Protocol for systematic reviews of determinants/correlates of obesity-related dietary and physical activity behaviors in young children (preschool 0 to 6 years): evidence mapping and syntheses Reducing TV watching during adult obesity treatment: two pilot randomized controlled trials. Energy balance-related behaviours associated with overweight and obesity in preschool children: a systematic review of prospective studies. Energy Balance 4 Kids with Play: Results from a Two-Year Cluster-Randomized Trial. Caffeine Intake, Short Bouts of Physical Activity, and Energy Expenditure: A Double-Blind Randomized Crossover Trial The social experiences of cancer patients under treatment: a comparative study. The effect of reinforcement or stimulus control to reduce sedentary behavior in the treatment of pediatric obesity. Evaluation of the Web-based computer-tailored FATaintPHAT intervention to promote energy balance among adolescents: results from a school cluster randomized trial. Energy flux, more so than energy balance, protein intake, or fitness level, influences insulin-like growth factor-I system responses during 7 days of increased physical activity. Is physical activity a gateway behavior for diet? Findings from a physical activity trial. Total energy intake, adolescent discretionary behaviors and the energy gap A parent focused child obesity prevention intervention improves some mother obesity risk behaviors: the Melbourne inFANT Program Balanced placebo design with marijuana: Pharmacological and expectancy effects on impulsivity and risk taking Adolescents demonstrate improvement in obesity risk behaviors after completion of choice, control & change, a curriculum addressing personal agency and autonomous motivation. A Culturally Adapted Telecommunication System to Improve Physical Activity, Diet Quality, and Medication Adherence Among Hypertensive African–Americans: A Randomized Controlled Trial US acculturation is associated with health behaviors and obesity, but not their change, with a hotel-based intervention among Asian-Pacific Islanders. Effectiveness of parent‐centred interventions for the prevention and treatment of childhood overweight and obesity in community settings: a systematic review Energy and nitrogen balances in 24 severely burned patients receiving 4 isocaloric diets of about 10 MJ/m2/day (2392 Kcalories/m2/day). ENERGY BALANCE IN ADOLESCENT GIRLS: THE TRIAL OF ACTIVITY FOR ADOLESCENT GIRLS COHORT Effects of Open-Loop Feedback on Physical Activity and Television Viewing in Overweight and Obese Children: A Randomized, Controlled Trial Physical activity, sedentary behaviors and dietary habits among Saudi adolescents relative to age, gender and region A group randomized controlled trial integrating obesity prevention and control for postpartum adolescents in a home visiting program Predictive Validity and Classification Accuracy of ActiGraph Energy Expenditure Equations and Cut-Points in Young Children
Background The aim of these review s is to inform the design and content of interventions to reduce obesity in young children . The behaviors that are associated with obesity/overweight have been studied extensively ; however , the factors associated with these behaviors in young children ( 0 to 6 years ) have not been systematic ally review ed . Over the past few years the focus of obesity prevention has shifted to preschool children because of the high prevalence of obesity at school entry and recognition that habits formed in early life could track into adulthood . In order to develop effective interventions and change behavior , it is important to underst and the factors that are associated with those behaviors . For example , we need to underst and whether it would be more important to target the family , childcare setting s or the wider environment and identify the most effective way of changing these energy balance related behaviors . Methods / Design Quantitative ( intervention and observational ) and qualitative literature on determinants/correlates of fruit and vegetable intake , sugar sweetened beverage and other unhealthy diet intake , and physical activity and sedentary behaviors in young children will be systematic ally identified , mapped and review ed . A common search strategy ( no language or period restrictions ) will be used to identify papers from eight electronic data bases and this will be supplemented by h and - search ing . Next , studies in developed countries that examine the factors associated with these behaviors in children aged 0 to 6 years ( at baseline ) will be screened and mapped descriptively followed by in-depth data extraction , quality assessment and synthesis . Data from quantitative studies will be summarized using either forest plots or harvest plots and narrative synthesis , and qualitative studies using thematic analysis . Qualitative evidence will be integrated with the quantitative evidence , using a parallel synthesis approach , to provide a deeper underst and ing of effective strategies to influence these energy balance related behaviors . Discussion In addition to updating and mapping current research , these review s will be the first to comprehensively synthesize and integrate both the quantitative and qualitative evidence pertaining to determinants/correlates/barriers/facilitators of obesity related behaviors in this young age group ( 0 to 6 years ) with the aim of informing future interventions . Systematic review registration International Prospect i ve Register for Systematic Review s ( PROSPERO ) Registration number : The more time adults spend being sedentary , the greater the risk of obesity . The effect of reducing television ( TV ) watching , a prominent sedentary behavior , on weight loss has not been tested in an adult st and ard behavioral obesity intervention , and the mechanisms by which reducing TV watching influences energy balance behaviors are not well understood . Two , 8-week , pilot , r and omized controlled trials were conducted examining the effect of a reduced TV watching prescription on energy balance behaviors and weight loss within an adult st and ard behavioral obesity intervention . In the first study , participants ( n=24 ) were r and omized into one of two conditions : ( a ) reduce energy intake and increase moderate to vigorous physical activity ( MVPA ) ( INCREASE PA ) ; or ( b ) reduce energy intake and decrease TV watching ( DECREASE TV ) . As findings from the first pilot study did not show an increase in MVPA in the DECREASE TV group , the second study was design ed to examine the effect of adding a reduced TV prescription to a st and ard intervention to optimize outcomes . In Pilot Study 2 , participants ( n=28 ) were r and omized to INCREASE PA or to INCREASE PA+DECREASE TV . Outcomes included objective ly measured TV watching and MVPA , self-reported light physical activity ( LPA-Pilot Study 2 only ) , self-reported dietary intake while watching TV , and weight . Conditions with TV watching prescriptions significantly reduced TV watching . Both studies showed medium to large effect sizes for conditions with TV watching prescriptions to show greater reductions in dietary intake while watching TV . Pilot Study 1 found a trend for an increase in MVPA in INCREASE PA and Pilot Study 2 found significant increases in MVPA in both conditions . Pilot Study 2 found a significant increase in LPA in the INCREASE PA+DECREASE TV . Results indicate adding a TV watching prescription to a st and ard obesity intervention did not enhance increases in MVPA , but may assist with reducing dietary intake while TV watching and increasing LPA . Future research should examine the effect of reducing TV watching during obesity treatment over a longer time frame in a larger sample The current review aim ed to systematic ally identify dietary , physical activity and sedentary behaviours in preschool children ( 4 - 6 years of age ) that are prospect ively related to overweight or obesity later in childhood . Prospect i ve studies published between January 1990 and June 2010 were selected from search es in PubMed , EMBASE , PsycINFO , CINAHL and Cochrane Library . Studies examining the prospect i ve association between at least one relevant behaviour measured during preschool period ( children aged 4 - 6 years at baseline ) in relation to at least one anthropometric measurement at follow-up ( age < 18 years ) were included . Harvest plots were used to summarize the results and draw conclusions from the evidence . Of the 8,718 retrieved papers , 23 papers reporting on 15 different study sample s were included in this review . Strong evidence was found for an inverse association between total physical activity and overweight . Moderate evidence was observed for a positive association between television viewing and overweight . Because of the heterogeneity in the assessed dietary behaviours , insufficient evidence was found for an association between  dietary intake or specific dietary behaviours and overweight . These results suggest that interventions aim ing to prevent overweight among preschool children should focus on promotion of total physical activity and limitation of screen time and that further research is needed to establish whether and which dietary behaviours are important for obesity prevention in this age group . However , despite the lack of evidence for dietary behaviours from the present review , future interventions may already target specific dietary behaviours that are highly prevalent and for which there a clear rationale as well as preliminary evidence that these behaviours are associated with overweight BACKGROUND Identifying sustainable approaches to improving the physical activity ( PA ) and nutrition environments in schools is an important public health goal . This study examined the impact of Energy Balance for Kids with Play ( EB4 K with Play ) , a school-based intervention developed by the Academy of Nutrition and Dietetics Foundation and Playworks , on students ' PA , dietary habits and knowledge , and weight status over 2 years . METHODS This cluster-r and omized , controlled trial took place in four intervention and two control schools over 2 years ( n=879 ; third- to fifth- grade students ) .  PA  ( fourth and fifth grade s only ) , dietary knowledge and behaviors , school policies , and BMI z-score  were assessed at baseline ( fall 2011 ) , midpoint ( spring 2012 ) , and endpoint ( fall 2012 for accelerometers ; spring 2013 for all other outcomes ) . RESULTS At endpoint , there were no group differences in change in PA or dietary behaviors , although BMI z-score decreased overall by -0.07 ( p=0.05 ) . Students ' dietary knowledge significantly increased , as did the amount of vegetables schools served . Post-hoc analyses stratified by grade revealed that , relative to control students , fourth- grade intervention students reduced school-day sedentary time by 15 minutes ( p=0.023 ) and third- grade intervention students reduced BMI z-score by -0.2 ( 0.05 ; p<0.05 ) . There were no significant differences for older students . CONCLUSIONS EB4 K with Play , which leverages the existing infrastructure of two national programs , increases  children 's dietary knowledge and may improve weight status and decrease sedentary behaviors among younger children . Future iterations should examine programming specific for different age groups PA energy expenditure ( PAEE ) is the most variable component of Total Energy Expenditure ( TEE ) and largely due to the balance of sedentary time ( SedT ) and low intensity physical activity ( LIPA ) . There has been an emergence for seeking an underst and ing of factors which determine variations in SedT , LIPA , and PAEE . Sedentary behavior and physical activity are relatively resistant to change by experimental dietary treatments and significant body weight changes . Although caffeine ( Caf ) is by far the most heavily used nutritional agent ingested to promote a sense of vigor/alertness , it is still unknown if Caf is effective in increasing PAEE and physical activity . The aim of the study was to test the hypothesis that 2 daily doses of Caf ( as a capsule to blind the treatment and divided equally during breakfast and lunch ) increase PAEE and TEE , and it would do so through increasing the frequent and brief bouts of physical activity ( ~1 - 5 min long ) through the day as measured by accelerometry . In 21 low Caf users ( < 100 mg day-1 ) , we used a double-blind crossover trial ( Clinical Trials.govID;NCT01477294 ) with two conditions ( 4-day each with a 3-day washout period ) r and omly ordered as 5 mg kg-1 day-1 of Caf and maltodextrin as placebo ( Plc ) . Resting energy expenditure ( REE ) by indirect calorimetry , total energy expenditure ( TEE ) from doubly labeled water , PAEE calculated as TEE-(REE+0.1TEE ) , and accelerometry measurements of both LIPA and MVPA were not different between conditions . However , regardless of caffeine or placebo , there were several significant relationships between brief bouts of LIPA and MVPA with PAEE . In conclusion , this double-blind study found that low and moderate-vigorous activity as well as the total volume of PAEE in free-living conditions is resistant to dietary caffeine intake that was equivalent to 5 cups of espresso or 7 cups of tea . Trial Registration Clinical Trials.gov As part of a larger study on the quality of life of cancer patients under treatment , the positive and negative experiences in social interaction  have been examined as compared to those of a  control group ( non patients , n = 201 ) . Two patient groups were included : 109 patients who had recently undergone surgery and 108 patients receiving chemotherapy .  The respondents returned a mailed question naire . Contrary to the assumptions based on a review from the literature , cancer patients appear to have more positive and fewer negative social experiences than a r and om sample from the ' normal ' population . Even under more severe medical circumstances ( a poor prognosis or heavy chemotherapy , a large number of chemotherapy cycles , poor progress after surgery ) the poorer the patients , medically speaking , the more help and support they perceive . The results of this study do not support the idea of stigmatization . The personality characteristics , neuroticism and self-esteem are especially important for the having of positive and negative experiences in social interaction . Positive social experiences show a relationship with self-esteem and negative social experiences show a relationship with neuroticism Obese children were r and omly assigned to a family-based behavioral treatment that included either stimulus control or reinforcement to reduce sedentary behaviors . Significant and equivalent decreases in sedentary behavior and high energy density foods , increases in physical activity and fruits and vegetables , and decreases in st and ardized body mass index ( z- BMI ) were observed . Children who substituted active for sedentary behaviors had significantly greater z- BMI changes at 6 ( -1.21 vs. -0.76 ) and 12 ( -1.05 vs. -0.51 ) months , respectively . Substitution of physically active for sedentary behaviors and changes in activity level predicted 6- and 12-month z- BMI changes . Results suggest stimulus control and reinforcing reduced sedentary behaviors are equivalent ways to decrease sedentary behaviors , and behavioral economic relationships in eating and activity may mediate the effects of treatment OBJECTIVE To evaluate the short- and long-term results of FATaintPHAT , a Web-based computer-tailored intervention aim ing to increase physical activity , decrease sedentary behavior , and promote healthy eating to contribute to the prevention of excessive weight gain  among adolescents . DESIGN Cluster r and omized trial with an intervention group and a no-intervention control group . SETTING Twenty schools in the Netherl and s. PARTICIPANTS A total of 883 students ( aged 12 - 13 years ) . INTERVENTION The FATaintPHAT ( VETisnietVET in Dutch ) Web-based computer-tailored intervention . OUTCOME MEASURES Self-reported behaviors ( diet , physical activity , sedentary behavior ) and pedometer counts were measured at baseline and at 4-month and 2-year follow-up ; body mass index ( BMI ) , waist circumference , and fitness were measured at baseline and at 2-year follow-up . Descriptive and multilevel regression analyses were conducted among the total study population and among students not meeting behavioral recommendations at baseline ( students at risk ) . RESULTS The complete case analyses showed that FATaintPHAT had no effect on BMI and waist circumference . However , the intervention was associated with lower odds ( 0.54 ) of drinking more than 400 mL of sugar-sweetened beverages per day and with lower snack intake ( β = -0.81 snacks/d ) and higher vegetable intake ( β = 19.3 g/d ) but also with a lower step count ( β = -10 856 steps/wk ) at 4-month follow-up . In addition , among students at risk , FATaintPHAT had a positive effect on fruit consumption ( β = 0.39 g/d ) at 4-month follow-up and on step count ( β = 14 228 steps/wk ) at 2-year follow-up but an inverse effect on the odds of sports participation ( odds ratio , 0.45 ) at 4-month follow-up . No effects were found for sedentary behavior . CONCLUSION The FATaintPHAT intervention was associated with positive short-term effects on diet but with no effects or unfavorable effects on physical activity and sedentary behavior The purpose of this study was to determine the impact of dietary factors and exercise-associated factors on the response of IGF-I and its binding proteins ( IGFBPs ) during a period of increased physical activity . Twenty-nine men completed a 4-day ( days 1 - 4 ) baseline period of a controlled energy balanced diet while maintaining their normal physical activity level followed by 7 days ( days 5 - 11 ) of a 1,000 kcal/day increase in physical activity above their normal activity levels . Two subject groups , one sedentary ( Sed , mean Vo(2peak ) : 39 mlxkg(-1)xmin(-1 ) , n = 7 ) and one fit ( FIT1 , mean Vo(2peak ) : 56 ml.kg(-1)xmin(-1 ) , n = 8) increased energy intake to maintain energy balance throughout the 7-day intervention . In two other fit subject groups ( FIT2 , n = 7 and FIT3 , n = 7 ) , energy intake remained at baseline result ing in a 1,000 kcal/day exercise-induced energy deficit . Of these , FIT2 received an adequate protein diet ( 0.9 g/kg ) , and FIT3 received a high-protein diet ( 1.8 g/kg ) . For all four groups , IGF-I , IGFBP-3 , and the acid labile subunit ( ALS ) were significantly decreased by day 11 ( 27 + /- 4 % , 10 + /- 2 % , and 19 + /- 4 % , respectively ) and IGFBP-2 significantly increased by 49 + /- 21 % following day 3 . IGFBP-1 significantly increased only in the two negative energy balance groups , FIT2 ( 38 + /- 6 % ) and FIT3 ( 46 + /- 8 % ) . Differences in initial fitness level and dietary protein intake did not alter the IGF-I system response to an acute increase in physical activity . Decreases in IGF-I were observed during a moderate increase in physical activity despite maintaining energy balance , suggesting that currently unexplained exercise-associated mechanisms , such as increased energy flux , regulate IGF-I independent of energy deficit OBJECTIVE While cross-sectional research indicates physical inactivity and poor diet tend to co-occur , there are limited longitudinal data on how interventions targeting one behavior affect other behaviors . The current investigation examined cross-sectional and longitudinal relationships between health behaviors within the context of a physical activity ( PA ) intervention . METHODS Sedentary women ( n=280 ; mean age=47.1 ; 94.6 % Caucasian ) were enrolled in a r and omized controlled PA trial comparing the effects of print-based , individually-tailored and gender-targeted PA interventions to a wellness/control condition . Women completed baseline , month 3 , and month 12 assessment s that included measures of PA and dietary behaviors . RESULTS Participants in more advanced PA stages of change reported significantly greater fruits/vegetables consumption than participants in less advanced stages , although the relationships between diet and minutes of weekly activity were less pronounced . The tailored and targeted print-based PA interventions had no effect on fruit/vegetable intake , although significant reductions in fat intake were observed from baseline ( M=31.24 % ) to month 3 ( M=30.41 % ) , p<0.03 ; and baseline to month 12 ( M=30.36 % ) , p<0.01 . Changes in PA  were not predictive of improvements in eating behaviors . CONCLUSIONS Although fat intake decreased in the context of this PA intervention , fruit/vegetable intake remained unchanged . Also , PA did not serve as a gateway behavior for dietary improvements . In fact , improvements in activity were associated with increases rather than decreases in fat intake Objective : To estimate total energy intake and the energy gap — the daily imbalance between energy intake and expenditure — associated with discretionary behaviors of adolescents , namely their leisure active behaviors ( playing or participating in sports and heavy chores ) , leisure sedentary behaviors ( television ( TV ) viewing and playing video and computer games ) , productive sedentary behaviors ( reading or doing homework ) . Design : Prospect i ve observational study . Participants : A total of 538 students ( mean age at baseline=11.7 years ) from public schools in the Boston area studied prospect ively from the fall of 1995 to the spring of 1997 . Measurements : Anthropometric assessment including height and weight , dietary assessment using a youth food frequency question  naire and measures of TV , video , reading/doing homework and youth physical activity .  Results : We estimate the change in total energy intake for each hour change in discretionary activity using regression methods . A 1-h increase in watching TV is associated with a 106 kcal h−1 increase in total energy intake ( 95 % confidence interval ( CI ) : 61–150 kcal day−1 ) . A similar change of 92 kcal h−1 ( 95 % CI : 37–147 kcal day−1 ) is seen with playing video and computer games . The change in energy intake associated with an hour change in physical activity is 292 kcal h−1 ( 95 % CI : 262–321 kcal day−1 ) . No significant change is associated with reading/doing homework . Assuming that typical energy expenditures are associated with these behaviors , reading/doing homework appears to be an ‘ energy neutral ’ activity , whereas watching TV and playing video and computer games is associated with an energy surplus . If we assume that physical activity levels are moderate ( 3.5 METs ) , then this is also an energy surplus activity . If physical activity is assumed to be vigorous for the entire time allotted ( > 6.0 METs ) , an energy deficit could be achieved . We vali date d these estimates by calculating regressions predicting change in weight . Results indicate that each hour increase in TV viewing is associated with a weight increase of 0.38 kg ( 95 % CI : 0.17–0.59 kg ) , with no significant associations for the other behaviors . A model with change in BMI as the dependent variable produced similar results . Conclusion : Watching TV is an activity associated with a daily energy surplus . Although physical activity is thought of as an energy deficit activity , our estimates do not support this hypothesis . Reading/doing homework is the only discretionary activity examined which appears to be clearly energy neutral . The differential impacts of these discretionary behaviors on energy intake and the energy gap are discussed in relation to food-related advertisements aim ed at children and adolescents Background The diets , physical activity and sedentary behavior levels of both children and adults in Australia are suboptimal . The family environment , as the first ecological niche of children , exerts an important influence on the onset of children ’s habits . Parent modeling is one part of this environment and a logical focus for child obesity prevention initiatives . The focus on parent ’s own behaviors provides a potential opportunity to decrease obesity risk behaviors in parents as well . Objective To assess the effect of a parent-focused  early childhood obesity prevention  intervention on  first-time mothers ’ diets , physical activity and TV viewing time .  Methods The Melbourne InFANT Program is a cluster-r and omized controlled trial which involved 542 mothers over their newborn ’s first 18 months of life . The intervention focused on parenting skills and strategies , including parental modeling , and aim ed to promote development of healthy child and parent behaviors from birth , including healthy diet , increased physical activity and reduced TV viewing time . Data regarding mothers ’ diet ( food frequency question naire ) , physical activity and TV viewing times ( self-reported question naire ) were collected using vali date d tools at both baseline and post-intervention . Four dietary patterns were derived at baseline using principal components analyses including frequencies of 55 food groups . Analysis of covariance was used to measure the impact of the intervention . Results The scores of both the " High-energy snack and processed foods " and the " High-fat foods " dietary patterns decreased more in the intervention group : -0.22 ( −0.42;-0.02 ) and −0.25 ( −0.50;-0.01 ) , respectively . No other significant intervention vs. control effects were observed regarding total physical activity , TV viewing time , and the two other dietary patterns , i.e. “ Fruits and vegetables ” and “ Cereals and sweet foods ” . Conclusions These findings suggest that supporting first-time mothers to promote healthy lifestyle behaviors in their infants impacts maternal dietary intakes positively . Further research needs to assess ways in which we might further enhance those lifestyle behaviors not impacted by the InFANT intervention Rationale Marijuana is believed to increase impulsivity and risk taking , but the processes whereby it affects such behaviors are not understood . Indeed , either the pharmacologic effect of delta-9-tetrahydrocannabinol ( THC ) or the expectancy of receiving it may lead to deficits in cognitive processing and increases in risk taking . Objectives and methods We examined the relative effects of expecting to receive active marijuana and the pharmacological drug effects using a balanced placebo design . Young adult regular marijuana users ( N = 136 ) were r and omly assigned into one of four groups in a two × two instructional set ( Told THC vs. Told no THC ) by drug administration ( smoked marijuana with 2.8 % THC vs. placebo ) design . Dependent measures included subjective intoxication , behavioral impulsivity , and decision-making related to risky behaviors . Results Active THC , regardless of expectancy , impaired inhibition on the Stop Signal and Stroop Color-Word tasks . Expectancy of having smoked THC , regardless of active drug , decreased impulsive decision-making on a delay discounting task among participants reporting no deception and increased perception of sexual risk among women , consistent with a compensatory effect . Expectancy of smoking THC in combination with active THC  increased negative perceptions from risky alcohol use . Active drug and expectancy independently increased subjective intoxication . Conclusions Results highlight the importance of marijuana expectancy effects as users believing they are smoking marijuana may compensate for expected intoxication effects when engaged in deliberate decision-making by making less impulsive and risky decisions . Effects of marijuana on impulsive disinhibition , by contrast , reflect direct pharmacologic effects for which participants did not compensate BACKGROUND The rapid increase of obesity and diabetes risk beginning in youth , particularly those from disadvantaged communities , calls for prevention efforts . OBJECTIVE To examine the impact of a curriculum intervention , Choice , Control & Change , on the adoption of the energy balance-related behaviors of decreasing sweetened drinks , packaged snacks , fast food , and leisure screen time , and increasing water , fruits and vegetables , and physical activity , and on potential psychosocial mediators of the behaviors . DESIGN Ten middle schools were r and omly assigned within matched pairs to either intervention or comparison/delayed control conditions  during the 2006 - 2007 school year . SUBJECTS/ SETTING Students were from low-income New York City neighborhoods ; 562 were in the intervention condition , and 574 in the comparison condition . INTERVENTION Students received the 24 Choice , Control & Change lessons that used science inquiry investigations to enhance motivation for action , and social cognitive and self-determination theories to increase personal agency and autonomous motivation to take action . MAIN OUTCOME MEASURES Self-report instruments to measure energy balance-related behaviors targeted by the curriculum and potential psychosocial mediators of the behaviors . STATISTICAL ANALYSES Analysis of covariance with group ( intervention/control ) as a fixed factor and pretest as covariate . RESULTS Students in intervention schools compared to the delayed intervention controls reported consumption of considerably fewer sweetened drinks and packaged snacks , smaller sizes of fast food , increased intentional walking for exercise , and decreased leisure screen time , but showed no increases in their intakes of water , fruits , and vegetables . They showed substantial increases in positive outcome expectations about the behaviors , self-efficacy , goal intentions , competence , and autonomy . CONCLUSIONS The Choice , Control & Change curriculum was effective in improving many of the specifically targeted behaviors related to reducing obesity risk , indicating that combining inquiry-based science education and behavioral theory is a promising approach Background Hypertension is more prevalent and clinical ly severe among African – Americans than whites . Several health behaviors influence blood pressure ( BP ) control , but effective , accessible , culturally sensitive interventions that target multiple behaviors are lacking . Purpose We evaluated a culturally adapted , automated telephone system to help hypertensive , urban African – American adults improve their adherence to their antihypertensive medication regimen and to evidence -based guidelines for dietary behavior and physical activity . Methods We r and omized 337 hypertensive primary care patients to an 8-month automated , multi-behavior intervention or to an education-only control . Medication adherence , diet , physical activity , and BP  were assessed at baseline and every 4 months for 1 year . Data were analyzed using longitudinal modeling . Results The intervention was associated with improvements in a measure of overall diet quality ( + 3.5 points , p < 0.03 ) and in energy expenditure ( + 80 kcal/day , p < 0.03 ) . A decrease in systolic BP between groups was not statistically significant ( −2.3 mmHg , p = 0.25 ) . Conclusions Given their convenience , scalability , and ability to deliver tailored messages , automated telecommunications systems can promote self-management of diet and energy balance in urban African – Americans BACKGROUND Immigration to the United States has been associated with obesity , yet the relationship of acculturation to obesity and energy balance ( ie , physical activity/dietary intake ) in adults is a complex issue . Limited longitudinal data are available on immigrant Asians and Pacific Isl and ers . DESIGN Analyses were conducted on baseline data and change data from baseline to 24 months in the hotel-based cluster-r and omized Work , Weight and Wellness trial involving 15 control and 15 intervention hotels on the isl and of Oahu , Hawaii . SAMPLE Participants were adult employees of predominantly Asian and Pacific Isl and er ancestry who were assessed one or more times over the course of 24 months . The full sample consisted of 4,236 hotel workers ( about 40 % of hotel workforce ) at baseline , 3,502 hotel workers at Year 1 and 2,963 hotel workers at the 24-month follow up . One thous and one hundred fifteen hotel workers had at least two measurements , and were included in the analysis . INTERVENTION The Work , Weight , and Wellness trial was design ed to promote weight loss via motivation and support for increases in physical activity and increased access to and consumption of healthy low-fat/low-energy foods . The measure of acculturation consisted of a score that was a compilation of a participant 's age when he or she immigrated to the United States , country of birth , language spoken at home , and years of education . STATISTICAL ANALYSES We used mixed effect regression models for cross-sectional baseline models and longitudinal multilevel regression analysis of change in diet and physical activity behaviors and obesity over time using a r and om intercept . Estimates of the intervention effect are expressed as an annual rate of change for all study outcomes . RESULTS At baseline acculturation was positively associated with body mass index ; physical activity level ; and fruit , meat , and sweetened drink intake level . In analyses of change across 24 months , acculturation did not significantly influence change in dietary intake or indexes of obesity ( ie , body mass index or waist-to-height ratio ) . However physical activity increased significantly more in the intervention group during the course of the intervention compared with the control group , which decreased activity , when sociodemographic factors ( including acculturation ) and food intake behavior were controlled for Background Worldwide in 2000 , 10 % of children aged five to 17 years were reported as being overweight with an additional 2‐3 % being obese . Overweight and obesity in childhood can adversely impact on both physical and psychological health . The rise in the prevalence of childhood obesity is a complex issue but widely recognised contributors include increased energy intake , decreased levels of physical activity and greater time spent in sedentary pursuits . A large number of environmental and cultural factors have also been identified as contributing to the problem . Evidence to support an optimal approach to treating childhood obesity is limited with many studies showing only modest results at best in the long‐term . However , the importance of family‐based treatment that combines diet , physical activity and behavioral components has been acknowledged in a recent Cochrane Systematic Review . It has also been suggested that interventions offered in the community setting may help overcome barriers to participation , by making programs more accessible and allowing the targeting of specific sub‐groups of the population . Objectives The objective of this review was to identify the effectiveness of parent‐centred interventions implemented in the community setting in modifying eating and physical activity behaviors or weight‐related outcomes of children . Inclusion criteria Types of participants This review considered studies that included free‐living children of pre‐school , primary and secondary school age and /or their parents/guardians aged > 18 years . Types of intervention(s)/phenomena of interest Intervention programs were required to have a parental component , to target eating and /or exercise behaviors for the prevention or treatment of obesity , and child weight status reported . Types of studies All intervention studies were included in the review including : r and omized controlled trials ( RCTs ) ; non‐r and omized controlled trials , longitudinal studies , cohort ( both retrospective and prospect i ve ) , case control and time series studies which had been conducted in a community setting . Types of outcomes This review considered studies that included overweight/obesity related outcomes , eating behavior outcomes , physical activity behaviour outcomes , and sedentary behavior outcomes and constructs . Search strategy A literature search of community‐based parent‐centred intervention studies to promote nutrition and physical activity for the prevention and treatment and of childhood overweight and obesity was performed in eight electronic data bases dating from 1975 to April 2009 . Method ological quality Studies were critically appraised for method ological quality using st and ardized tools . Data collection Data was extracted by one review er using a st and ardized data extraction form developed by the research ers and checked for accuracy and consistency by a second review er . Data synthesis Data in relation to setting , methodology , intervention components and effect on weight , dietary intake and physical activity was extracted , and described in a narrative synthesis . Where possible a meta‐ analysis was undertaken . Results Of the home‐based interventions , five of nine studies reported statistically significant changes in anthropometric outcomes post intervention . Of the 10 studies in the before and after school care setting , seven reported a significant decrease in a weight‐related outcome post intervention , with only one reporting an increase . Conclusions Results from the review support the after‐school setting as the most promising for community intervention setting for targeting parents as agents of change within child obesity prevention and treatment programs . Implication s for practice At this stage , interventions to support parents should target the after‐school environment as opposed to being conducted in the home , summer camps , leisure centers or churches . Targeting a decrease in energy intake and sweetened beverages in parallel with increasing number of daily steps and decreasing screen time use . Implication s for research Future studies of high quality are needed across the full range of community setting s. Given that currently most of the higher quality RCTs and the studies showing positive impacts of weight change are in the after‐school setting , further studies in this area using similar method ologies to those already published will facilitate future meta‐analyses in this area Twenty-four subjects with burns ranging from 25 - 70 per cent received for 12 days exclusively per os a series of 4 isocaloric diets of about 4000 Kcal--'normal ' , or hyperproteic , or hyperlipidic , or hyperglucidic according to a r and omized schedule . Oxygen consumptions were measured at the end of each diet and nitrogen balance was determined every day . Though patients were not massively overfed there remained a positive energy gap . The nitrogen balance was found to be equilibrated on the whole but clearly positive with the hyperproteic diet and clearly negative with the hyperlipidic-normoproteic diet . Thus there is no rationale for the huge energy overfeeding classically used Objectives To study correlates of change in BMI percentile and body fat among adolescent girls Design and Methods A longitudinal prospect i ve study following 265 girls from the Trial of Activity for Adolescent Girls ( TAAG ) cohort measured in 8th grade and during 10 and 11th grade or 11th and 12th grade . Twice during 2009 - 2011 girls wore an accelerometer and completed a food frequency question naire and 7-day diary documenting trips and food eaten away from home and school . Physical activity , BMI , and percent body fat were objective ly measured at each time point . Results Moderate to vigorous physical activity ( MVPA ) declined , but was not independently associated with changes in BMI percentile . Increased vigorous physical activity was associated with reductions in body fat . Diet was associated with both changes in BMI percentile and body fat . Girls who increased the percentage of caloric intake from snacks and desserts reduced their BMI percentile and body fat . Conclusions Some relationships between energy balance behaviors and BMI and body composition were counter-intuitive . While it is plausible that vigorous activity would result in reductions of body fat , until more accurate methods are devised to measure diet , the precise contribution of dietary composition to health will be difficult to assess OBJECTIVES . Television viewing and physical inactivity increase the risk of obesity in youth . Thus , identifying new interventions that increase physical activity and reduce television viewing would be helpful in the prevention and treatment of pediatric obesity . This study evaluated the effects of open-loop feedback plus reinforcement versus open-loop feedback alone on  physical activity , targeted sedentary behavior , body composition , and energy intake in youth . METHODS . Thirty overweight or obese 8- to 12-year-old children were r and omly assigned to an  intervention ( n = 14 ) or control group ( n = 16 ) . Participants wore accelerometers every day for 8 weeks and attended biweekly meetings to download the activity monitors . For children in the open-loop feedback plus reinforcement ( intervention ) group , accumulating 400 counts of physical activity on pedometers earned 1 hour of television/VCR/DVD time , which was controlled by a Token TV electronic device . Open-loop feedback control subjects wore activity monitors but had free access to targeted sedentary behavior . RESULTS . Compared with controls , the open-loop feedback plus reinforcement group demonstrated significantly greater increases in daily physical activity counts ( + 65 % vs + 16 % ) and minutes per day of moderate-to-vigorous physical activity ( + 9.4 vs + 0.3 ) and greater reductions in minutes per day spent in television viewing ( −116.1 vs + 14.3 ) . The intervention group also showed more favorable changes in body composition , dietary fat intake , and energy intake from snacks compared with controls . Reductions in sedentary behavior were directly related to reductions in BMI , fat intake , snack intake , and snack intake while watching television . CONCLUSIONS . Providing feedback of physical activity in combination with reinforcing physical activity with sedentary behavior is a simple method of modifying the home environment that may play an important role in treating and preventing child obesity Background Few lifestyle factors have been simultaneously studied and reported for Saudi adolescents . Therefore , the purpose of the present study was to report on the prevalence of physical activity , sedentary behaviors and dietary habits among Saudi adolescents and to examine the interrelationships among these factors using representative sample s drawn from three major cities in Saudi Arabia . Methods This school-based cross-sectional study was conducted during the years 2009 - 2010 in three cities : Al-Khobar , Jeddah and Riyadh . The participants were 2908 secondary -school males ( 1401 ) and females ( 1507 ) aged 14 - 19 years , r and omly selected using a multistage stratified sampling technique . Measurements included weight , height , sedentary behaviors (  TV viewing  , playing video games and computer use ) , physical activity using a vali date d question naire and dietary habits . Results A very high proportion ( 84 % for males and 91.2 % for females ) of Saudi adolescents spent more than 2 hours on screen time daily and almost half of the males and three-quarters of the females did not meet daily physical activity guidelines . The majority of adolescents did not have a daily intake of breakfast , fruit , vegetables and milk . Females were significantly ( p < 0.05 ) more sedentary , much less physically active , especially with vigorous physical activity , and there were fewer days per week when they consumed breakfast , fruit , milk and diary products , sugar-sweetened drinks , fast foods and energy drinks than did males . However , the females ' intake of  French fries and potato chips , cakes and donuts , and c and y and chocolate was significantly ( p < 0.05 ) higher than the males ' . Screen time was significantly ( p < 0.05 ) correlated inversely with the intake of breakfast , vegetables and fruit .  Physical activity had a significant ( p < 0.05 ) positive relationship with fruit and vegetable intake but not with sedentary behaviors . Conclusions The high prevalence of sedentary behaviors , physical inactivity and unhealthy dietary habits among Saudi adolescents is a major public health concern . There is an urgent need for national policy promoting active living and healthy eating and reducing sedentary behaviors among children and adolescents in Saudi Arabia Background Adolescence represents a critical period for the development of overweight that tracks into adulthood . This risk is significantly heightened for adolescents that become pregnant , many of whom experience postpartum weight retention . The aim of this study was to evaluate Balance Adolescent Lifestyle Activities and Nutrition Choices for Energy ( BALANCE ) , a multicomponent obesity prevention intervention targeting postpartum adolescents participating in a national home visiting child development-parent education program . Methods A group r and omized , nested cohort design was used with 1325 adolescents , 694 intervention and 490 control , ( mean age = 17.8 years , 52 % underrepresented minorities ) located across 30 states .  Participatory methods were used to integrate lifestyle behavior change strategies within st and ard parent education practice . Content targeted replacement of high-risk obesogenic patterns ( e.g. sweetened drink and high fat snack consumption , sedentary activity ) with positive behaviors ( e.g. water intake , fruit and vegetables , increased walking ) . Parent educators delivered BALANCE through home visits , school based classroom-group meetings , and website activities . Control adolescents received st and ard child development information . Phase I included baseline to posttest ( 12 months ) ; Phase II included baseline to follow-up ( 24 months ) . Results When compared to the control group , BALANCE adolescents who were ≥12 weeks postpartum were 89 % more likely ( p = 0.02 ) to maintain a normal BMI or improve an overweight/obese BMI by 12 months ; this change was not sustained at 24 months . When compared to the control group , BALANCE adolescents significantly improved fruit and vegetable intake ( p = .03 ) . In stratified analyses , water intake improved among younger BALANCE teens ( p = .001 ) and overweight/obese BALANCE teens ( p = .05 ) when compared to control counterparts . There were no significant differences between groups in sweetened drink and snack consumption or walking . Conclusion Prevention of postpartum weight retention yields immediate health benefits for the adolescent mother and may prevent the early development or progression of maternal obesity , which contributes to the intergenerational transmission of obesity to her offspring . Implementing BALANCE through a national home visiting organization may hold promise for promoting positive lifestyle behaviors associated with interruption of the progression of maternal obesity . Trial registration Clinical Trails.gov NCT01617486 Objectives Evaluate the predictive validity of ActiGraph energy expenditure equations and the classification accuracy of physical activity intensity cut-points in preschoolers . Methods Forty children aged 4–6 years ( 5.3±1.0 years ) completed a ∼150-min room calorimeter protocol involving age-appropriate sedentary , light and moderate-to vigorous-intensity physical activities . Children wore an ActiGraph GT3X on the right mid-axillary line of the hip . Energy expenditure measured by room calorimetry and physical activity intensity classified using direct observation were the criterion methods . Energy expenditure was predicted using Pate and Puyau equations . Physical activity intensity was classified using Evenson , Sirard , Van Cauwenberghe , Pate , Puyau , and Reilly , ActiGraph cut-points . Results The Pate equation significantly overestimated VO2 during sedentary behaviors , light physical activities and total VO2 ( P<0.001 ) . No difference was found between measured and predicted VO2 during moderate-to vigorous-intensity physical activities ( P = 0.072 ) . The Puyau equation significantly underestimated activity energy expenditure during moderate-to vigorous-intensity physical activities , light-intensity physical activities and total activity energy expenditure ( P<0.0125 ) . However , no overestimation of activity energy expenditure during sedentary behavior was found . The Evenson cut-point demonstrated significantly higher accuracy for classifying sedentary behaviors and light-intensity physical activities than others . Classification accuracy for moderate-to vigorous-intensity physical activities was significantly higher for Pate than others . Conclusion Available ActiGraph equations do not provide accurate estimates of energy expenditure across physical activity intensities in preschoolers . Cut-points of ≤25counts⋅15 s−1 and ≥420 counts⋅15 s−1 for classifying sedentary behaviors and moderate-to vigorous-intensity physical activities , respectively , are recommended
It can be concluded that physical activity may be effective in reducing burn-out risk .
The few observational studies linking sedentary and dietary behavior with burn-out risk suggest that being more sedentary and eating less healthy are each associated with higher burn-out risk .
Although it is believed that physical activity , sedentary , and dietary behavior ( i.e. , energy balance-related behavior ) may decrease the risk of burn-out  , the association between both is currently not well understood .
Therefore , the aim of this systematic review was to synthesize studies investigating the relationship between energy balance-related behavior  and  burn-out risk .