GOLAN, MORIA, AND SCOTT CROW. Targeting parents exclusively in the treatment of childhood obesity: long-term results. Obes Res. 2004;12:357-361. Objective: To report the long-term change in children's overweight following a family-based health-centered approach where only parents were targeted compared with a control intervention where only children were targeted. Research Methods and Procedures: Fifty of the 60 children who participated in the original study were located 7 years later, and their weight and height were measured. At the point of the 7-year follow-up, the children were 14 to 19 years of age. Repeated measure ANOVA was used to test differences between the groups in percent overweight at different time-points. Results: Mean reduction in percent overweight was greater at all follow-up points in children of the parent-only group compared with those in the children-only group (p Ͻ 0.05). Seven years after the program terminated, mean reduction in children's overweight was 29% in the parent-only group vs. 20.2% in the children-only group (p Ͻ 0.05). Discussion: Over the long term, treatment of childhood obesity with the parents as the exclusive agents of change was superior to the conventional approach.

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.

The home environment is undoubtedly the most important setting in relation to shaping children's eating and physical activity behaviors. Family-based behavioral treatment is the most well-established intervention for the treatment of childhood obesity. Historically, family based interventions target the obese child and at least one or both parents. Presented here is a review of the literature on parents as exclusive agents of change, with the addition of some recent results indicating the effectiveness of this approach when implemented in public health programs. Targeting parents as the exclusive mediator has resulted in a better reduction in children's percentage overweight, and improvement in the obesogenic environment and behaviors, in comparison to a setting in which parents attended sessions with the obese child, or only children attended sessions. The findings from these studies were subsequently implemented in a national community-based survey. Both children's and parents' weight status were significantly improved, although only parents attended the group sessions. A significant reduction in the obesogenic load at home was also found. Permissive parenting style was associated with less reduction in obesogenic load at home (p < 0.01) and with less weight loss (p < 0.05). Omitting the obese child from direct intervention and targeting parents only is a cost-effective approach with integrated messages for the management of weight-related problems.

There is a consensus that interventions to prevent and treat childhood obesity should involve the family; however, the extent of the child's involvement has received little attention. The goal of the present study was to evaluate the relative efficacy of treating childhood obesity via a familybased health-centred intervention, targeting parents alone v. parents and obese children together. Thirty-two families with obese children of 6-11 years of age were randomised into groups, in which participants were provided for 6 months a comprehensive educational and behavioural programme for a healthy lifestyle. These groups differed in their main agent of change: parents-only v. the parents and the obese child. In both groups, parents were encouraged to foster authoritative parenting styles (parents are both firm and supportive; assume a leadership role in the environmental change with appropriate granting of child's autonomy). Only the intervention aimed at parents-only resulted in a significant reduction in the percentage overweight at the end of the programme (P¼ 0·02) as well as at the 1-year follow-up meeting. The differences between groups at both times were significant (P,0·05). A greater reduction in food stimuli in the home (P,0·05) was noted in the parents-only group. In both groups, the parents' weight status did not change. Regression analysis shows that the level of attendance in sessions explained 28 % of the variability in the children's weight status change, the treatment group explained another 10 %, and the improvement in the obesogenic load explained 11 % of the variability. These results suggest that omitting the obese child from active participation in the health-centred programme may be beneficial for weight loss and for the promotion of a healthy lifestyle among obese children.

There is growing agreement among experts that an obesogenic environment, which encourage excess food intake and idealizes thinness, plays a crucial role in the epidemic of childhood obesity and eating disorders. Because parents provide a child's contextual environment, they should be considered key players in interventions aimed at preventing or treating weight-related problems. Parenting style and feeding style are crucial factors in fostering healthy lifestyle and awareness of internal hunger and satiety cues and de-emphasizing thinness. Effective interventions for prevention and treatment of weight-related problems should be approached from a health-centered rather than a weight-centered perspective, with the parents as central agents of change. This paper reviews the environmental risk factors and parents' role in the prevention and treatment of children's weight-related problems.

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There is growing agreement among experts that an obesogenic environment, which encourage excess food intake and idealizes thinness, plays a crucial role in the epidemic of childhood obesity and eating disorders. Because parents provide a child's contextual environment, they should be considered key players in interventions aimed at preventing or treating weight-related problems. Parenting style and feeding style are crucial factors in fostering healthy lifestyle and awareness of internal hunger and satiety cues and de-emphasizing thinness. Effective interventions for prevention and treatment of weight-related problems should be approached from a health-centered rather than a weight-centered perspective, with the parents as central agents of change. This paper reviews the environmental risk factors and parents' role in the prevention and treatment of children's weight-related problems.

Treatment of childhood obesity with the parents as the exclusive agents of change, induces more behavioural changes as well as greater weight loss, than the conventional approach.