 years overweight was defined as a body mass index ( BMI ) ≥ 25 ; and obesity as a BMI ≥ 30 . RESULTS The proportion of overweight individuals increased from 20 % in mid-adolescence to 33 % at the age of 24 years . Obesity increased from 3.6 % to 6.7 % . Approximately 40 % of young adults with a BMI ≥ 25 had been persistently at normal weights during adolescence and approximately 80 % had been at a normal weight at some point . Around half of obese young adults had never been classified as obese as adolescents . No individual with persistent obesity in adolescence had a BMI < 25 at 24 years . A total of 31 % of females and 59 % of males who had been overweight for only one or two waves of adolescent data collection had a BMI ≥ 25 at 24 years . CONCLUSIONS Substantial shifts in overweight and obesity occur between adolescence and young adulthood ; the extent of continuity depends on both the severity and persistence of adiposity in adolescence . Few adolescents who peak into obesity or are persistently overweight achieve a normal weight in young adulthood . Resolution is more common in those who are less persistently overweight as teenagers , suggesting scope for lifestyle interventions in this subgroup BACKGROUND Adolescence is a critical time to intervene and establish healthy long-term behaviors to decrease the impact of adult obesity in the future . The purpose of this study was to identify key intervention strategies and techniques for community interventions by analyzing the short-term and longer-term shared experiences of both adolescents with overweight or obesity and their parents involved in a community-based , healthy lifestyle intervention .  METHODS Qualitative interviews and focus groups were conducted with teens ( aged 12 - 16 years with a BMI above the 85th percentile ) and their parents immediately following the 8-week intervention ( n = 37 teens , n = 33 parents ) and at 12 months follow-up ( n = 23 teens , n = 20 parents ) . Results were analyzed thematically . RESULTS Both teens and parents reported high satisfaction with the program . Immediately following the 8-week intervention , teens reported enjoying participating in exercise with similar peers . Parents described inaccurate expectations from the program . After the 12-month follow-up , teens reported struggling with a cyclical pattern of health behaviors , and parents described a sense of loss following the intensive program and improved communication skills with their adolescent . CONCLUSIONS Several practical strategies emerged for use in future community programs for adolescents with overweight or obesity . Future programs should consider management of expectations , perceptions vs. outcomes , and the cyclical nature of behavior change in adolescents . Strategies for future health behavior change interventions with overweight adolescents should address time management , translation of knowledge into behavior change , successful implementation of practical goal - setting strategies , and increasing intrinsic motivation BACKGROUND In an effort to enhance the vividness and personal relevance of a text messaging intervention to promote weight loss among obese adolescents , a modified Photovoice process was evaluated with adolescents in a weight management program . METHODS Photovoice is a method using photography to generate relevant images and stories from users . Participants were recruited from the Michigan Pediatric Outpatient Weight Evaluation and Reduction ( MPOWER ) program , a multidisciplinary weight management program for obese adolescents and their parents . Twenty-three adolescents with a mean BMI of 40 were asked to take pictures on three to five r and omly assigned weight-related topics , such as “ something that reminds you to exercise , ” and to text them to a research assistant . Adolescents then engaged in semistructured interviews about the experience . Detailed notes of the interviews were analyzed to identify themes . RESULTS Participants generally provided high ratings of the process , indicating that ( 1 ) deciding what pictures to take caused them to reflect on their weight loss experience , and ( 2 ) a mobile intervention incorporating personally relevant images ( e.g. , basketball as their favorite sport rather than sports in general ) would increase treatment adherence . The su bmi tted photographs frequently featured family members and friends , and participants indicated that family and friends played a major role in motivating and supporting them . CONCLUSIONS This study suggests that a Photovoice component has the potential to enhance weight management programs for teens as part of a text messaging intervention and as an independent entity . Further work should evaluate the effect of this promising intervention on weight loss A qualitative study nested within a r and omized controlled trial explored obese adolescents ' experiences of participation in an exercise therapy intervention .  Semi-structured interviews were conducted with participants assigned to exercise therapy . Participants ' reported feeling more energetic during and after exercise , than before . Many participants reported feeling happy/happier and expressed feeling better about themselves as individuals after the intervention . Most participants felt more confident in their ability to exercise regularly . Greater emphasis needs to be placed upon educating obese adolescents about the wide range of health benefits that exercise can provide , and that weight loss , while important , is only one such benefit INTRODUCTION There has been a paucity of theory-based interventions to improve health outcomes in overweight adolescents . Therefore , two intervention studies were conducted to : ( a ) determine the feasibility of implementing the Creating Opportunities for Personal Empowerment ( COPE ) Healthy Lifestyles Thinking , Emotions , Exercise , and Nutrition ( TEEN ) program with overweight adolescents ; ( b ) obtain feedback that could be used to refine the program ; and ( c ) examine the preliminary efficacy of the COPE program on the adolescents ' weight and body mass index ( BMI ) . METHOD Phase I and Phase II clinical trials were conducted with 23 overweight teens . The Phase 1 trial used a pre-experimental design with one group of 11 urban adolescents . The Phase 2 trial was conducted with 12 suburban teens using a r and omized controlled pilot study . COPE teens received a 15-session cognitive-behavioral skills building program that included physical activity , while the control group received an attention control program .  Weight change and BMI were the key outcomes . RESULTS COPE teens experienced a significantly greater reduction in weight and BMI than did teens in 
    Output:
    
Key themes included ensuring adolescents receive a ' tailored intervention ' that involves ' active engagement ' .
Support from professionals , family and peers were valued highly .
Adolescents expressed ' prior fears of attending interventions ' and wanted ' longer term support ' . '
Enjoyment of sport and physical activity ' was evident , and adolescents were strongly motivated by improving body image and social desirability .
DISCUSSION Considering the views of adolescents attending obesity interventions  may help to inform policy makers in the development of future interventions .
This may lead to an improvement in recruitment and attrition rates