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The role of mindfulness, mindful eating and a newer concept of intuitive eating in modulating eating habits is an area of increasing interest. In this structured literature review, a summary of the current evidence is presented, together with details of interventions undertaken and the tools to measure outcomes. It is broad in scope given the emerging evidence base in this area. The review yielded sixty-eight publications: twenty-three interventions in obese/overweight populations; twenty-nine interventions in normal-weight populations; sixteen observational studies, three of which were carried out in overweight/obese populations. Mindfulness-based approaches appear most effective in addressing binge eating, emotional eating and eating in response to external cues. There is a lack of compelling evidence for the effectiveness of mindfulness and mindful eating in weight management. Mindfulness-based approaches may prevent weight gain. Reduced food intake was seen in some of the studies in overweight and obese populations, but this was less apparent in the studies in normal-weight populations. The evidence base for intuitive eating is limited to date and further research is needed to examine its potential in altering eating behaviours. Mindfulness appears to work by an increased awareness of internal, rather than external, cues to eat. Mindfulness and mindful eating have the potential to address problematic eating behaviours and the challenges many face with controlling their food intake. Encouraging a mindful eating approach would seem to be a positive message to be included in general weight management advice to the public.

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OBJECTIVE: Adolescent obesity is difficult to treat and the optimal dietary pattern, particularly in relation to macronutrient composition, remains controversial. This study tested the effect of two structured diets with differing macronutrient composition versus control, on weight, body composition and metabolic parameters in obese adolescents. DESIGN: A randomized controlled trial conducted in a children's hospital. METHODS: Eighty seven obese youth (means: age 13.6 years, BMI z-score 2.2, waist: height ratio 0.65, 69% female) completed a psychological preparedness program and were then randomized to a short term 'structured modified carbohydrate' (SMC, 35% carbohydrate; 30% protein; 35% fat, n = 37) or a 'structured low fat' (SLF, 55% carbohydrate; 20% protein; 25% fat, n = 36) or a wait listed control group (n = 14). Anthropometric, body composition and biochemical parameters were measured at randomization and after 12 weeks, and analyzed under the intention to treat principle using analysis of variance models. RESULTS: After 12 weeks, data was collected from 79 (91%) participants. BMI z-scores were significantly lower in both intervention groups compared to control after adjusting for baseline values, SLF vs. control, mean difference = -0.13 (95%CI = -0.18, -0.07), P<0.001; SMC vs. control, -0.14 (-0.19, -0.09), P<0.001, but there was no difference between the two intervention diet groups: SLF vs. SMC, 0.00 (-0.05, 0.04), P = 0.83. CONCLUSIONS: Both dietary patterns resulted in similar changes in weight, body composition and metabolic improvements compared to control. The use of a structured eating system which allows flexibility but limited choices can assist in weight change and the rigid application of a low fat eating pattern is not exclusive in its efficacy. TRIAL REGISTRATION: International Clinical Trials Registry ISRCTN49438757.

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The aim of this study was to examine gender differences in the impact of a school garden and nutrition curriculum on fruit and vegetable intake, willingness to taste, and taste ratings in 127 children (11 to 12 years, 54% boys) in regional New South Wales, Australia. Classes were assigned to wait-list control, nutrition education only (NE), or nutrition education plus garden (NE + G) groups. Carrot taste rating was the only vegetable for which there was a significant gender difference, with girls rating it more highly (p = .04). There were no significant gender differences in fruit and vegetable consumption or willingness to taste scores for any other vegetables. There was a group effect (p < .001) for overall willingness to taste, overall taste rating, and the taste rating of pea and broccoli (p < .001), tomato (p = .03), and lettuce (p = .02). In the post hoc analysis by gender, both boys and girls in NE + G and NE groups were more willing to taste vegetables compared with control boys and girls postintervention (p < .001, p = .02). Boys in the NE + G group were more willing to taste all vegetables overall compared with NE boys at posttest (p = .05) and this approached significance for girls (p = .07). For overall tasting scores, a group effect was seen in girls only (p = .05). No significant treatment-time effect was found for vegetable intake in either gender. Further research is needed to examine whether a school garden, with or without school curriculum components, can be used to optimize fruit and vegetable intakes, particularly in boys.

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OBJECTIVES: Outcomes of childhood obesity interventions are rarely reported beyond 1 year. We hypothesized that the impact on the BMI z score from a child-centered physical-activity program in combination with a parent-centered dietary-modification program would be greater than either program conducted alone at 24 months' after baseline. PARTICIPANTS AND METHODS: A total of 165 overweight prepubertal children (68 boys, aged 5.5-9.9 years, mean BMI z score: 2.8) were randomly assigned to either a child-centered physical-activity program, a parent-centered dietary-modification program, or both conducted together in an assessor-blinded 6-month intervention. RESULTS: Using linear mixed models, all groups reduced their mean (95% confidence interval) BMI z score at 24 months from baseline (P < .001) (the activity and diet group: -0.24 [-0.35 to -0.13]; the diet-only group: -0.35 [-0.48 to -0.22]; activity-only group -0.19 [-0.30 to -0.07]). There was a significant group-by-time interaction (P = .04) with the activity + diet and the diet-only groups showing a greater reduction than the activity-only group. For waist z score and waist-to-height ratio, there was a significant time effect (P < .0001) at 24 months but no between-group differences (P > .05). Some metabolic outcomes improved at 24 months, although there were no between-group differences (P > .05). CONCLUSIONS: A reduction in BMI z score was sustained at 24 months by treatment with either program combination. The greatest effects were achieved through inclusion of a parent-centered diet program, indicating the importance of targeting parents within treatment and the possibility of targeting them exclusively in treating obese prepubertal children.

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OBJECTIVE: To describe dietary changes in men participating in an obesity intervention as part of the Self-Help, Exercise and Diet using Information Technology (SHED-IT) study. DESIGN: An assessor-blinded randomized controlled trial comparing Internet (n 34) v. information-only groups (n 31) with 6-month follow-up. Dietary intake assessed by FFQ, reporting usual consumption of seventy-four foods and six alcoholic beverages using a 10-point frequency scale. A single portion size (PSF) factor was calculated based on photographs to indicate usual serving sizes. SETTING: The campus community of the University of Newcastle, New South Wales, Australia. SUBJECTS: Sixty-five overweight/obese men (43 % students, 42 % non-academic general staff, 15 % academic staff; mean age 35.9 (sd 11.1) years, mean BMI 30.6 (sd 2.8) kg/m2). RESULTS: The average PSF decreased significantly over time (χ2 = 20.9, df = 5, P < 0.001) with no differences between groups. While both groups reduced mean daily energy intake (GLM χ2 = 34.5, df = 3, P < 0.001), there was a trend towards a greater reduction in the Internet group (GLM χ2 = 3.3, P = 0.07). Both groups reduced percentage of energy from fat (P < 0.05), saturated fat (P < 0.001) and energy-dense/nutrient-poor items (P < 0.05), with no change in dietary fibre or alcohol (P > 0.05). CONCLUSIONS: Although men reported some positive dietary changes during weight loss, they did not increase vegetable intakes nor decrease alcohol consumption, while saturated fat, fibre and Na intakes still exceeded national targets. Future interventions for men should promote specific food-based guidelines to target improvements in their diet-related risk factor profile for chronic diseases.

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SUMMARY: Recruiting men to weight loss programs is notoriously difficult and little is known about the experiences of men who participate in weight loss programs. The aims of this paper were to report the perceptions and experiences of men who enrolled in the SHED-IT (Self-Help, Exercise, Diet and Information Technology) randomized controlled trial in the context of (1) what attracted them to the program, (2) their satisfaction with the program and its components, and (3) their suggestions for improvements to the program. The SHED-IT program exclusively targeted men and was developed to appeal to men. Individual semi-structured interviews were conducted with 18 overweight/obese (BMI between 25 and 37 kg/m(2)) men aged 18-60 years who were employed or enrolled at the University of Newcastle and who had been enrolled to the SHED-IT trial and randomly allocated to receive either the Internet intervention or basic weight-loss Information Only. Significant weight loss was achieved by both groups. A thematic analysis was undertaken applying the constant comparison method. Results indicated that lack of knowledge was a major weight loss barrier and men were attracted to a program that did not require extensive time commitments, was tailored for men and allowed inclusion of 'treat' food and drinks. Men were satisfied with both programs and valued the education about energy balance and the humour used to deliver simple messages. More face-to-face contact was a common suggestion for improvement. Our findings will inform future weight loss interventions for men and assist researchers and practitioners to engage men in weight loss.:

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This article reports the 12-month follow-up results and process evaluation of the SHED-IT (Self-Help, Exercise, and Diet using Information Technology) trial, an Internet-based weight loss program exclusively for men. Sixty-five overweight/obese male staff and students at the University of Newcastle (Callaghan, Australia) (mean (s.d.) age = 35.9 (11.1) years; BMI = 30.6 (2.8)) were randomly assigned to either (i) Internet group (n = 34) or (ii) Information only control group (n = 31). Both received one face-to-face information session and a program booklet. Internet group participants were instructed to use the study website for 3 months. Participants were assessed at baseline, 3-, 6-, and 12-month follow-up for weight, waist circumference, BMI, blood pressure, and resting heart rate. Retention at 3- and 12-months was 85% and 71%, respectively. Intention-to-treat (ITT) analysis using linear mixed models revealed significant and sustained weight loss of -5.3 kg (95% confidence interval (CI): -7.5, -3.0) at 12 months for the Internet group and -3.1 kg (95% CI: -5.4, -0.7) for the control group with no group difference. A significant time effect was found for all outcomes (P < 0.001). Per-protocol analysis revealed a significant group-by-time interaction for weight, waist circumference, BMI, and systolic blood pressure. Internet group compliers (who self-monitored as instructed) maintained greater weight loss at 12 months (-8.8 kg; 95% CI -11.8, -5.9) than noncompliers (-1.9 kg; 95% CI -4.8, 1.0) and controls (-3.0 kg; 95% CI -5.2, -0.9). Qualitative analysis by questionnaire and interview highlighted the acceptability and satisfaction with SHED-IT. Low-dose approaches to weight loss are feasible, acceptable, and can achieve clinically important weight loss in men after 1-year follow-up.

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BACKGROUND: Obesity is a major cause of preventable death in Australia with prevalence increasing at an alarming rate. Of particular concern is that approximately 68% of men are overweight/obese, yet are notoriously difficult to engage in weight loss programs, despite being more susceptible than women to adverse weight-related outcomes. There is a need to develop and evaluate obesity treatment programs that target and appeal to men. The primary aim of this study is to evaluate the efficacy of two relatively low intensity weight loss programs developed specifically for men. METHODS AND DESIGN: The study design is an assessor blinded, parallel-group randomised controlled trial that recruited 159 overweight and obese men in Newcastle, Australia. Inclusion criteria included: BMI 25-40 (kg/m2); no participation in other weight loss programs during the study; pass a health-screening questionnaire and pre-exercise risk assessment; available for assessment sessions; access to a computer with e-mail and Internet facilities; and own a mobile phone. Men were recruited to the SHED-IT (Self-Help, Exercise and Diet using Internet Technology) study via the media and emails sent to male dominated workplaces. Men were stratified by BMI category (overweight, obese class I, obese class II) and randomised to one of three groups: (1) SHED-IT Resources - provision of materials (DVD, handbooks, pedometer, tape measure) with embedded behaviour change strategies to support weight loss; (2) SHED-IT Online - same materials as SHED-IT Resources plus access to and instruction on how to use the study website; (3) Wait-list Control. The intervention programs are three months long with outcome measures taken by assessors blinded to group allocation at baseline, and 3- and 6-months post baseline. Outcome measures include: weight (primary outcome), % body fat, waist circumference, blood pressure, resting heart rate, objectively measured physical activity, self-reported dietary intake, sedentary behaviour, physical activity and dietary cognitions, sleepiness, quality of life, and perceived sexual health. Generalised linear mixed models will be used to assess all outcomes for the impact of group (Resources, Online, and Control), time (treated as categorical with levels baseline, 3-months and 6-months) and the group-by-time interaction. These three terms will form the base model. 'Intention-to-treat' analysis will include all randomised participants. DISCUSSION: Our study will compare evidence-based and theoretically driven, low cost and easily disseminated strategies specifically targeting weight loss in men. The SHED-IT community trial will provide evidence to inform development and dissemination of sustainable strategies to reduce obesity in men. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry (ACTRN12610000699066).

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OBJECTIVE: To investigate the impact of school garden-enhanced nutrition education (NE) on children's fruit and vegetable consumption, vegetable preferences, fruit and vegetable knowledge and quality of school life. DESIGN: Quasi-experimental 10-week intervention with nutrition education and garden (NE&G), NE only and control groups. Fruit and vegetable knowledge, vegetable preferences (willingness to taste and taste ratings), fruit and vegetable consumption (24 h recall × 2) and quality of school life (QoSL) were measured at baseline and 4-month follow-up. SETTING: Two primary schools in the Hunter Region, New South Wales, Australia. SUBJECTS: A total of 127 students in Grades 5 and 6 (11-12 years old; 54 % boys). RESULTS: Relative to controls, significant between-group differences were found for NE&G and NE students for overall willingness to taste vegetables (P < 0·001) and overall taste ratings of vegetables (P < 0·001). A treatment effect was found for the NE&G group for: ability to identify vegetables (P < 0·001); willingness to taste capsicum (P = 0·04), broccoli (P = 0·01), tomato (P < 0·001) and pea (P = 0·02); and student preference to eat broccoli (P < 0·001) and pea (P < 0·001) as a snack. No group-by-time differences were found for vegetable intake (P = 0·22), fruit intake (P = 0·23) or QoSL (P = 0·98). CONCLUSIONS: School gardens can impact positively on primary-school students' willingness to taste vegetables and their vegetable taste ratings, but given the complexity of dietary behaviour change, more comprehensive strategies are required to increase vegetable intake.

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OBJECTIVE: To evaluate whether a child-centered physical activity program, combined with a parent-centered dietary program, was more efficacious than each treatment alone, in preventing unhealthy weight-gain in overweight children. STUDY DESIGN: An assessor-blinded randomized controlled trial involving 165 overweight/obese 5.5- to 9.9- year-old children. Participants were randomly assigned to 1 of 3 interventions: a parent-centered dietary program (Diet); a child-centered physical activity program (Activity); or a combination of both (Diet+Activity). All groups received 10 weekly face-to-face sessions followed by 3 monthly relapse-prevention phone calls. Analysis was by intention-to-treat. The primary outcome was change in body mass index z-score at 6 and 12 months (n=114 and 106, respectively). RESULTS: Body mass index z-scores were reduced at 12-months in all groups, with the Diet (mean [95% confidence interval]) (-0.39 [-0.51 to 0.27]) and Diet + Activity (-0.32, [-0.36, -0.23]) groups showing a greater reduction than the Activity group (-0.17 [-0.28, -0.06]) (P=.02). Changes in other outcomes (waist circumference and metabolic profile) were not statistically significant among groups. CONCLUSION: Relative body weight decreased at 6 months and was sustained at 12 months through treatment with a child-centered physical activity program, a parent-centered dietary program, or both. The greatest effect was achieved when a parent-centered dietary component was included.

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Physical activity has a fundamental role in the prevention and treatment of chronic disease. The precise measurement of physical activity is key to many surveillance and epidemiological studies investigating trends and associations with disease. Public health initiatives aimed at increasing physical activity rely on the measurement of physical activity to monitor their effectiveness. Physical activity is multidimensional, and a complex behaviour to measure; its various domains are often misunderstood. Inappropriate or crude measures of physical activity have serious implications, and are likely to lead to misleading results and underestimate effect size. In this review, key definitions and theoretical aspects, which underpin the measurement of physical activity, are briefly discussed. Methodologies particularly suited for use in epidemiological research are reviewed, with particular reference to their validity, primary outcome measure and considerations when using each in the field. It is acknowledged that the choice of method may be a compromise between accuracy level and feasibility, but the ultimate choice of tool must suit the stated aim of the research. A framework is presented to guide researchers on the selection of the most suitable tool for use in a specific study.

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The purposes of this article are to (a) outline findings from secondary or process outcome data of the Hunter Illawarra Kids Challenge Using Parent Support (HIKCUPS) study and (b) inform the design and development of future research interventions and practice in the management of child obesity. Data were collected by means of facilitator evaluations, independent session observation, attendance records, and parent questionnaires. Internal validity and reliability of the program delivery were high. All parents reported positive changes in their children as a result of the physical activity program, the dietary modification program, or both. Most participants completed the home activities, but more than half reported that finding time to do them was problematic. Facilitator review indicated that future programs should specifically cater to children of similar age or same sex, allow adequate time for explanation of complex nutritional concepts, and use intrinsic motivators for participants. Recommendations for future interventions, specifically the implementation of subsequent HIKCUPS or other multisite effectiveness studies, are detailed.

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BACKGROUND: Statistical mediation analysis can be used to improve the design of obesity prevention and treatment programs by identifying the possible mechanisms through which an intervention achieved its effects. The aim of this study was to identify mediators of weight loss in an Internet-based weight-loss program specifically designed for overweight men. METHODS: The Self-Help, Exercise and Diet using Information Technology (SHED-IT) program was a 3-month randomized controlled trial (Internet-based intervention group vs information only control group) that was implemented in 2007 with baseline and 6-month follow-up assessment of weight, physical activity and dietary behaviors. Intention-to-treat and per-protocol mediation analyses were conducted using a product-of-coefficients test. RESULTS: Participants (N = 65) were overweight and obese male academic (n = 10) and non-academic (n = 27) staff and students (n = 28) from the University of Newcastle, Australia. Mean (SD) age = 35.9 (11.1) years and mean (SD) BMI = 30.6 (2.8). In the intention-to-treat analysis, both groups lost weight, but relative to the control group, the intervention did not have a statistically significant 'total effect' on weight, tau = -.507, p = .716 (95% CI = -3.277 to 2.263). In the per-protocol analysis, the intervention had a statistically significant 'total effect' on weight, tau = -4.487, p < .05 (95% CI = -8.208 to -.765). The intervention did not have a statistically significant effect on any of the hypothesized mediators and none of the behavioral variables mediated weight loss in the SHED-IT program. Although participants in the intervention group reduced their fat intake over the study period, the changes did not satisfy the criteria for mediation. CONCLUSION: Few studies have examined the mediators of weight loss in obesity treatment interventions. While none of the hypothesized mediators satisfied the criteria for mediation in the current study, there was some evidence to suggest that overweight men in the SHED-IT intervention reduced their fat intake over the study period. Future obesity treatment and prevention programs should explore behavioral mediators of weight loss using appropriate statistical methods. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry No: ANZCTRN12607000481471.

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The aim of this study was to evaluate the efficacy of an Internet-based weight-loss program for men in an assessor blinded randomized controlled trial. In total, 65 overweight/obese male staff and students at the University of Newcastle (mean (s.d.) age = 35.9 (11.1) years; BMI = 30.6 (2.8)) were randomly assigned to either (i) Internet group (n = 34) or (ii) control group (information only) (n = 31). Both groups received one face-to-face information session and a program booklet. Internet group participants used the study website to self-monitor diet and activity with feedback provided based on participants' online entries on seven occasions over 3 months. Participants were assessed at baseline, 3-, and 6-month follow-up for weight, waist circumference, BMI, blood pressure, resting heart rate, objectively measured physical activity, and self-reported total daily kilojoules. Intention-to-treat analysis revealed significant weight loss of 5.3 kg (95% confidence interval (CI): -7.3, -3.3) at 6 months for the Internet group and 3.5 kg (95% CI: -5.5, -1.4) for the control group. A significant time effect was found for all outcomes but no between-group differences. Per-protocol analysis revealed a significant group-by-time interaction (P < 0.001), with compliers losing more weight at 6 months (-9.1 kg; 95% CI -11.8, -6.5) than noncompliers (-2.7 kg; 95% CI -5.3, -0.01) and the control group (-4.2 kg; 95% CI -6.2, -2.2). Simple weight-loss interventions can be effective in achieving statistically and clinically significant weight loss in men. The Internet is a feasible and effective medium for weight loss in men but strategies need to be explored to improve engagement in online programs.

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Assessing dietary intake in children is difficult and limited validated tools exist. Plasma carotenoids are nutritional biomarkers of fruit and vegetable intake and therefore suitable to validate reported dietary intakes. The aim of this study was to examine the comparative validity of a food frequency questionnaire (FFQ), completed by parents reporting child fruit and vegetable intake compared to plasma carotenoid concentrations. A sample of children aged 5-12 years (n = 93) from a range of weight categories were assessed. Dietary intake was measured using a 137-item semi-quantitative FFQ. Plasma carotenoids were measured using reverse phase high-performance liquid chromatography. Pearson correlation coefficients between reported dietary intake of carotenoids and plasma carotenoid concentrations were strongest after adjustment for BMI (beta-carotene (r = 0.56, P < 0.05), alpha-carotene (r = 0.51, P < 0.001), cryptoxanthin (r = 0.32, P < 0.001)). Significantly lower levels (P < 0.05) of all plasma carotenoids, except lutein, were found among overweight and obese children when compared to healthy weight children. Parental report of children's carotenoid intakes, using a FFQ can be used to provide a relative validation of fruit and vegetable intake. The lower plasma carotenoid concentrations found in overweight and obese children requires further investigation.

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AIM: To highlight and discuss the practical aspects of conducting high quality, randomised controlled trials (RCTs) with overweight and obese children and their families. CONTENT: Realistic considerations and suggestions for researchers arising from the experiences of three Australian interventions in overweight/obese children are highlighted. The practical implications of key issues arising during this type of RCT include study design, obtaining ethical approval, choice of outcome measures, recruitment, working with families, impact and process evaluation, retention strategies, managing multi-site trials and data management. CONCLUSION: Interventions for overweight children and their families are challenging. Although there were some differences in the design and outcome measures among the three studies, there were many similarities. Multi-site trials, although more expensive than single-site trials, are advantageous in increasing sample size and external validity. Collectively we have developed strategies to address key problems in conducting RCTs, including the common challenges of recruitment, retention and working with families.

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BACKGROUND: Childhood obesity is one of the most pressing health issues of our time. Key health organizations have recommended research be conducted on the effectiveness of well-designed interventions to combat childhood obesity that can be translated into a variety of settings. This paper describes the design and methods used in the Hunter Illawarra Kids Challenge Using Parent Support (HIKCUPS) trial, an ongoing multi-site randomized controlled trial, in overweight/obese children comparing the efficacy of three interventions: 1) a parent-centered dietary modification program; 2) a child-centered physical activity skill-development program; and 3) a program combining both 1 and 2 above. METHODS/DESIGN: Each intervention consists of three components: i) 10-weekly face-to-face group sessions; ii) a weekly homework component, completed between each face-to-face session and iii) three telephone calls at monthly intervals following completion of the 10-week program. Details of the programs' methodological aspects of recruitment, randomization and statistical analyses are described here a priori. DISCUSSION: Importantly this paper describes how HIKCUPS addresses some of the short falls in the current literature pertaining to the efficacy of child obesity interventions. The HIKCUPS trial is funded by the National Medical Research Council, Australia.

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Background The prevalence of overweight and obesity in children and adolescents is increasing at an alarming rate around the world and prevention has become a key public health objective. Treatment and management of those already overweight and obese must be aligned with the best available evidence on effectiveness, if the risk of obesity-related morbidity and mortality is yet be reduced. Diet plays a pivotal role in successful treatment of obesity but to date, there is limited evidence on which to base practice. Objectives To identify and present the best available evidence on the optimal dietetic treatment and management of children and adolescent who are overweight or obese. Search strategy Published English language literature was searched using the electronic databases CINAHL, MEDLINE, PRE-MEDLINE, DARE, COCHRANE, EMBASE, AUSTROM, Current Concepts and Dissertation Abstracts. The databases were limited to English Language from 1975 until 2003. Government reports from the UK, USA and Australian were also searched and a hand search performed for the Journal of the Dietitians Association of Australia, International Journal of Obesity and the Journal of Human Nutrition and Dietetics and the bibliographies of retrieved articles. Selection criteria (i) Interventions that evaluated the effectiveness of nutrition or dietary interventions to treat or manage overweight and obesity; (ii) Children aged less than 18 years; and (iii) Participants were defined as overweight or obese by relative weight or a measure of body weight status, studies that reported body weight per se were excluded. Data collection and analysis An experienced professional librarian searched the databases, and two trained research assistants independently identified studies for retrieval and assessed each article for inclusion. The included studies were critically appraised for methodological quality by two people independently. Data were extracted from the appropriate articles and when a discrepancy arose, a third party would arbitrate. Main results There were 116 articles that met the inclusion criteria. While 49 articles described randomised controlled trials, they arose from 37 separate studies. There were 67 non-randomised trials. Meta-analyses were performed on eight studies that included both a dietary intervention component and an adequate control group and on four studies that had follow-up data. There was a high degree of heterogeneity between studies and this made comparisons between studies problematic. Interventions that include diet therapy generally result in significant weight loss, at least in the short term. Many studies were poorly designed and had no or only minimal follow up. The details of the dietary intervention were often inadequately described and dietary outcomes rarely reported, making repetition of the studies difficult. Reviewers' conclusions There is an urgent need for high quality studies investigating the optimal dietary approach to management of paediatric overweight and obesity. These studies require adequate follow up to ascertain if weight loss can be sustained in the long term. Details of the dietary prescription, adherence to the dietary intervention and diet-specific outcomes need to be reported in order to inform best practice.

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BACKGROUND: The prevalence of overweight and obesity in children and adolescents is increasing at an alarming rate around the world and prevention has become a key public health objective. Treatment and management of those already overweight and obese must be aligned with the best available evidence on effectiveness, if the risk of obesity-related morbidity and mortality is yet be reduced. Diet plays a pivotal role in successful treatment of obesity but to date, there is limited evidence on which to base practice. OBJECTIVES: To identify and present the best available evidence on the optimal dietetic treatment and management of children and adolescent who are overweight or obese. SEARCH STRATEGY: Published English language literature was searched using the electronic databases CINAHL, MEDLINE, PRE-MEDLINE, DARE, COCHRANE, EMBASE, AUSTROM, Current Concepts and Dissertation Abstracts. The databases were limited to English Language from 1975 until 2003. Government reports from the UK, USA and Australian were also searched and a hand search performed for the Journal of the Dietitians Association of Australia, International Journal of Obesity and the Journal of Human Nutrition and Dietetics and the bibliographies of retrieved articles. SELECTION CRITERIA: (i) Interventions that evaluated the effectiveness of nutrition or dietary interventions to treat or manage overweight and obesity; (ii) Children aged less than 18 years; and (iii) Participants were defined as overweight or obese by relative weight or a measure of body weight status, studies that reported body weight per se were excluded. DATA COLLECTION AND ANALYSIS: An experienced professional librarian searched the databases, and two trained research assistants independently identified studies for retrieval and assessed each article for inclusion. The included studies were critically appraised for methodological quality by two people independently. Data were extracted from the appropriate articles and when a discrepancy arose, a third party would arbitrate. MAIN RESULTS: There were 116 articles that met the inclusion criteria. While 49 articles described randomised controlled trials, they arose from 37 separate studies. There were 67 non-randomised trials. Meta-analyses were performed on eight studies that included both a dietary intervention component and an adequate control group and on four studies that had follow-up data. There was a high degree of heterogeneity between studies and this made comparisons between studies problematic. Interventions that include diet therapy generally result in significant weight loss, at least in the short term. Many studies were poorly designed and had no or only minimal follow up. The details of the dietary intervention were often inadequately described and dietary outcomes rarely reported, making repetition of the studies difficult. REVIEWERS' CONCLUSIONS: There is an urgent need for high quality studies investigating the optimal dietary approach to management of paediatric overweight and obesity. These studies require adequate follow up to ascertain if weight loss can be sustained in the long term. Details of the dietary prescription, adherence to the dietary intervention and diet-specific outcomes need to be reported in order to inform best practice.

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BACKGROUND: The prevalence of obesity has increased rapidly in most developed countries in the last decades, and this rise is now spreading to developing countries. Childhood obesity is also increasing. The UK government has set a target to halt the rise in childhood obesity by 2010. Dietary recommendations are a central component of any comprehensive weight-loss programme. A low-fat energy-restricted diet is the conventional therapy for obesity, but alternative dietary interventions have been proposed in recent years. METHODS: We conducted a systematic review to assess dietary intervention studies designed to reduce weight in childhood and adolescence. The studies included overweight or obese children or adolescents in which there was a comparison group and change in body weight or BMI was reported. RESULTS: We identified only nine such studies, seven of which were randomized. Six were conducted in the USA, two in Cuba, and one in France. Low-carbohydrate and low-glycaemic-index diets appeared to be at least as effective as energy-restricted low-fat diets for short-term weight loss, but most studies were too small to be informative, and none provided evidence on long-term weight control. CONCLUSIONS: There is a marked mismatch between the public health importance of childhood obesity and the number and quality of the studies conducted so far to assess dietary interventions for weight reduction in childhood and adolescence, and little evidence to support the current recommendation of a low-fat energy-restricted diet. There is an urgent need for well-designed intervention studies of the long-term effectiveness of alternative diets to provide a basis for evidence-based recommendations.

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