***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 Epidemiological studies have shown television watching to be a risk factor for the development of obesity in children . The effect of reducing television watching and other sedentary behaviors as a component of a comprehensive obesity treatment program has not been thoroughly tested . OBJECTIVE To compare the influence of targeting decreases in sedentary behavior vs. increases in physical activity in the comprehensive treatment of obesity in 8- to 12-year-old children . DESIGN R and omized , controlled outcome study . SETTING Childhood obesity research clinic . DESIGN Ninety families with obese 8- to 12-year-old children were r and omly assigned to groups that were provided a comprehensive family-based behavioral weight control program that included dietary , and behavior change information but differed in whether sedentary or physically active behaviors were targeted and the degree of behavior change required . RESULTS Results during 2 years showed that targeting either decreased sedentary behaviors or increased physical activity was associated with significant decreases in percent overweight and body fat and improved aerobic fitness . Self-reported activity minutes increased and targeted sedentary time decreased during treatment . Children substituted nontargeted sedentary behaviors for some of their targeted sedentary behaviors . CONCLUSION These results support reducing sedentary behaviors as an adjunct in the treatment of pediatric obesity BACKGROUND Little is known about how the intensity of exercise influences cardiovascular fitness and body composition , especially in obese adolescents . OBJECTIVE Our goal was to determine the effects of physical training intensity on the cardiovascular fitness , percentage of body fat ( % BF ) , and visceral adipose tissue ( VAT ) of obese adolescents . DESIGN Obese 13 - 16-y-olds ( n = 80 ) were assigned to 1 ) biweekly lifestyle education ( LSE ) , 2 ) LSE + moderate-intensity physical training , or 3 ) LSE + high-intensity physical training . The intervention lasted 8 mo . Physical training was offered 5 d/wk , and the target energy expenditure for all subjects in physical training groups was 1047 kJ ( 250 kcal)/session . Cardiovascular fitness was measured with a multistage treadmill test , % BF with dual-energy X-ray absorptiometry , and VAT with magnetic resonance imaging . RESULTS The increase in cardiovascular fitness in the high-intensity physical training group , but not in the moderate-intensity group , was significantly greater than that in the LSE alone group ( P = 0.009 ) ; no other comparisons of the 3 groups were significant . Compared with the LSE alone group , a group composed of subjects in both physical training groups combined who attended training sessions > or=2 d/wk showed favorable changes in cardiovascular fitness ( P < 0.001 ) , % BF ( P = 0.001 ) , and VAT ( P = 0.029 ) . We found no evidence that the high-intensity physical training was more effective than the moderate-intensity physical training in enhancing body composition . CONCLUSIONS The cardiovascular fitness of obese adolescents was significantly improved by physical training , especially high-intensity physical training . The physical training also reduced both visceral and total-body adiposity , but there was no clear effect of the intensity of physical training 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 OBJECTIVE The goal of this study was to evaluate the effect of a parent-focused behavioral intervention on parent and child eating changes and on percentage of overweight changes in families that contain at least one obese parent and a non-obese child . RESEARCH METHODS AND PROCEDURES Families with obese parents and non-obese children were r and omized to groups in which parents were provided a comprehensive behavioral weight-control program and were encouraged to increase fruit and vegetable intake or decrease intake of high-fat/high-sugar foods . Child material s targeted the same dietary changes as their parents without caloric restriction . RESULTS Changes over 1 year showed that treatment influenced targeted parent and child fruit and vegetable intake and high-fat/high-sugar intake , with the Increase Fruit and Vegetable group also decreasing their consumption of high-fat/high-sugar foods .  Parents in the increased fruit and vegetable group showed significantly greater decreases in percentage of overweight than parents in the decreased high-fat/high-sugar group . DISCUSSION These results suggest that focusing on increasing intake of healthy foods may be a useful approach for nutritional change in obese parents and their children The role of insulin in the regulation of blood pressure was evaluated in 50 obese adolescents before and after a 20-week weight loss program .  When compared with 10 nonobese adolescents , the obese subjects had significantly higher systolic , diastolic , and mean arterial pressures ( p = 0.005 ) , an elevated 24-hour urinary sodium excretion ( p = 0.002 ) , an elevated fasting insulin concentration ( p = 0.001 ) , and an abnormal insulin response to an oral  glucose tolerance test ( sum of the insulins at 0 , 1 , and 2 hours post-oral glucose load ; p = 0.001 ) . We also observed a significant correlation between systolic and diastolic blood pressure ( age and sex normalized ) and body weight ( r = 0.57 , p less than 0.01 and r = 0.7 , p less than 0.01 ) , fasting insulin ( r = 0.49 , p less than 0.01 and r = 0.54 , p less than 0.01 ) , and sum of insulins ( r = 0.42 , p less than 0.01 and r = 0.46 , p less than 0.01 ) . To study the effect of weight loss on the relationship between blood pressure and insulin , the obese subjects were r and omly assigned to three groups : 15 to a diet and behavior change group , 18 to a diet , behavior change , and exercise group , and 17 to an obese control group . Compared with the obese control group , the two weight loss groups each experienced a significant decrease in insulin ( p less than 0.01 ) , sum of the insulins ( p less than 0.01 ) , and blood pressure ( p less than 0.01 ) . The decrease in blood pressure during the weight loss program significantly correlated with the change in both insulin and body weight . ( ABSTRACT TRUNCATED AT 250 WORDS Aims : To evaluate effects of a low energy diet , with or without strength training , on blood lipid profile in obese children . Methods : Eighty two obese children were enrolled into a six week dietary programme , and were r and omly allocated to a training group or a non-training group . The training group underwent regular exercise sessions with emphasis on strength training . Results : Height increased significantly , with a non-significant reduction in body mass index . Fat free mass increased significantly in the training group . Serum total cholesterol was significantly reduced in both groups . The LDL : HDL ratio significantly decreased in the training group . Conclusion : Results support the potentially beneficial effects of both diet and physical training . Further and longer term evaluation of such programmes is required OBJECTIVE : Family-based , behavioral treatment has been shown to be an effective intervention for the management of pediatric obesity .  The goal of this study was to compare the cost-effectiveness of two protocol s for the delivery of family-based behavioral treatment . REA SEARCH METHODS AND PROCEDURES : Thirty-one families with obese children were r and omized to groups in which families were provided mixed treatment incorporating both group and individualized treatment vs group treatment only .  Cost-effectiveness of treatment was defined as the magnitude of reduction in st and ardized BMI and percentage overweight per dollar spent for recruitment and treatment . Anthropometric data were assessed at baseline , 6 months and 12 months post-r and omization . RESULTS : Results for the 24 families with complete data showed the group intervention was significantly more cost-effective than the mixed treatment . This was due to the similarity between the two groups in Z- BMI or percentage overweight change for children and their parents , while the mixed treatment was significantly more expensive to deliver than the group treatment . DISCUSSION : These findings suggest that a family-based , behavioral intervention employing group treatment alone is a more cost-effective approach to treating pediatric obesity than a mixed group plus individual format BACKGROUND The rising prevalence of obesity in children has been linked in part to the consumption of sugar-sweetened drinks . Our aim was to examine this relation . METHODS We enrolled 548 ethnically diverse schoolchildren ( age 11.7 years , SD 0.8 ) from public schools in four Massachusetts communities , and studied them prospect ively for 19 months from October , 1995 , to May , 1997 . We examined the association between baseline and change in consumption of sugar-sweetened drinks ( the independent variables ) , and difference in measures of obesity , with linear and logistic regression analyses adjusted for potentially confounding variables and clustering of results within schools . FINDINGS For each additional serving of sugar-sweetened drink consumed , both body mass index ( BMI ) ( mean 0.24 kg/m2 ; 95 % CI 0.10 - 0.39 ; p=0.03 ) and frequency of obesity ( odds ratio 1.60 ; 95 % CI 1.14 - 2.24 ; p=0.02 ) increased after adjustment for anthropometric , demographic , dietary , and lifestyle variables . Baseline consumption of sugar-sweetened drinks was also independently associated with change in BMI ( mean 0.18 kg/m2 for each daily serving ; 95 % CI 0.09 - 0.27 ; p=0.02 ) . INTERPRETATION Consumption of sugar-sweetened drinks is associated with obesity in children Recent findings indicate that nearly 50 % of black American women are obese and that adolescence is a critical period for the development of their obesity . This study investigated the efficacy of a behavioral weight control program in 36 black female adolescents with a mean age of 14.0 years , weight of 95.0 kg , and height of 163.2 cm . All subjects participated in the same 16-week program but had different levels of parent participation : ( 1 ) child alone with no parent participation ; ( 2 ) mother and child treated in the same session ; and ( 3 ) mother and child treated in separate but concurrent session . At the end of the 16-week program , children in the three conditions lost 1.6 , 3.7 , and 3.1 kg , respectively . Differences among conditions were not statistically significant ; however , a secondary analysis revealed that the greater the number of sessions attended by mothers , the greater their daughters ' weight losses . Weight reduction was associated with significant improvements in body composition , serum total cholesterol concentrations , and psychological status . Results are discussed in terms of the need to improve the maintenance of weight loss in adolescents and to explore possible differences between black and white females in their preferred body types The feasibility and effectiveness of conducting a school-based multi-component behavioral weight reduction program was tested on 119 overweight junior high school students . Four schools in the metropolitan New York area were r and omly assigned to either the experimental or control conditions . After participating in a school-wide health-profile screening , students in the experimental group were invited to participate in a ten-session weight reduction program that included behavior modification , nutrition education , and exercise management . Comparison of the experimental and control groups with respect to changes on weight and triceps skinfold measures indicated significant differences between the two groups . Although the long-term effectiveness of the weight reduction program can not be 
    Output:
    
DATA SYNTHESIS The 2 strongly qualified meta-analyses suggest that interventions that include a dietary treatment do achieve relative weight loss .
It is not possible to evaluate the effectiveness of dietary treatment  for childhood obesity because of the lack of high- quality studies and the heterogeneity of design s , treatment combinations , outcome measures , and follow-up .