Context-Identifying and evaluating efficacious treatments for pediatric weight loss is of critical importance.Objective-This quantitative review represents the first meta-analysis of the efficacy of randomized controlled trials comparing lifestyle interventions to control conditions. Data Sources-MEDLINE, PsychINFO, and Cochrane Controlled Trials Register were searched up to August 2005.Study Selection-Eligible studies were randomized controlled trials involving lifestyle interventions for pediatric overweight that had as a comparison either a no-treatment or information/ education-only control. The primary outcome of interest was change in weight status. Fourteen trials were eligible, resulting in 19 effect sizes.Data Extraction-Information on study design, participant characteristics, interventions, and results were extracted using a standardized coding protocol.Data Synthesis-For trials with no-treatment controls, the mean effect size was 0.75 (k=9, 95% CI 0.52 to 0.98) at end of treatment and 0.60 (k=4, CI 0.27 to 0.94) at follow-up. For trials with information/education only controls, the mean effect size was 0.48 (k = 4, CI 0.13 to 0.82) at end of treatment and 0.91 (k = 2, CI 0.32 to 1.50) at follow-up. No significant moderator effects were identified.Conclusions-Lifestyle interventions for the treatment of pediatric overweight are efficacious in the short-term with some evidence for persistence of effects. Future research is required to identify moderators and mediators of outcome and to determine the optimal length and intensity of treatment required to produce enduring changes in weight status.

Several studies support the efficacy of interpersonal psychotherapy (IPT) in the treatment of eating disorders. Treatment outcomes are likely to be augmented through a greater understanding, and hence treatment targeting, of the mechanisms whereby IPT induces therapeutic gains. To this end, the present paper seeks to develop a theoretical model of IPT in the context of eating disorders (IPT-ED). After providing a brief description of IPT, the IPT-ED model is presented and research supporting its theorized mechanisms is summarized. This model proposes that negative social evaluation plays a pivotal role as both a cause (via its detrimental impact on self evaluation and associated affect) and consequence of eating disorder symptoms. In the final section, key eating disorder constructs (namely, the developmental period of adolescence, clinical perfectionism, cognitive dysfunction, and affect regulation) are re-interpreted from the standpoint of negative social evaluation thereby further explicating IPT's efficacy as an intervention for individuals with an eating disorder.

Obesity in adults has nearly doubled in the past 30 years and has risen similarly in children and adolescents. Obesity affects all systems of the body and the serious health consequences of obesity include an increased risk for cardiovascular disease, such as type 2 diabetes or high blood pressure, which are occurring at ever younger ages. The present article provides an introduction to traditional, behavioral weight loss strategies designed to change energy-balance behaviors (i.e., dietary and physical activity behaviors) and the contexts within which these interventions have typically been delivered. The applicability of findings from behavioral economics, cognitive processing, and clinical research which may lead to more potent weight loss and weight loss maintenance interventions are also considered. Given the pervasiveness of obesity, this paper concludes with a discussion of efforts towards wider-scale dissemination and implementation of behavioral treatments designed to address obesity and to reduce the risk of cardiovascular disease.

Weight loss outcomes achieved through conventional behavior change interventions are prone to deterioration over time. Basic learning laboratory studies in the area of behavioral extinction and renewal and multilevel models of weight control offer clues as to why newly acquired weight loss skills are prone to relapse. According to these models, current clinic‐based interventions may not be of sufficient duration or scope to allow for the practice of new skills across the multiple community contexts necessary to promote sustainable weight loss. Although longer, more intensive interventions with greater reach may hold the key to improving weight loss outcomes, it is difficult to test these assumptions in a time efficient and cost‐effective manner. A research design tool that has been increasingly utilized in other fields (e.g., pharmaceuticals) is the use of biosimulation analyses. The present study describes our research team's use of computer simulation models to assist in designing a study to test a novel, comprehensive socio‐environmental treatment approach to weight loss maintenance in children ages 7–12 years. Weight outcome data from the weight loss, weight maintenance, and follow‐up phases of a recently completed randomized controlled trial (RCT) were used to describe the time course of a proposed, extended multilevel treatment program. Simulations were then conducted to project the expected changes in child percent overweight (POW) trajectories in the proposed study. A 12.9% decrease in POW at 30 months was estimated based upon the midway point between models of “best‐case” and “worst‐case” weight maintenance scenarios. Preliminary data and further analyses, including biosimulation projections, suggest that our socio‐environmental approach to weight loss maintenance treatment is promising and warrants evaluation in a large‐scale RCT. Biosimulation techniques may have utility in the design of future community‐level interventions for the treatment and prevention of childhood overweight.

Better weight loss outcomes are achieved in adults and youth who adhere to obesity treatment regimens (i.e., session attendance and prescribed changes in weight control behaviors). However, more research is needed regarding children’s adherence to a range of behaviors relevant for weight maintenance over long-term follow-up. Overweight children (N=101, aged 7-12 years), along with an overweight parent, participated in a 20-week family-based behavioral weight loss treatment (FBT) and were then assigned to either a behaviorally-focused or socially-focused 16-week weight maintenance treatment (MT). Treatment attendance and child and parent adherence (i.e., reported use of skills targeted within treatment) were examined in relation to child percent overweight change from baseline to post-FBT, post-MT, and 2-year follow-up. Higher attendance predicted better child weight outcomes at post-MT, but not at 2-year follow-up. Adherence to self-regulatory skills/goal-setting skills predicted child weight outcomes at 2-year follow-up among the behaviorally-focused MT group. Future research is needed to examine mediators of change within family-based weight control interventions, including behavioral and socially-based targets. Incorporating self-regulatory weight maintenance skills into a comprehensive MT may maximize children’s sustained weight control.