***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 We developed a Dutch outpatient multidisciplinary group treatment ( Go4it ) for obese adolescents , including cognitive behavioural therapy and education on healthy dietary and physical activity behaviour . This study examined the effect of Go4it on Health Related Quality of Life ( HRQoL ) . Methods At our outpatient paediatric obesity clinic , obese adolescents ( n = 122 , 11–18 years ) were r and omly assigned to 1 ) Go4it , 7 sessions with an interval of 2 weeks or 2 ) current regular care consisting of referral to a dietician in the home care setting ( controls ) . Linear mixed model analysis was performed to evaluate the intervention effects on HRQoL at 6 and 18-month follow-ups . HRQoL indicators included the Child Health Question naire , the Paediatric Quality of Life Inventory ™ Version 4.0 ( PedsQL ™ 4.0 ) , and the Body Esteem Scale ( BES ) . Results In total , 95 adolescents ( Go4it 57 , controls 38 ) were included in the current analysis with a mean age of 14.5 ± 1.7 and mean BMI -SDS of 2.9 ± 0.5 . At baseline , all participants experienced lower levels of physical and psychosocial well-being compared to a normal weight reference group . At the 18 month follow-up , we found small but beneficial intervention effects on all subscales of the PedsQL ™ 4.0 and BES question naires . Two subscales improved significantly ; i.e. , physical health ( between group difference 5.4 ; 95%CI : 0.3 ; 10.6 ) , and school functioning ( between group difference 7.4 ; 95%CI : 1.6 ; 13.2 ) . Conclusion Obese adolescents  experienced lower HRQoL than their healthy peers . The Go4it intervention had small beneficial effects on HRQoL compared to the current regular care practice s for obese adolescents . Trial registration Netherl and s Trial Register : IS RCT N27626398 , METC number : 05.134 ( WMO , monocenter ) Background There is an urgent need for innovative and developmentally appropriate lifestyle interventions to promote healthy lifestyle behaviors and to prevent the early onset of type 2 diabetes and cardiovascular disease risk in obese Latino adolescents . Guided imagery offers promise to reduce stress and promote lifestyle behavior change to reduce disease risk in obese adolescents . Our objectives were : 1 ) To pilot test a new 12-wk lifestyle intervention using a r and omized trial design in obese Latino adolescents , in order to determine the effects of the mind-body modality of Interactive Guided ImagerySM ( IGI ) , over and above those of a didactic lifestyle education , on insulin resistance , eating and physical activity behaviors , stress and stress biomarkers ; and 2 ) To explore the role of intervention-related changes in stress and stress biomarkers on changes in metabolic outcomes , particularly insulin resistance . Methods Obese ( BMI > 95th percentile ) , Latino adolescents ( n = 35 , age 14 - 17 ) were r and omized to receive either 12 weekly sessions of a lifestyle education plus guided imagery program ( GI ) , or lifestyle education plus a digital storytelling computer program ( DS ) . Between-group differences in behavioral , biological , and psychological outcomes were assessed using unpaired T-tests and ANCOVA in the 29 subjects who completed the intervention . Results The GI group demonstrated significant reductions in leisure sedentary behavior ( p < .05 ) and increases in moderate physical activity ( p < .05 ) compared to DS group , and a trend toward reduced caloric intake in GI vs DS ( p = .09 ) . Salivary cortisol was acutely reduced by stress-reduction guided imagery ( p < .01 ) . There were no group differences in adiposity , insulin resistance , perceived stress , or stress biomarkers across the 12-week intervention , though decrease in serum cortisol over the course of the intervention was associated with improved insulin sensitivity ( p = .03 ) independent of intervention group and other relevant co-variates . Conclusions The improvements in physical activity and stress biomarkers following this pilot intervention support the role of guided imagery in promoting healthy lifestyle behavior change and reducing metabolic disease risk in obese Latino adolescent population s. Future investigations will be needed to determine the full effects of the Imagine HEALTH intervention on insulin resistance , stress , and stress biomarkers . Trial registration Clinical trials.gov Registry # : 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 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 INTRODUCTION The present study describes a r and omised controlled trial ( RCT ) based on a novel , generalisable intervention for childhood obesity , comparing the intervention with a no-treatment control group . METHOD The Malaysian Childhood Obesity Treatment Trial ( MASCOT ) was a single-blind RCT of a dietetic treatment for childhood obesity in children of primary school age ( 7 to 11 years old ) in Kuala Lumpur , Malaysia . The MASCOT comprising eight sessions , of an 8-hour family-centred group treatment programme is described , based on behavioural change techniques . The study sample was characterised by BMI z-score , health related quality of life reported by participants and their parents ( PedsQL question naire ) , objective ly measured habitual physical activity and sedentary behaviour ( Actigraph accelerometry ) RESULTS The MASCOT sample of 107 children was characterised by a low quality of life , mean total score on PedsQL 67.7 ( 4.5 ) as reported by the children , and 66.0 ( 16.4 ) as reported by their parents . The children spent , on average , 89 % of their waking day on sedentary activity , and 1 % of the day in moderate-vigorous intensity physical activity , equivalent to only around 8 minutes/day . CONCLUSION Obese children in the MASCOT study had an impaired quality of life , high levels of sedentary behaviour and very low levels of physical activity OBJECTIVE The objective was to compare targeting increased eating of healthy foods vs. reducing intake of high energy-dense foods within the context of a family-based behavioral weight control program . METHODS AND PROCEDURES Forty-one 8 - 12 year-old children > 85th BMI percentile were r and omly assigned to a 24-month family-based behavioral treatment that targeted increasing fruits and vegetables and low-fat dairy vs. reducing intake of high energy-dense foods . RESULTS Children in the increase healthy food group showed greater reduction in z BMI compared to children in the reduce high energy-dense food group at 12- ( -0.30 z BMI units vs. -0.15 z BMI units , P = 0.01 ) and 24- ( -0.36 z BMI units vs -0.13 z BMI units , P = 0.04 ) month follow-up . Parents in the increase healthy food group showed greater reductions in concern about child weight ( P = 0.007 ) , and these changes were associated with child z BMI change ( P = 0.008 ) . Children in the reduce high energy-dense group showed larger sustained reductions in high energy-dense foods ( P < 0.05 ) . Baseline levels of high energy-dense foods ( P < 0.05 ) , parent food restraint ( P = 0.01 ) , parent concern over parent weight ( P = 0.01 ) and parent acceptance of the child ( P < 0.05 ) moderated child z BMI change , with greater sustained reductions in z BMI for children in the increase healthy food group for each measure . Parent z BMI change followed the same pattern as child changes , and parent and child z BMI changes were correlated ( P < 0.001 ) . DISCUSSION Focusing on healthy food choices within an energy restricted diet may be useful in family-based weight control programs OBJECTIVE To assess the process variables involved in a weight loss program for African-American ad 
    Output:
    
Conclusions This systematic review identified wide variation in the dose of behavioral interventions to prevent and treat pediatric obesity , but was unable to detect a clear relationship between dose and weight-related outcomes .