TABLE 1
Summary table of randomised controlled trials on the treatment of overweight and obesity in adolescents
Year AuthorsReference number / Subjects / Treatment / F/U & Attrition / Blinding
& RA / Outcomes / Results / Discussion/Conclusions/Limitations
2006
Ebbeling et al. [24] / N = 103
13-18 YO
Mean BMI 25.3 kg/m² / 1. Rx – weekly home deliveries of non-caloric beverages for 25 weeks
2. Control - continued normal consumption / 25 weeks / ND / 24 hr diet & PA recall, BMI, beverage intake / Sig reduction in BMI in the treatment grp by -0.75kg/m² / Conclusions: Consumption of non-caloric soft drink appears to be effective in reducing BMI in adolescents. Limitations: F/u 25 weeks. Effects may not be maintained after the researchers stop delivering replacement beverages – did not encourage a change in behaviour. No direct measures of adiposity. Did not assess pubertal status.
2006
Maahs et al. [54] / N=40
14-18YO
Mean BMI 40 kg/m² / 1. Orlistat 120mg X 3 day
2. Placebo / 6 month f/u
Attrition ND / Double blind / BMI / No sig difference between grps for BMI
Orlistat grp had sig more adverse effects, mainly GI symptoms / Conclusions: Orlistat is not useful for adolescent weight loss when used with lifestyle recommendations only. Orlistat appears to have GI side effects associated. Limitations: Didn’t assess pubertal status. Side effects of orlistat
2006 Jelalian et al. [45] / N= 76
13-16YO
Mean % O/V 60.56% / 1. CBT + adventure therapy + diet + PA
2. CBT + aerobic exercise + diet + PA / 10 month f/u
26% attrition / ND / Height, weight, % O/V, psychosocial indicators / Post Rx: Both grps had sig in weight with no diff between grps post Rx. Older adolescents lost 4X more weight immediately post Rx. 10 Months: Sig diff in the % of adolescents who maintained 4.5kg WL at 10 months / Conclusions: Adventure therapy as an adjunct to CBT may particularly useful for older adolescents. Limitations: Did not assess pubertal development, did not include direct measures of body composition, did not use Cole’s classification for O/V & O/B in children. Lack of long term f/u. Unlikely this study uses a true CBT approach as they reference BT strategies
2005 Chanoine et al. [13] / N= 539
12-16YO / 1.120mg orlistat X3 day for 1 year
2. Placebo
Both grps received hypocaloric diet, BT & Ex / 1 year f/u
Attrition ND / double blind / BMI, weight, hip & waist circum., glucose, lipids, DEXA / - BMI in orlistat grp by 0.55 kg/m² in placebo, waist circum sig in orlistat grp. GI side effects experienced by orlistat grp / Conclusions: Authors conclude that orlistat combined with reduced calorie diet, Ex & behaviour modification assists in weight management of obese adolescents
Limitations: Didn’t assess pubertal develop. Authors did not assess compliance with recommendations. 1 year f/u not adequate to determine long-term effects & safety of the drug. Authors did not assess what happened once adolescents stopped taking the medication. Side effects of greasy stools, fecal urgency, flatus.
2005 Nemet et al. [60] / N= 54
Aged 6-16 years
Mean BMI 28.2 kg/m² / 1. Combined family BT- 3 month program, attended 4 lectures, dietician X 6 visits, controlled diet & Ex X2 week.
2. Control – nutritional advice X 1 session, & instructed to Ex 3 X week / 1 year f/u
20 % attrition / ND / - Height, weight BMI, skin folds
- 2 day food, PA questionnaire, Fitness & blood lipids
- assessed pubertal status / @ 3 months. Rx grp: Sig weight 2.8kg. Sig BMI by 1.7 kg/m² & body fat by 3.3%. PA sig . No sig differences between groups in dietary intake although they both reported a . Control Grp - Sig body fat & weight
1 year follow up: Sig BMI, body fat % in Rx compared with an in the control / Conclusions: Combined approach to intervention appears to be effective for WL with results maintained 12 months later. Authors encourage weight maintenance rather than WL. Limitations: Included children & adolescents. Didn’t use Cole’s classification for O/V & O/B. No direct measures of adiposity. Unable to determine if effects were maintained into the longer- term. Likely that both the control grp & treatment grp under-reported their food intake. Authors said that they focused on behavioural change but did not describe the approach used.
2005
Jiang et al. [46] / N= 106
41 males
Mean age 13 years
Mean BMI 26 kg/m² / 1. BT (family). Based on Epstein & colleagues approach using the ‘traffic light’ diet, Ex advice,
2. Control – no Rx / 2 year f/u
7% attrition / ND / Height, weight, Blood pressure, serum lipids / - Rx grp lost 0.3 kg
- control grp put on 5.5kg
- Sig relationship between BMI & triglycerides.
- sig between grp changes in SBP, DBP, total cholesterol & triglycerides.
- no adverse effects on growth / Conclusion: Weight maintenance achieved in treatment group. Limitations: No direct measures of adiposity, did not assess pubertal development, only included Chinese students at one school can’t not be generalised, although results are consistent with those found by Epstein & colleagues who used this approach in children with long-term benefit @ 10 year f/u.
2004 Herrera al. [41] / N= 50
6-18 years
26 males
Mean % O/V 67.1% Control condition (archival data) / 1. control (anonymous archival data)
2. CT + nutritional education & Ex
3. BT + nutritional therapy & Ex
10 weekly sessions for 120 minutes. / 8% attrition rate
10 week f/u / ND / BMI, % O/V (using ideal BMI) / BT was superior to comparison and cognitive interventions. 84% of participants in the BT had a sig. improvement. / Conclusions: No conclusions can be drawn about long-term effectiveness of any of the interventions due to lack of f/u. BT appears most effective strategy for improvements in % O/V. All strategies are useful for weight loss. Limitations: Not able to determine long-term effects of treatment as no f/u was done. Did not assess puberty, only used indirect measures of adiposity. Independently assessed effects of cognitive & behavioral strategies, where as CBT (combined approach) is frequently used. Small sample size & power.
2004
Watts et al. [77] / N=19
9 males
Mean BMI 34 kg/m²
Matched lean controls / 8 weeks, circuit training 1 hr 3 times per week. Included cycle ergometry and resistance training. / 8 weeks / ND / DEXA, anthropometrics, endothelial function, strength, Ex capacity,
bloods / No differences in blood chemistry, blood pressure, BMI, segment girth, skin folds. DEXA – sig in body fat in abdominal and trunk regions. Average 700g. Sig improvement in fitness & vascular function improved / Conclusions: considered pubertal development. Ex training produces short-term improvements in fitness, abdominal and trunk fat and vascular function is obese adolescents. Limitations: Unknown whether improvements are maintained as short f/u. Small sample size & low power
2003
Ebbling et al. [25] / N= 16
13-21 YO
5 males
BMI > 27 kg/m²
Mean BMI 33.9 kg/m² / 1. Ad libitum reduced glycemic load diet (30-35% fat, 40-50% carbohydrate) + BT & nutritional counseling
2. energy restricted reduced fat diet (250-500Kcal deficient & <30% fat, 55-60% carbohydrate) + BT / 12 months
6 month f/u
12.5% attrition / ND / - DEXA, height, bloods, food diary, / 1. Glycemic load sig . GL was a sig predictor of treatment response. BMI & fat mass sig at 12 months. No weight regain from 6-12 months
2. Dietary fat sig at 6 months. / Conclusion: Ad libitum reduced GL diet is a promising alternative to conventional diet for obese adolescents. Flexibility of the diet approach also suits adolescents who have autonomy. Strengths: of design include treatment ‘fidelity’, use of conceptual framework, fair length of follow up, ‘high retention’, & theoretical framework (social cognitive). Limitations: did not assess puberty, included adults, small sample, and reliance on self report measures for diet. Fibre or palatability of food may affect compliance & were not assessed. Results may be confounded by baseline differences in fat mass.
2003 Berkowitz et al. [7] / 13-17 YO
N= 82
33%male
45% non-white
BMI 32-44 kg/m² / 1. Rx – Sibutramine + family based BT
2. Placebo – BT alone
- All received the drug from months 7-12 / 12 months / Double blind / % change in BMI, BP, pulse, hunger / 1. Lost 7.8 kg & BMI by 8.5% in the 1st 6 months. From months 7 – 12 adolescents put on weight with continued drug treatment (0.8kg). Systolic BP sig 1.8mmHg
2. Lost 3.2kg and 4% BMI. systolic BP by 3.6mmHg. / Conclusions: This medication is not recommended for clinical use due to side effects until further research is done into safety & efficacy of medication. Limitations: Side effects of the drug ( BP & pulse rate) raises questions about long-term safety & efficacy, as participants in the treatment group put on weight from months 7-12. Only had a control group for the 1st 6 months – therefore no long- term f/u.
2003 Sondike et al. [69] / N = 30, 12-18 YO, O/B>95th %, BMI 35 kg/m² / 1. Low carbohydrate diet (<20g carbohydrate/day)
2. Low fat diet (<40g/day fat) / 12 weeks / RA, no blinding / Lipids, weight, % O/V / 1. Lost more weight than 2. (9.9 + 9.3 versus 4.1 + 4.9kg), improved lipids in both grps. / Conclusions: Low carbohydrate diet is effective in the short- term for WL in adolescents without having a harmful effect on lipids. Limitations: Long- term effect of diet on weight status unknown, small sample, no blinding, no direct measures adiposity, did not assess pubertal development.
2002 Gutin et al. [40] / 13-16 YO
N= 80 Mean 40% BF
stratified sex, ethnicity / 1.Lifestyle education (BT + PA, nutrition)
2. Mod intensity aerobic Ex + lifestyle education
3.High intensity aerobic Ex 5 X week + lifestyle education / 8 month f/u
Attrition ND / ND / DEXA (%BF), MRI visceral fat
CVF / CVF improved by physical training – esp high intensity. Physical training reduced %BF & visceral fat , but no clear effect of exercise intensity
Correlational analyses: %BF was associated with low levels of free living vigorous activity. High intensity training produced sig changes in CVF / Conclusions: Combining Ex with BT likely to produce improvements in body composition, with no clear effect of Ex intensity. High intensity training improves CVF
Limitations: No f/u after the end of the intervention periods, therefore unable to assess if effects maintained. Not enough detail about the BT – unable to tell if it included a CBT approach or not.
2002 Kang [48]
**same as Gutin 2002[40] / As for Gutin 2002 / see Gutin 2002 [40] / see Gutin 2002 [40] / ND / Blood pressure, bloods & plasma markers / - high intensity Ex grp had more favorable improvements in blood pressure and plasma triglycerides. / Conclusions: Adolescents engaging in regular exercise experience CV & metabolic benefits, especially if Ex is of a higher intensity. Limitations: As for Gutin 2002.[40]
2002 Saelens et al. [64] / N= 44
12 -16YO
26 males
Mean BMI 30.95 kg/m² / 1. BT based program– computer with 4 months of telephone & mail contact, ‘traffic light’ diet & PA & sedentary time
1. Control – single session counseling / 7 months including treatment
16% attrition / Yes / Weight, height, 2 day diet recall, 7 day physical activity recall, sedentary activity (self report), weight related eating behaviours / -energy intake, % calories from fat, physical activity, sedentary behaviour & problematic weight related behaviours or beliefs were not sig different between grps
- in BMI Z scores in treatment grp @ 4months. No further in BMI Z score @ f/u / Conclusions: ‘modest’ in weight. Limitations: F/u not long enough to determine if effects were maintained. Did not include older adolescents, did not assess pubertal development, 7 day recall of PA & 2 day recall of diet likely to be subject to accuracy due to memory decay.
2001 Freedmark and Bursey [34] / N=29
White & black, both sexes
BMI >30kg/m² /
- Metformin 500mg X day, 6 months
- Placebo X2 6 months
40% had side effects of diarrhea & abdominal discomfort / Conclusions: Metformin shows promise for moderating weight gain in adolescents. Limitations: No direct measures of adiposity, small sample, short duration, no long term f/u, side-effects of drug.
2001
Warschburger et al. [76] / N= 197
9 -19 years
Mean 64.2% O/V / 6 weeks inpatient rehab 2 conditions:
1. ‘Obesity training’ including CBT, calorie reduced diet & Ex program
2. Muscle relaxation + same diet & Ex / 12 months f/u
Attrition ND / ND / % O/V, BMI / - % O/V in both groups but no stat sig diff between groups
- CBT grp had stat sig improvement in their self efficacy that was maintained / Conclusions: Morepower than most other studies. Both approaches successful in long-term weight maintenance & improved quality of life. CBT improves self efficacy. Limitations: Inpatient intervention high cost & not practical, muscle relaxation may have been an active treatment and hence was not a true control comparison. Local GP did 6 month & 12 month f/u – hence may have questionable reliability.
2000 Molnar et al. [57] / N= 32
Mean BMI 35.9 kg/m² / 1. Diet & ephedrine/caffeine (CE), X 3 day
2. Placebo X 3 day / 20 weeks f/u
Attrition 1% / Double blind / BMI, relative weight, bioimpedence % body fat) / - sig relative body weight, BMI & body fat in CE grp cf placebo / Conclusions: Suggests that CE is effective for WL in adolescents. Limitations: no direct measures adiposity, didn’t measure pubertal development, lacks long- term f/u, unknown whether rebound occurs once CE is ceased.
2000
James et al. [44] / N= 605
Mean BMI 30 - 45 kg/m² / 1. For 6 months – diet + sibutramine
2. Diet + placebo / 2 years f/u
Attrition 34% / Double blind / RMR, weight, uric acid, glycemic, lipids, / triglycerides, VLDL cholesterol, insulin, C peptide, and uric acid were sustained in the sibutramine grp.
in the 2nd year: 20.7% (sibutramine) &11.7% (placebo, n = 20 (sibutramine grp) had diastolic BP 2.3mmHg & pulse (4.1 bpm) / Conclusions: Sibutramine useful for long term weight loss & maintenance, however blood pressure must be monitored. Limitations: side effects of medication, didn’t assess pubertal development, included adults & skewed to elderly, therefore caution extrapolating to adolescents.
2000
Braet and Vander Winckel [10] / N= 136
Aged 7-17 YO
Mean % O/V 55% / 12 session CBT delivered;
1. Grp Therapy 2X week
2. Daily Grp therapy - 10day summer camp + daily lifestyle Ex & diet 1,500Kcal/day
3. 1:1 sessions
4. control - one advice session / 19% attrition
4.6 year f/u / RA to 1.2.3, but not 4.
No blinding / height & weight
% O/V
DEBQ parent version, PCSC, CBCL, EDI / Weight- No sig diff between grps 1,2,3
Mean WL of grps 1,2,3 is sig higher than condition 4 (control) at 1 year and 4.6 year f/u.
WL at 4.6 years was;
1. 17.26% (SD 21) – large effect size
2. 11% (SD17) – med to large effect
3. 14.57 (SD 20) – med to large effect
4. 6.21 (SD 2) – small effect size / Conclusions: Subjects who received CBT showed better results than ‘advice in one session’ controls. Cautious conclusion that CBT program seems to help children to control external eating stimuli & develop eating restraint (although analysis only included ½ subjects). No evidence that CBT anorexia. CBT helpful for O/B & O/V. Limitation: Randomisation for control grp – not a true control grp as it was a convenience sample. Limitation with long-term f/u studies is lower power due to high SD. No comparison with O/V children who did not seek treatment.
1999 Schwingshandl and Borkenstein [66] / N= 30
6-16 years
43% male
Mean SD BMI score 5.58 / 1. Dietary advice + individualised physical training sessions. 60-70 min duration, X 2 X week for 12 weeks
2. Control – dietary advice, sessions @ baseline, 4,8,12 weeks, 6 months & 12 months / 12 months f/u
Attrition ND / ND / Weight
BMI
Fat free mass estimated from bioimpedence / After 12 weeks, children in grp 1. Had a sign greater mean change in fat free mass (2.7kg) compared with grp 2. (0.4kg). / Conclusions: Diet and individualised training more effective than dietary advice alone for fat loss.
Limitations: Outcome data at 12 months not presented unable to assess if results were maintained. Did not assess pubertal development, only used indirect measures of adiposity. Low power & small sample.
1997
Braet et al [9] / As for Braet & Vander Winckel 2000 / As for Braet & Vander Winckel 2000 / 1 year f/u / See Braet 2000 / 1. Lost 13% overall weight
2. Lost 15% overall weight
3. Lost 10% overall weight
4. Lost 7% overall weight / Conclusions: Subjects who received CBT showed better results than ‘advice in one session’ controls. Cautious conclusion that CBT program seems to help children to control external eating stimuli & develop eating restraint. No evidence that CBT anorexia. CBT helpful for O/B & O/V. Limitation: Analysis only included ½ subjects Randomisation for control grp – not a true control grp as it was a convenience sample. Lower power, high SD. No comparison with O/V children who didn’t seek Rx.
1997 Johnson et al. [47] / N= 32
Aged 8-17 YO
Mean % O/V 153-186% / 16 weekly 90 min sessions
1. Nutrition & BT
2. BT & modified traffic light diet & Ex
3. BT & Ex, then traffic light diet / 5 year f/u
44% attrition / ND / Weight, BMI , % O/V / Week 16
1. +0.3kg
2. -2.3kg
3. - 1.0kg
5 year f/u
1. -11.3% O/V
2. -31.5% O/V
3. - 15.2% O/V / Conclusions: BT, diet and Ex are superior to BT & nutrition education alone. Limitations: low power, large loss to f/u, no direct measures of adiposity, did not assess pubertal development, included children as well as adolescents
1994
Israel et al. [43] / N= 36 families
8-13YO
47% O/V (=obese) / 1. BT, parents had primary responsibility
2. Enhanced child involvement, parents separated for 8X 90 min sessions, followed by 9 biweekly sessions for a total of 26 weeks. / 41% attrition
3 year f/u / Blind allocation / % O/V based on weight for age, height & sex / -Children in both groups had a reduction in % O/V, ? sig.
-Over 3 years, both grps showed a gain in % O/V;
1. Baseline – 45.9%, 6 month – 33.4%, 1 year – 45.2%, 3 year – 52.3%
2.Baseline – 48.1%, 6 months – 32.6%, 1 year – 42.3%, 3 years – 43.3%, / Conclusions: Both treatment approaches show improvements in % O/V in the short-term, with most improvements lost in the long-term, where the standard treatment group were more % O/V than when they started. Limitations: Didn’t assess level of pubertal development. Only included younger adolescents results can not be extrapolated to all adolescents.
1993
Duffy & Spence [23] / 7-13 years
N= 27
6 males, 22 females
Mean % O/V 48.3% / 8 week, 90 minute behavioural sessions
1. BT + Cognitive self management
2. BT + relaxation therapy (RT)
All to do exercise & avoid ‘red light’ foods / 37% attrition
6 month f/u / Block allocation
No blinding / Weight kg, % overweight
No. ‘red’ foods per day / -Both approaches resulted in sig % O/V by 8.5%, no diff between grps, maintained at 3 & 6 month f/u. No sig diff between 3 & 6 month f/u.
-Children were still around 38% O/V at the end of follow up.
- no further improvement during maintenance phase / Conclusions-: CBT did not appear to improve efficacy of BT approach. Limitations: No direct measures of adiposity, didn’t assess for pubertal develop, only included younger children, only 3 hrs allocated to CBT. Many children were reluctant participants –CBT focused on eating but not Ex. Relaxation may not be a real ‘placebo Rx’ CBT may add to BT with results masked by effect of relaxation. Low power & small sample size. Skewed towards younger children (mean age = 9YO)
1993 Figueroa-Colon et al. [32] / N=19
7.5-16.9 YO
Mean % O/V 45-131% / 10 sessions, then monthly sessions for 1 year
1. Protein sparing diet (2520-3360J)
2. Hypocaloric diet (3360-4200J) / 1 year f/u / ND / % O/V / Post Rx
- -32.2% O/V
- -20.3% O/V
- -23.3%
- 20.3%
1990
Amador et al. [1] / N= 94
10-13 YO
47.9% girls
O/B
>97th percentile (Cuban) / 1. Restrictive diet to 30% energy requirement
2. Non-restrictive diet, nutritional information / 1 year f/u
Attrition ND / ND / Assessed Tanner stage, weight for height, skin folds, %BF, bloods / Grp 2 gained more lean body weight than grp 1.
No diff in change in height between grps / Conclusions: Restrictive diet may affect lean mass. Non restrictive diet is better tolerated by adolescents than a restrictive diet. Limitations: Only included indirect measures of adiposity. Classification of obese status (Cuban reference population).
1990
Emes et al. [27] / N= 33, 12-15 YO
48% O/V / Diet & BT;
1. 5X per week, gradual to 3 X week
2. 1 X Ex per week, 3 X week
3. Leisure advice / 24% attrition
No f/u past week 9 / ND / % O/V /
- -8.7% O/V
- -17.2% O/V
- -6.4% O/V
1990 Wadden et al. [75] / 12-16 years
All female
N= 47
Black
Mean BMI 35.7 kg/m² / 16 weekly 1 hr BT sessions
1. Child alone,
2. Mother & child together,
3. Mother & child separately / 6 months
Attrition 22% / ND / Weight (kg), BMI /
- @ 16 weeks, lost 1.6 kg
- @ 16 weeks, lost 3.7 kg
- @ 16 lost 3.1kg
1988
Becque et al. [6] / 12-13YO
N= 36
58.3 % girls / 1. Diet + BT, no Ex
2. Diet, BT + Ex (50 min X 3 per week 60-80% max)
3. Control – no treatment / 20 weeks / RA / Lipids, BP, maximal O2 uptake / 41.4% in CV risk factors in grp 2.
14.8% CV risk factors in grp 1. / Conclusions: O/B adolescents are at a high risk of developing coronary heart disease. Modest diet restriction, combined with Ex & BT seems to CV risk
Limitations: Small sample & low power, skewed towards pre-pubertal girls, hence limited generalisability. Didn’t assess pubertal development.
1987 Mellin et al. [56] / 12-18years
N= 66
133% relative weight / SHAPEDOWN program 14 X 90 min sessions
Cognitive, Behavioural & affective techniques / 15 months
16% attrition rate / ND / Relative weight, height,
obesity-related behaviours
Assessed @ baseline, 3months & 6 months / Shape down grp had sig improvement (not just maintenance) in relative weight, weight related behaviour, depression, knowledge at 1 year.
Control grp remained static / Conclusions: CBT group therapy associated with sig improvement in relative weight, weight-related behaviour, depression & knowledge following Rx. WL was shown to continue during the post-intervention period. This study importantly compares this Rx to no Rx. Limitations: Fairly modest WL, low power, no direct measures of body comp, didn’t assess sexual maturation .
1983
Brownel et al. [11] / 12-16 YO
N= 32
78.6% females
20% O/V / 1. Mother & child seen separately
2. Mother & child seen together
3. Child seen alone
1, 2 & 3 given nutritional & exercise information / 1 year f/u
14% attrition / RA / Weight, height, BP / Grp 1 had superior results where they maintained their WL at 1 year f/u (sig WL), where as the other groups put on weight and were a mean of 3kg heavier than their baseline weight @ 1 year
- sig WL assoc with BP / Conclusions: Rx is most effective when mothers are involved in treatment but are seen separately to the child. Limitations: Bias towards girls. More expensive intervention as it involves double the therapist time for condition 1. Did not assess pubertal development, only used indirect measures of adiposity + different definitions of O/V & O/B.
1982
Coateset al. [14] / 13-17
N= 38
68.4% girls
Mean age 15.6 years
Mean % O/V 32.7% / 1. Mother and child seen separately
2. Child seen alone
+ nutritional info monetary deposits and exercise to both / 9 month f/u
Attrition NR / RA / % O/V height, weight, blood lipids, BP, Stanford diet questionnaire, PA questionnaire / Parent participation enhanced short term changes. Grps 1 & 2 were equivalent at f/u. Both grps had sig in % above ideal weight. Sig relationship between PA & WL. / Conclusion: Parental involvement appears to be important for modeling of appropriate behaviour when adolescents are learning new behaviours during Rx. Maintenance of WL relies on the adolescent self modulating their behaviours, & parents seem to have limited influence on success. Limitations: Appears that PA questionnaire was not validated? Did not assess pubertal. Only used indirect measures of adiposity.
1982
Coates et al. [15] / 13-17
N=31
64.5% girls
Mean % O/V 40.6% / 1. Daily contact, reinforced for weight
2. Weekly contact re-enforced for weight
3. Daily contact reinforced for calories
monetary rewards to all / 6 month f/u
Attrition
9.5 % / RA / % O/V height, weight, blood lipids, BP / Group1 were the only grp with sig % above ideal weight at 15 week post test Assessment (-12%). Some rebound was evident at 6 months f/u (-8%). / Conclusions: daily reinforcement leads to better changes in % above ideal weight. Limitations: No direct measures of adiposity. Did not assess pubertal development. Only used indirect measures of adiposity.
1982
Ikeda et al [42] / N= 50 , aged 14-16YO / 14 weekly sessions relaxation + nutrition;
1. BT
2. BT + energy restricted diet / 12 month f/u
50% attrition / ND / % O/V / Post Rx
- -2.2% O/V
- -1.1% O/V
- +2.3% O/V
- -0.5% O/V
Abbreviations. CBT – Cognitive Behavioral Therapy, CT – cognitive therapy, BT- behaviour therapy, DEXA – dual energy xray absorptiometry, GP – general practitioner, Ex – Exercise, Rx- treatment, RCT – randomised controlled trial, hr –hour, RAC – random allocation concealment, - psychology/psychological/psychologist, DEBQ – Dutch eating behavior questionnaire, EDI- Eating disorder Inventory, PCSC – perceived competence scale for children, CBCL – Child Behavior checklist, RA – random allocation, SBP – systolic blood pressure, DBP – diastolic blood pressure, BMI – body mass index, PA - physical activity, GL – Glycemic load, Grps – groups, diff – difference, sig – significant, int – international, esp – especially, WL – weight loss, N = number, mod – moderate, grps – groups, CVF – cardiovascular fitness, YO – year old, O/V – overweight, O/B – obese, f/u – follow up, cf – compared with, GI – gastrointestinal, ND – not described, - increase, - decrease, - change, - therefore, > - greater than, < - less than, % - percent, X – times, @ - at.