Table 1.

Summary of Characteristics of Articles included in the Systematic Review (n=49)

Source	Objective (s)	Sample Size	Weight Status	Sex (F/M)	Follow-up duration	Subject, age	Study Groups		Adiposity Measure(s)	Study Findings
							Intervention(s)	Control
Abraham 2015 (57)	To assess the feasibility of adding an adapted internet-based curriculum to an existing nutritional program to reduce obesity among adolescents	48 youth with obesity	BMI > 95th percentile for age	19/29	3- and 6- months	12–18 years with a mean age of 14.4 years	INT1: Usual care visits at obesity clinic plus internet-based curriculum where participants set monthly diet and PA goals, and received weekly text messages. INT2: Usual care visits at obesity clinic plus four visits with nutritionists over 3 months.	Usual care visits at obesity clinic that consisted of dietary, PA, and medical history; physical examination, laboratory screening, and obesity counseling with a physician.	% BF, BMI, WC, and HC	No differences between groups for any of the adiposity measures at either 3- or 6-month follow-up.
Ahmad 2018 (30)	To evaluate the effectiveness of a FB intervention that combined social media and face-to-face sessions on improvement in adiposity	134 children with overweight or obesity	BMI z-score > 1.0 SD	76/58	3- and 6- months	8–11 years old, with a mean age of 9.6±1.2 years	Parental training on children’s nutrition, PA, behavior modification techniques, and parenting skills to improve their children’s health behaviors over 4-months with two weekly Facebook and two half-day face-to-face sessions followed by weekly booster sessions for 12 weeks.	The wait-list control group received small incentives after data collection visits and were offered the intervention after the completion of the final 6-month follow-up.	BMI z-score, WC percentile, and % BF	The intervention led to significant reductions in WC percentile which was maintained at 6-months. However, the between-group difference in BMI z-score was only significant at 6-months.
Balagopal 2010 (64)	To examine the effects of PA-based lifestyle intervention on obesity and cardiometabolic outcomes	15 adolescents with obesity	BMI percentile > 95th percentile for age	8/7	3 months	14–18 years old, with a mean age of 15.8±0.4 years	45 min of PA, three times/week with one FB, clinic monitored session per week combined with caloric restriction and healthy nutrition education	Received advice for PA and diet	Weight, BMI, and % BF	The intervention group had a significant reduction in % BF, and maintenance of weight and BMI whereas the control group increased weight and BMI.
Benestad 2017 (39)	To assess the effectiveness of a camp-based immersion vs. outpatient family treatment program for obesity prevention	90 children with obesity	BMI ≥ iso-BMI 30	45/45	24-months	7–12 years old, with a mean age of 9.7±1.2 years	2-week inpatient family summer camp with group and individual sessions focused on behavioral change strategies to make healthier choices.	4 outpatient days with group and individual sessions on healthy nutrition, PA, parenting skills, and goal setting	Weight, BMI, BMI z-score, WC, % BF, and FM	There were significant between group differences for reduction in BMI, WC, % BF, and FM but not for BMI z-score.
Berntsen 2010 (52)	To determine whether the addition of guided active play to a weight management program improved body composition	60 youth with overweight or obesity	BMI > 97.5th percentile for height*	31/29	5 months	7–17 years old, with a mean age of 12.1±2.4 years	Received dietary advice by clinical nutritionists at enrollment and participated in biweekly guided group active play sessions for 5 months that included endurance and strength-based activity. Families received a pedometer and an exercise diary book to inspire increased leisure time.	Received dietary advice by clinical nutritionist and encouraged to increase PA and reduce sedentary lifestyle. Offered active play program after study completion.	BMI, FM, % BF, and LM	The intervention led to a significant 1.8% decrease in % BF but did not lead to improvements in any of the other adiposity measures.
Bonham 2017 (65)	To evaluate the effectiveness of a commercially available, structured short-term weight management program to decrease BMI in adolescents	74 adolescents with obesity	BMI z-score ≥ 1.282*	55/19	3- and 6-months	13–17 years old, with a mean age of 15.2±1.3 years	JenMe program is a 12-week program developed by dieticians at Jenny Craig that consists of 13 one-on-one sessions that cover dietary and behavioral education, and progress monitoring.	Received the standard healthy eating guidelines for children and were advised to maintain their current lifestyle habits by a consultant.	Weight, BMI z-score	The JenMe program led to a significant decrease in both weight and BMI z-score as compared to the waist-list control (mean diff=−0.23), which contained to decrease in the post-study period.
Boodai 2014 (58)	To compare the effectiveness of a good practice intervention vs. primary care referral for treatment of adolescent obesity.	82 youth with obesity	BMI ≥ 95th percentile	40/42	6 months	10–14 years old, with a mean age of 12.4±1.2 years.	Intervention consisted of six 1-hour group sessions delivered to adolescents and their parents over a 24-week period that focused on changing behavior targeting factors related to obesity.	Informed that the adolescent had obesity and referred to primary care treatment.	BMI z-score and WC	There was no significant difference in BMI z-score or WC between the groups. Only 23% of the intervention group maintained or lost weight at 6-months compared to 17% of the control group.
Boudreau 2013 (72)	To evaluate the effectiveness of a family-centered, primary care– based approach to control childhood obesity through lifestyle choices.	41 youth with overweight or obesity	BMI ≥ 85th percentile	16/10	6 months	9–12 years old, with a mean age of 10.3±1.3 years	Intervention included 1.5-hour interactive group classes (1 session/week for 5 weeks with 1 additional session 3 months later) combined with monthly culturally sensitive coaching monthly) to encourage learned lifestyle changes and address barriers for 6 months.	Received intervention 6-month study period	Metabolic markers of obesity and BMI	There was no difference in metabolic markers of obesity or BMI between intervention and waist-list control participants.
Brennan 2013 (53)	To test the efficacy of a FB lifestyle program to improve body composition among overweight and obese adolescents.	63 adolescents with overweight or obesity	BMI adjusted for age and sex ≥ 20.55 kg/m2 according to international cutoffs**	34/29	6 months	11–19 years old, with a mean age 14.3±1.9 years	Aimed to instigate small maintainable improvements in eating and PA (~60 min/day and <2 hours/day of screen time) habits following Australian national recommendations. Cognitive behavioral principles were used to assist to help families manage barriers to change.	Offered intervention program after 6-month study period	BMI, BMI percentile, BMI-z score, WC, % BF, FM, and LM	The intervention led to significant reductions in weight, BMI, BMI z-score, BMI percentile, fat mass. However, the control group had a significant increase in lean mass compared to the intervention group.
Chan 2018 (63)	To evaluate the efficacy of a lifestyle modification program at reversing and reducing NAFLD in obese adolescents.	52 adolescents with obesity	BMI ≥ 95th percentile	19/33	4- and 17-months	14–18 years old, with a mean age of 14.8±4.4	Counseling sessions were provided weekly for 4 months and then bi-monthly for 52 weeks. The lifestyle modification program aimed to improve knowledge, attitudes, and practices regarding diet and exercise based on motivational interviewing and behavioral modification.	Received diet and exercise advice during routine consultations at the Obesity Clinic every 4 months by attending physicians.	Weight, BMI, BMI z-score, WC, % BF	The intervention led to significant between-group changes in weight, BMI, BMI z-score, WC, and % BF. Only % BF was significantly different than control group at 68-week follow-up.
Cohen 2016 (31)	To test a family-centered lifestyle intervention using Canada’s Food and PA Guidelines to reduce BMI z-score in children with overweight and obesity.	78 children with overweight or obesity	BMI for-age > 1 SD for overweight and BMI for-age >2 SD for obesity	39/39	12 months	6–8.5 years old, with a mean age 7.8±0.8 years	Both groups received six intervention sessions that covered healthy diet and PA. StnTx group participants were advised to consume two milk and meat alternatives per day. ModTx were advised to consume four milk and meat alternatives per day.	Control group participants were provided the Canada’s Food and PA Guidelines.	BMI z-score, WC, % BF, FM, and LM	Both intervention groups had a significant reduction in BMI z-score at 6- and 12-months. ModTx had significant reductions in BMI z-score, % BF, and fat mass at 6- and 12-months as compared to control.
Croker 2012 (68)	To examine the impact of FB behavioral treatment program on improvement in adiposity among children with obesity compared with a waiting-list control group.	72 children with overweight or obesity	BMI adjusted for age and sex between 18.35 and 27.24 kg/m2 according to international cutoffs**	50/22	1 year	8–12 years old, with a mean age of 10.3±1.6 years	Children and their parents attended 15, one-hour sessions over 6 months (10 weekly, 3 biweekly, 2 monthly) that included behavior modification techniques to improve diet and PA.	Offered the intervention program after the 6-month study period	BMI, BMI z-score, weight, weight SDSs, waist, waist SDSs, FM index, FFM index	There were no significant between-group differences for any of the anthropometrics or body composition measures.
Diaz 2010 (67)	To compare a lifestyle intervention to a brief primary care physician intervention for treating pediatric obesity in the primary care setting.	76 youth with obesity	BMI > 95th percentile	55/21	12 months	9–17 years old, with a mean age of 11.7±2.2	Twelve consecutive, weekly 2-hour group sessions led by an RD that encouraged goal setting for PA and sedentary levels and focused on the Traffic Light approach to improve dietary habits.	Received monthly consultations with primary care physician that monitored BMI and encouraged healthy lifestyle behaviors.	Weight, BMI z-score, BMI, WC, % BF	The lifestyle group participants had non-significant decreases in weight and BMI whereas the control group had a non-significant increase in both measures leading to significant between-group differences.
Farpour-Lambert 2019 (38)	To compare the effectiveness of 6-month lifestyle interventions with standard care on BMI z-score and CVD risk factors.	74 children with obesity	BMI adjusted for age and sex > 97th percentile	36/38	6 months	7.5–11.9 years old, with a mean age of 9.6±1.1 years	Individual delivery: Seven monthly behavioral change sessions (3 hrs w/ pediatrician and 4 hrs w/dietician) and two 1-hr PA sessions/week. Group delivery: Fourteen 90-min parent-only and 60-min child-only (11 weekly then 3 monthly meetings over 6 months) behavioral change sessions and two 1-hr PA sessions/week.	Standard of care for 12 months that included four 45-min consultations (every 3 months) and instructed to maintain current PA level.	BMI, BMI z-score, WC, total fat, abdominal fat, and FFM	Both individual and group delivery resulted in significant reductions in abdominal fat at 6 months. Group delivery also led to significant decreases in BMI and BMI z-score, which continued to improve at 12 months. There were significant reductions in weight, BMI, BMI z-score, and WC at 12 months for the group vs. individual delivery intervention.
Gerards 2015 (44)	To assess the effectiveness of a parent-only lifestyle intervention for the prevention of excessive weight gain in children with overweight and obesity	86 children with overweight or obesity	BMI adjusted for age and sex between 17.28 and 21.6 kg/m2 according to international cutoffs**	48/44	1 year	4–8 years old, with a mean age of 7.2±1.4 years	14-weeks comprised of ten 90-min parental group sessions and four individual 15–30-min phone sessions. The intervention consisted of active skills training methods based on self-regulation principles focused on nutritional, PA, and positive parenting strategies.	Received two brochures (one on healthy nutrition and PA and the other on positive parenting) and an internet-based knowledge quiz that tailored advice for home exercises.	BMI z-score, WC, biceps and triceps skinfolds	There were no significant reductions in children’s BMI z-score, WC, or skinfold thickness at 4 or 12 months. There were positive intervention effects of parenting behaviors, child nutrition, and active play.
Gillis 2007 (74)	To determine whether reinforcement of nutrition and exercise modification improves child anthropometrics.	27 youth with obesity	BMI > 90th percentile	NA	6 months	7–16 years old, with a mean age of 10.6±2.3 years	30-min lifestyle education session pre- and post- intervention period, food record one day per week, and weekly phone calls for 3 months	Received basic discussion on healthy diet and exercise.	BMI	The intervention group had a non-significant decrease in BMI whereas the control group had a non-significant increase; however, there were no between-group differences.
Golley 2007 (26)	To evaluate the effectiveness of a parenting-skills training for the treatment of overweight in children.	111 children with overweight	BMI adjusted for age and sex between 17.34 and 19.10 kg/m2 according to international cutoffs**	71/40	6- and 12-months	6–9 years old, with a mean age 8.2±1.1 years.	Parenting-skills training alone (P) consisted of 4 weekly 2-hr group sessions, then 3 monthly 15 to 20-min individual phone sessions focused on parent competence to manage child’s behavior. Parenting-skills training plus intensive lifestyle education (P+DA) completed parent-only training program plus 7 intensive lifestyle support group sessions.	Received general healthy lifestyle pamphlet and 4 phone calls over 5 months for retention.	BMI and WC z-score	There was a non-significant reduction in BMI z-score for all groups. Both the P and P+DA groups had a significant decrease in WC z-score at 12-months. Boys in both intervention group had significantly lower BMI and WC z-scores at 6 and 12 months compared with baseline, whereas girls in the WLC group had a significant reduction in BMI z-score.
Hofsteenge 2014 (59)	To determine the effects of a multidisciplinary group treatment on anthropometrics and body composition among adolescents with obesity.	122 adolescents with obesity	BMI adjusted for age and sex ≥ 20.55 kg/m2 according to international cutoffs**	68/54	6- and 18- months	11–18 years old, with a mean age 14.5±1.8 years	Received 7 sessions (90 mins) every ~3 weeks consisting of healthy diet, sedentary and PA education. Parents also received 2 parallel sessions. Four booster group sessions were scheduled 6, 14, 26, and 36 weeks after the 3-months intervention period.	Received referral to a dietician in the home care setting, which is considered standard of care in the Netherlands	Weight, BMI, BMI z-score, WC, trunk fat, total fat mass	The intervention group had significant reductions in BMI z-score at 18 months, but not at 6 months, when compared to control group.
Hughes 2008 (71)	To determine whether a best-practice individualized behavioral intervention reduced BMI z-score relative to standard dietetic care.	134 youth with obesity	BMI ≥ 98th percentile relative to the UK 1990 reference data*	75/59	1 year	5–11 years old, with a mean age 8.8±1.8 years	Eight, one-on-one appointments with pediatric RD trained in behavior change counseling over 26 weeks. Sessions used family-centered counseling and behavioral strategies to modify diet, PA, and sedentary behavior.	Received ~4 outpatient appointments with a pediatric RD over 6–10 months, which is standard care in Scotland.	BMI z-score, weight, fat distribution	There were no significant differences in between-group changes in BMI z-or WC score, or weight at 6- or 12-months. BMI z-score significantly decreased, and weight significantly increased in both groups.
Janicke 2008 (46)	To investigate the effectiveness of PO vs. FB interventions for pediatric weight management in underserved rural settings.	93 youth with overweight or obesity	BMI adjusted for age and sex ≥ 85th percentile	Girls: 57% (n=53) Boys: 43% (n=40)	4- and 10-months	8–14 years old, with a mean age of 11.1 years.	Interventions were either FB or PO and consisted of weekly 90-min group sessions for 8 weeks, then biweekly for the next 8 weeks. Sessions addressed diet modification, food monitoring, setting dietary goals, and increasing PA.	Offered the weight management intervention after study completion.	Weight, BMI z-score	There were significant reductions in children’s BMI z-scores between PO vs. WLC groups at 4- months. Further, there were significant reductions in BMI z-scores at 10 months in both PO and FB compared to WLC.
Jiang 2005 (55)	To determine the feasibility and effectiveness of a FB behavioral approach for treatment of children with obesity in China.	68 children with obesity	Weight-for-height ≥ 120% of the Chinese reference	27/41	2 years	Children in grades 7–9, with a mean age 13.3±0.7	Monthly home visits by study pediatrician for behavioral goal setting and obtainment combined with dietary modification using the Traffic Light approach and increase in PA to 20–30 mins per day for four days per week.	No information or intervention	Weight, BMI z-score	The intervention resulted in significant reduction in BMI z-score over the 24-month period. Despite similar linear growth, the control group gained 5.5 kg whereas intervention group lost 0.3 kg in weight.
Johnson 1997 (40)	To investigate the influence of nutrition and exercise interventions on weight loss.	32 children with obesity	Weight at least 20% above ideal for age and sex	23/9	4 months, and 5-years	8–17 years old, with a mean age of 11±2.3 years	Promoted the stoplight diet and included a gradual increase of aerobic exercise to 45 mins 5–7 days/week. NE group received nutrition intervention for 7 weeks followed by an exercise intervention for 7 weeks. EN group received the opposite sequence.	Control group attended weekly informational sessions on diet and exercise	Weight, skinfold thickness, % BF	Both the NE and EN interventions resulted in significant reductions in weight, BMI, and % BF. which was maintained at 5-year follow-up. There were no differences in adiposity changes between NE vs. EN groups.
Johnston 2007 (60)	To evaluate an intensive intervention for weight loss among Mexican American middle school children who are overweight.	60 children with overweight or obesity	BMI adjusted for age and sex ≥ 85th percentile	27/33	3- and 6- months	10–14 years old, with a mean age 12.4±0.7	Twelve-week trainer-led intervention that included nutrition education (1 day/wk) and PA (4 days/wk) followed by 12 weeks of bi-weekly sessions. Parents attend one nutrition and four outdoor PA lessons	Received a 1-week parent-guided manual to increase healthy eating and increasing PA.	BMI, BMI z-score, % BF	Children in the intervention had significant reductions in BMI z-score at both 3 and 6 months when compared to control children.
Kalarchian 2009 (41)	To evaluate the efficacy of FB, behavioral program for the management of severe pediatric obesity.	192 youth with obesity	BMI adjusted for age and sex ≥ 97th percentile	109/83	6-, 12-, and 18-months	8–12 years old, with a mean age 10.2±1.2 of years	Twenty, 60-min child- and parent-only group meetings for 6 months which followed the Stoplight Eating Plan, recommended daily energy intake based on body weight, and encouraged more PA. Three group sessions and 3 telephone calls were provided between 6–12 months.	Offered two nutrition consultations sessions to develop individual nutrition plan using the Stoplight Eating Plan.	Proportion overweight, % BF, FM, FFM, WC	The intervention led to significant decreases in weight, BMI, % overweight, WC, % BF, and total fat mass at 6 months only. There were no significant long-term (12- and 18-months) differences between intervention and control.
Kalavainen 2007 (47)	To compare the efficacy of group treatment focused on promoting a healthy lifestyle with routine counseling for the treatment of childhood obesity.	70 children with obesity	Weight-for-height between 115–182% above ideal	42/28	6- and 12- months	7–9 years old, with a mean age of 8.1±0.8 years	Fifteen (weekly for first 10 weeks, biweekly for the last 5 weeks) parent- and child-only 90-min sessions that included non-competitive PA and nutrition education, with one joint session about healthy snacks.	Received booklets about weight management, eating habits, and PA; and attended two 30-min counseling sessions with school nurse.	Weight, BMI, BMI z-score	Intervention children lost significant more weight-for-height and had greater reductions in BMI and BMI z-score than the control children at 6- and 12- months, with girls having greater reductions than boys
Kelishadi 2009 (37)	To determine the long-term effects of a dairy-rich diet on generalized and abdominal obesity among prepubescent children with obesity.	120 children with obesity	BMI adjusted for age and sex ≥ 95th percentile	Not specified	36 months	5–6 years old, with a mean age 5.6±0.5 years	All 3 groups attended 6 consecutive monthly family-centered education sessions about healthy nutrition and PA conducted by pediatrician and nutritionist.		BMI z-score, WC, and % BF	BMI z-score, WC, and % BF decreased significantly after the 6-month trial for all groups with WC and % BF remaining lower than baseline values for the DR group at 12 months.
							DR group was placed on an isocaloric dairy-rich diet (>800 mg ca/d). ER group was placed on a caloric restricted regimen.	The control (C) group did not receive any additional recommendation.
Lee 2014 (29)	To evaluate the effectiveness of a multi-component school-based weight management program for children with overweight or obesity.	106 youth with overweight or obesity	BMI adjusted for age and sex between 18.35 and 26.67 kg/m2 according to international cutoffs**	31/75	4- and 8- months	8–12 years old, with a mean age of 10.4±0.8 years	Attended 75-min after-school sessions and one 3-hour weekend session covering healthy eating, exercise and meal planning with parents for 4 months. Parents received an introductory seminar and two, 1-hour sessions on healthy eating and exercise strategies.	Wait-list control group was offered the intervention after study completion	BMI z-score and % BF	The intervention group significantly reduced BMI z-score and % BF as compared to the control group, which was maintained at 8-month follow-up.
Mameli 2018 (61)	To test whether a personalized lifestyle program was superior to a standard lifestyle change program at promoting weight loss in children with obesity.	43 youth with obesity	BMI ≥ 95th percentile for age and sex	30/19	3 months	10–17 years old, with a mean age of 12.5±2.0	All participants were encouraged to practice 1 hr/day of moderate to vigorous PA, to minimize sedentary time by reducing screen time (<2 hr/day), and to follow the Mediterranean diet during the 3-month study.		Weight, BMI z-score	A personalized lifestyle program did not result in a significantly greater improvement in weight or BMI z-score. Both groups had a modest increase in weight and a slight decrease in BMI z-score.
							Participants were equipped with a wristband accelerometer that calculated energy expenditure and smartphone application to measure energy intake with weekly diet and PA feedback delivered via text message.	Received only dietary and PA instruction.
McCallum 2007 (69)	To evaluate the effect of a physician-delivered, solution focused intervention on improvement in BMI among children with overweight or obesity.	163 children with overweight or obesity	BMI age- and sex-adjusted z-score >1.0 but less than 3.0	84/79	9- and 15-months	5–9 years old, with a mean age of 7.4±1.6 years.	Intervention included four standard GP consultations over 12 weeks that targeted change in nutrition, PA, and sedentary guided by a personalized family plan.	Received no contact with GP or research team.	BMI and BMI z-score	The brief, FB intervention did not result in BMI improvements at 9- or 15-month follow-up but result in sustained improvement in child nutrition score.
Moens 2012 (43)	To evaluate the effect of a parent-led intervention for improvement in weight evolution among children that were overweight.	50 families with children with overweight	Adjusted BMI for age and sex >120%	17/33	6- and 12-months	6–12 years old, with a mean age of 9.2±1.4	Six, 2-hour parent-only group meetings that promoted health lifestyles as an effective approach to prevent further weight gain by RDs and psychologists.	The wait list control group was provided the intervention following the study period.	BMI	The intervention led to a significant decrease in BMI; however, there were no significant between-group differences in BMI.
Morell-Azanza 2019 (32)	To evaluate the effects of a FB lifestyle intervention on anthropometric indices in children with abdominal obesity.	106 youth with obesity	Waist circumference > 90th percentile	66/40	2 years	7–16 years old, with a mean age of 11.3±2.5 years.	Individual (six sessions with a RD) and group (one PO, and one parent/child) sessions delivered by a multidisciplinary team over 8 weeks and encouragement to follow a moderate hypocaloric Mediterranean diet	Received standard pediatric recommendations on healthy diet and one 30-min RD counseling session and five monitoring visits to obtain anthropometrics.	BMI z-score, WC, HC	The intervention group had a significantly greater reduction in BMI z-score and hip circumference, both groups had a significant reduction in waist circumference.
Nemet 2005 (42)	To examine the short- and long-term effects of a 3-month, combined dietary-behavioral-PA intervention on anthropometric measures and body composition among children with obesity.	46 youth with obesity	BMI ≥ 95th percentile for age and gender	20/26	3- and 12- months	6–16 years old, with a mean age 11.1±2.4	Four evening lectures on childhood obesity, general nutrition, a therapeutic nutritional approach for childhood obesity, and PA; six RD counseling sessions; and twice weekly 1-hour PA sessions. Participants were instructed to obtain 30–45 min/wk of additional PA and followed a hypocaloric diet.	Referred to one ambulatory nutritional consultation and instructed to perform PA 3 times per week independently.	BMI-for-age percentile, BMI z-score, % BF, triceps and subscapular skinfolds	The intervention group had significant decreases in weight, BMI, and % BF with continued decreases in BMI and % BF among the intervention group at 12 months. Whereas control subjects had significant increase in weight and % BF after the 3-month study period.
O’Connor 2013 (70)	To test the feasibility of a primary care delivered intervention targeted ethnic minority children and their parents for obesity prevention.	40 children with overweight or obesity	BMI between 85th and 99th percentile	32/8	6 months	5–8 years old, with a mean age of 6.8±1.1 years	Monthly sessions with trained health advisors for behavior modification goal setting. Sessions focused on national recommendations for age-appropriate dietary intake, PA and TV viewing, parenting practices, and use of the Helping HAND program.	Advised to regularly schedule doctor’s visits and asked to avoid participation in other obesity prevention programs.	BMI, BMI z-score	There were no differences in BMI-z between groups. However, the intervention group had a non-significant improvement in sedentary time and TV viewing.
Reinehr 2010 (51)	To evaluate the effectiveness of lifestyle intervention among children with obesity.	60 youth with obesity	BMI between 90th and 97th percentile*	38/28	6 months	8–16 years old, with a mean age of 11.5±1.6 years	Two 3-month phases: Intensive phase included 6 child-only behavior counseling and nutrition education sessions (each ~1.5 hrs), 6 parent-only evening sessions (~1.5 hrs), and weekly PA training sessions Establishing phase included one individual nutrition counseling and three, 30-min parent/child counseling sessions	Waitlist control was offered the intervention after the 6-month study period.	BMI, BMI z-score, WC, FM, LM, % BF, triceps and subscapularis skinfold thickness, and degree of overweight	The intervention group had a significant decrease in BMI, BMI-z-score, WC, % BF, and FM as compared to the control group. There was not a significant sex difference in reduction in BMI z-score among the intervention group.
Rodearmel 2007 (73)	To evaluate the effect of small change strategy recommended by America on the Move at preventing excessive weight gain in families with overweight children.	218 youth with overweight or at risk for overweight	BMI ≥ 85th percentile	114/104	3- and 6- months	7–14 years old, with a mean age of 11.2± 2.2 years	FB intervention that encouraged a 2000 step increase in average baseline daily steps and a 100 kcal/day reduction in usual diet. Families also received nutrition and PA education and behavioral therapy sessions (15 sessions).	Monitored daily steps and completed pre- and post- sweets survey. Received no nutrition or PA educational materials but completed intervention after study period.	BMI z-scores, BMI%ile, WC, % BF	Both groups had a significant increase in weight but a significant decrease in BMI z-score, with no statistically significant differences between groups.
Sacher 2010 (33)	To evaluate the effectiveness of a multicomponent community-based childhood obesity intervention program.	116 youth with obesity	BMI ≥ 98th percentile relative to the UK 1990 reference data*	63/53	6- and 12- months	8–12 years old, with a mean age of 10.3±1.3 years	The program included 8 behavior change, 8 nutrition education sessions, 16 one-hour PA (two/week), and one closing session delivered over 9 weeks followed by 12-weeks of free community pool access. A “nondieting” philosophy was advocated throughout the intervention	Waitlist control group received the program after the study period.	WC z-score, BMI z-score, FM, FFM, % BF	Children in the intervention had a significantly greater reduction in BMI z-score, WC, and FM when compared to the control group at 6- and 12- months.
Sauder 2018 (34)	To assess a culturally sensitive behavioral intervention adapted from the DPP for American Indian youth for obesity prevention	62 children with overweight or obesity	BMI ≥ 85th percentile for age and gender	32/30	8 months	7–10 years old, with a mean age of 9.2±1.1 years	Participants attended 10, 2-hour group classes that included PA, cooking demonstrations, culture crafts, and a group meal. Program goals used the 5–2-1–0 messaging and dietary goals used the Traffic Light Diet. Five counseling sessions to assist with goal setting.	Control participants attended 3 general health and safety group sessions. Sessions also included a healthy group meal.	BMI, BMI z-score, and WC	There was a significant increase in BMI and WC for the control group but not the intervention group. BMI z-score significantly decreased among the intervention group, but significantly increased for the control group.
Savoye 2014 (54)	To examine the effects of FB, intensive lifestyle intervention on anthropometrics among youth with obesity and prediabetes.	75 adolescents with obesity	BMI ≥ 95th percentile for age and gender	49/26	6 months	10–16 years old, with a mean age of 13.0±1.9 years	Program consisted of two 50-min PA sessions per week, one weekly weigh-in, and a 40-min nutrition/behavior modification class. Participants were encouraged to exercise 3 additional times per week.	Received diet and exercise instruction from clinic RD and followed every 2–3 months by clinician.	Weight, BMI, BMI z-score, % BF, FM	The Bright Bodies program led to significant reductions in BMI z-score, FM, and % BF compared to standard care controls.
Savoye 2007 (62)	To compare effects of a weight management program on adiposity of children who are overweight compared to a control group	135 youth with overweight	BMI ≥ 95th percentile for age and gender	69/49	6- and 12-months	8–16 years old, with a mean age 12.1±2.3 years	Program consisted of two 50-min PA sessions per week, one weekly weigh-in, and a 40-min nutrition/behavior modification class. Participants were encouraged to exercise 3 additional times per week.	Received diet, exercise, and psychosocial counseling in the obesity clinic every 6 months.	BMI, % BF, FM, weight	The Bright Bodies weight management program led to significantly greater decreases in BMI, weight, FM, and % BF at 6- and 12- months compared to control group.
Serra-Paya 2015 (50)	To evaluate the effectiveness of a FB multi-component behavioral intervention on improving anthropometric parameters	113 children with overweight or obesity	BMI adjusted for age and sex between 17.34 and 26.67 kg/m2 according to international cutoffs**	60/53	8 months	6–12 years old, with a mean age 9.9±2.0 years	Completed three 1-hour PA sessions/week, 60-min parent- and child-only counseling sessions/week, and three parent and child behavior strategy sessions/week plus 3 weekend fun PA days.	Received 10-min structured family meetings with pediatrician on healthy eating and PA once per month.	Weight, BMI, BMI z-score, WC, WhtR	There were no significant differences in anthropometric parameters between the two groups.
Soltero 2018 (13)	To examine the short- and long-term effects of a culturally- and community-based lifestyle intervention among Latino youth with obesity.	136 adolescents with obesity	BMI ≥ 95th percentile for age and gender or BM ≥ 30 kg/m2	74/62	3-, 6-, and 12- months	14–16 years old, with a mean age of 15.4±0.8 years	Youth and their families participated in weekly nutrition and health classes (1 day/week for 60-min) and exercise sessions (3 days/week for 60-min) for 3 months, followed by monthly booster sessions for 3 months	Youth received laboratory results and general health information from a pediatric endocrinologist and RD twice during the study.	BMI, BMI %ile, WC, % % BF, and FFM	The intervention youth significantly reduced weight, BMI %ile, BMI, WC, and % BF compared to control youth. Between group differences for BMI %ile and % BF remained significant at 12 months.
Taylor 2015 (35)	To determine whether a FB intervention using frequent contact and limited expert involvement was effective in reducing excessive weight compared with usual care.	206 children with overweight or obesity	BMI ≥ 95th percentile for age and gender	114/92	12- and 24-months	4–8 years old, with a mean age of age 6.5±1.4 years	Families attended a single multidisciplinary session (1–2 hours) to develop specific family goals, then had either 10-min phone or 45-min in-person monthly mentor meetings for 12 months, then every third month for another 12 months.	Families had one 45 -min appointment to receive personalized feedback and general healthy lifestyle advice at baseline and 6 months.	Weight, BMI, BMI z-score, WC, WHtR, % BF	Children in the intervention had a significantly lower BMI, BMI z-score, WC, and WHtR at 24-months compared to control children.
Vos 2011 (56)	To evaluate short- and long-term effects of a FB multi-disciplinary cognitive behavioral lifestyle intervention on markers of adiposity compared with standard care in children with obesity.	79 youth with obesity	BMI adjusted for age and sex between 21.57 and 29.69 kg/m2 according to international cutoffs**	42/37	3-, 12-, and 24-months	8–17 years old, with a mean age 13.3±2.0 years	2.5 hour group treatment sessions for children alone (7 sessions), parents alone (5 sessions), and one parent and child session. Two to three refresher sessions offered per year. Sessions focused on healthy diet using the traffic life approach, increase PA to optimal amount, and motivational interviewing for behavior change strategies.	Control group received standard advice on PA and nutrition at the start of the study and offered the intervention after the 1-year study period.	BMI and WC z-score, WHtR	Youth in the intervention had a 10% decrease in BMI z-score and 19% decrease in WC z-score at 12 months compared to baseline measures which was maintained at 2-year follow-up.
Wake 2009 (45)	To determine the effectiveness of physician delivered, solution focused intervention to reduce BMI gain among children with overweight or obesity using	258 children with overweight or obesity	BMI adjusted for age and sex between 17.15 and 24.11 kg/m2 according to international cutoffs**	156/102	6- and 12-months	5–10 years old, with a mean age 7.5±1.4 years	Four standard consultations over 12 weeks targeting change in nutrition, PA, and sedentary behavior, supported by family materials. Same components as LEAP 1 trial design (McCallum et al.)	Received no contact with GP or research team.	BMI, BMI z-score, WC	The intervention youth had a non-significant decrease in BMI at 6- and 12-months when compared to control youth. There were no between-group differences in BMI z-score or WC.
Wang 2008 (66)	To investigate the short-term effect of a lifestyle intervention on BMI z-score compared to a control group among children with obesity and NAFLD.	57 youth with obesity	BMI ≥ 95th percentile for age and gender	18/39	1 month	10–17 years old, with a mean age of 13.7±2.2 years	Youth participated in daily PA (e.g., swimming, basketball, table tennis) for three hours at a summer camp. Prescribed a low-calorie diet that consisted of 50% carbohydrates and 10% fat with the goal to achieve a reduction of 250 kcal/day.	Received no lifestyle intervention	BMI z-score	The lifestyle intervention led to a significant decrease in BMI and BMI z-score whereas the control group had no change in these indices. However, there were no between-group differences.
Weigel 2008 (48)	To evaluate the impact of an outpatient program on BMI z-score among children and adolescents with obesity.	73 youth with obesity	BMI ≥ 97th percentile for age and gender*	40/33	6- and 12- months	7–15 years old, with a mean age of 11.2 years	Received 45 to 60-min sessions twice per week that covered PA, nutritional education, and coping strategies. Parents attended monthly meetings and medical supervision including laboratory tests at 0,6, and 12 months.	Received written therapeutic advice from a physician during outpatient visits at baseline and 6 months and were given medical supervision and laboratory tests at 0, 6, 12 months.	BMI, BMI z-score, FM, LM	The intervention group had a significant reduction in BMI and BMI z-score at 12-months but not 6-months. There was a significant between group difference in BMI, BMI z-score, FM, and LM at 6- and 12- months
Wilfley 2017 (36)	To evaluate the effects of two doses (high vs. low) of FB weight-control intervention vs control education on child anthropometrics.	172 children with overweight or obesity	BMI ≥ 85th percentile for age and gender	106/94	4-, 8-, and 12-months	7–11 years old, with a mean age of 9.4±1.3 years	FB eating and PA changes, skills to manage peer interactions, and building a supportive family and peer environment delivered in 30-min family sessions and 45-min separate child and parent group sessions. LOW intervention group received the intervention biweekly whereas HIGH intervention group received the intervention weekly.	Control group received novel information on nutrition and exercise and participated in hands-on activities as families.	Percentage of overweight, BMI, BMI z-score	The HIGH intervention led to significant decrease of 3.37 and 6.71 in percentage of overweight when compared to the LOW intervention and control groups. Similarly, the HIGH intervention group had a significant change in BMI Z-score (−0.14) when compared to the control group.
Wylie-Rosett 2018 (25)	To evaluate the efficacy of a bilingual, physician delivered weight management program to standard care approach with the addition of an enhanced program in a safety-net pediatric primary care setting.	360 children with overweight or obesity	BMI ≥ 85th percentile for age and gender	185/175	3-, 6-, 9-, and 12 months	7–12 years old, with a mean age of 9.3±1.7 years.	The Standard Care + Enhanced Program was enriched with eight skill-building core (four in-person group sessions, and four parent/guardian phone consultation) and monthly post-core sessions that focus on dietary modification and increased PA.	One initial, structured 40-min followed by brief (~15-min) quarterly semi-structured pediatrician visits to assess weight-related issues and target FB behavioral changes.	BMI z-score, WC, HC	Both the intervention and standard care group participants had a decrease in BMI z-score during the 12-month study period. There were no group differences; however, older children and female youth exhibited greater decreases compared to younger children and male youth.
Yackobovitch-Gavan 2018 (49)	To assess effects of FB interventions targeted parents only or to parents and child for the prevention of childhood obesity	168 children with obesity	BMI between 85th and 98th percentile for age and gender	111/57	3-, 12-, and 24-months	5–11 years, with a mean age of 8.3±1.4 years	Consisted of 12 weekly sessions with a dietician and psychologist that targeted behavioral changes in nutrition or lifestyle. In the parents-only group, at least one parent attended the meetings, and in the parents–child group, at least one parent and child attended separate group meetings.	Did not participate in group meetings. Received clinical follow-up only.	BMI z-score	Both the parent-only and parent+child intervention groups had a significant decrease in BMI z-score at 3 months whereas only the parent+child group had a significant decrease at 24 months. There were no significant between-group differences.

Abbreviations: % BF= percent body fat; BMI=body mass index; BMI %ile= body mass index percentile; BMI z-score; body mass index standard deviation score; DR=dairy-rich; EN=exercise before nutrition group; ER=energy-restricted; FB=family-based; FFM=fat-free mass (kg); FM=fat mass (kg); GP=general practitioner; HC=hip circumference; hrs=hours; INT1=intervention one; INT2=intervention two; JenMe=Jenny Craig’s adolescent weight management program; LM=lean mass (kg); min=minute; ModTx=modified treatment intervention; NAFLD=non-alcoholic fatty liver disease; NE=nutrition before exercise group; PA=physical activity; P=parent-skills training alone; P+DA=parenting-skills training plus intensive lifestyle education; PO=parent-only; RD=registered dietitian; StnTx=standard treatment intervention; WC=waist circumference; WhtR=waist-to-hip ratio; wk=week.

^*Definitions of overweight and obesity were county specific and differed from U.S. definitions. Norwegian definition for obesity was BMI>97.5^th percentile for height. Germany definition for overweight was BMI >90^th percentile but <97^th percentile, which would be considered obese by U.S. standards. Australia definition for obesity was a BMI z-score ≥ 1.282 with no comorbidities or BMI percentile > 90^th.

^**International cutoffs for BMI were based on the publication by Cole TJ et al, BMJ, 2000;320(7244):1240. The BMI range provided is for the study-specific age-range.

Terminology: Youth referred to studies that included children and adolescents aged greater than 6 but less than 18 years old; Child referred to studies that included children aged greater than 6 but less than 12 years old; Adolescents referred to studies that included adolescents aged greater than 12 but less than 18 years old.