Table 3.

Research Design and Findings

Author (Year)	Reported N (retention or participation rates, if available)	Outcomes reported						Key Conclusions Reported
		Diet	Physical activity	Physical fitness	Anthropometrics	Psychosocial constructs	Other
PILOT/FEASIBILITY STUDIES
Beech et al. (2003)	60 (100%)	Child *						Recruitment and retention goals can be met
Cullen & Thompson (2008)	67 families (82%)					Child x Adult x		Failure to meet log-on rate goals and declining participation may be attributable to inadequate intervention dose. The positive change in mediating psychosocial variables suggests that Web-based programs can be successful if more attention is paid to recruitment.
Northrup et al. (2008)	Approximately 1,250 students and 825 parents	Child Ø	Child Ø					Addressing childhood obesity may be accomplished through the school setting and outreach to parents. Optimal programs should be flexible and include and desirable incentives.
Ransdell, Robertson, Ornes, & Moyer-Mileur (2004)	37 participants (43% control: 93% intervention)		Child and Adult: * x	Child and Adult: * xa	Child and Adult: Ø			Pilot results indicate that further research is needed on involving 3 generations of women in a home-based intervention to improve physical activity and fitness levels. Study limitations, especially small sample size and a high drop-out rate in the control group, should be addressed in future research to determine whether this intervention is efficacious or effective.
Rodearmel et al. (2006)	105 families (77%)	Child and parent: *	Child and parent: *		Child and parent: *			The intervention was successful in increasing steps/day and cereal consumption. The intervention had positive, significant effects on percentage BMI-for-age and percentage for body fat for children and weight, BMI and percent body fat for parents.
Warren et al. (2003)	213 children (83%)	Child: x			Child: Ø	Child: x		School is an appropriate setting for children’s health interventions. Future interventions should have multiple components with a behavioral focus and include all children in the school, targeting the whole environment and striving to be sustainable.
Quasi-experimental studies (no controls)
Cookson et al. (2000)	1387 children (27%)		Child: x					Low-cost Family Fun Pack is effective in promoting healthy lifestyle modifications, particularly among those with the intention to change behavior.
Grassi et al. (1999)	202 adults, aged 18+ (56%)		Ø			X		Strong family and communities ties facilitated involvement; word of mouth was the best recruitment tool. Low costs, flexibility of participation, involvement of family members were incentives to participate. The actual decrease in physical activity hours reported may stem from over estimation at baseline and inaccurate recall.
Harrington et al. (2005)	575 families (71%)							Successful interventions require optimal program completion. For this project, the main predictors of program completion were: participation in program kick off night; interactive family style; having several adults and several children in the household; having parents who are married; having a relatively high income; and being African American. To best implement the program requires understanding issues specific to each family and initial program experience. Participation, but not outcome, data are reported
Klohe-Lehman et al. (2007)	91 parents (39% of those who attended the first class)	Child: x Parent: x	Child: x Parent: x		Child: x Parent: x			Weight loss classes for women of low socioeconomic status appeared to improve several facets of energy balance in overweight and obese mothers and their 1–3 year old children.
Levine et al. (2001)	24 families (67%)				Child: x	Child: x		Children who completed the family based intervention lost a significant amount of weight and reported significant improvements in depression, anxiety and eating attitudes
Lytle et al. (2006)	16 schools, 3600 students						Food environment: * Ø Healthier grocery choices: *	Intervention school parents reported healthier grocery choices, however no differences were observed in a home food inventory. Intervention schools had healthier a la carte offering and purchases, but no increases in regular meal fruit and vegetable sales.
Sääkslahti et al. (2004)	228 children (86% control, 84% intervention)		Child: * x					Children’s physical activity levels can be increased through programs that focus primarily on parental education.
Stern et al. (2006)	39 daughters and mothers							A family-based approach shows promise for weight loss, as daughters and mothers differed in their perception of weight, and such differing perceptions will shape programming. Article provides baseline data only
Teufel-Shone et al. (2005)	72 families	Adult: *	Adult: *			Adult: *		A promotora-delivered intervention is feasible and results in an improvement in knowledge of risk factors for diabetes and self-efficacy to change food and activity behaviors.
Randomized control trials
Anand et al. (2007)	57 households (89%)	Household: *	Household: Ø		Household: Ø	Household: Ø		While this household-based intervention had some positive results and trends, a more comprehensive intervention is needed to address both individual change and structural barriers in the community.
Caballero et al. (2003)	1704 children (83%)	Child: *	Child: Ø		Child: Ø	Child: *		Intervention resulted in reduction of energy from fat and improvements in health knowledge and behaviors, but no impact on activity levels or body fat. Intervention also resulted in a reduction of self-reported recall of energy intake, but did not show a similar reduction in direct observation of energy intake.
De Bourdeaudjuij and Brug (2000)	40 families (88%)	Child: x Adult: x						Both tailored and general nutrition education letters improved diet, but only mothers received additional benefit from tailoring the letter.
De Bourdeaudjuij et al. (2002)	180 participants (79%)	Child: x Adult: x				Child: x Adult: x		Tailored nutrition education letters were associated with decrease in fat intake for only those already eating above-recommended levels of fat. Psychosocial determinants of fat intake were affected similarly with the tailored individual and the tailored family letters.
Eisenmann et al. (2008)	1359 children (65%)							To develop a broad range series of intervention activities aimed at reducing screen time, increasing physical activity, and enhancing nutrition requires extensive, transdisciplinary partnerships and multiple players. Focus is on design and implementation of intervention; outcome dat not reported.
Epstein et al. (2000)	90 families (84.4%)				Child:* Parent: Ø	Child: x Parent: *		Problem solving did not add to treatment effectiveness beyond the standard family-based treatment.
Epstein et al. (2004)	63 families (95%)	Child: x	Child: x		Child: x			Obese children assigned to the treatment that included stimulus control and reinforcement to reduce sedentary behaviors had equivalent decreases in BMI z-scores, improvements in diet, decreases in sedentary activities, and increases in physical activities.
Epstein et al. (2008)	41 families (66%)	Child: *			Child:*	Parent:*		Focusing on increasing fruit and vegetable and low-fat dairy intake led to a greater reduction in BMI z-scores than focusing on reducing high energy-dense foods.
Fitzgibbon et al. (2002)	24 Head Start programs							Energy balance is best achieved through prevention and early intervention and prevention approaches. Authors provide the rationale and details on study design for an upcoming RCT.
Golan et al. (2006)	96 parents and children (95%)				Parents only group for children only:* Parents and children in the parent- child group: Ø	Parent only and parent- child group: Ø	Household food environment: Ø	Combined child and parent interventions are less likely to bring weight loss to obese children than sessions attended only by parents. Omitting the child from intervention activities is more likely to result in weight loss and sustained weight loss at one year follow up. Involving parents only shows a slight, though not statistically significant, improvement in obesogenic habits in the home.
Golan et al. (1998)	60 children (17% dropout)				Child:*			Treatment of childhood obesity with the parents as the exclusive agents of change, induces more behavioral changes as well as greater weight loss, than the conventional approach.
Gombosi et al. (2007)	4,241 K-8th graders	Child: Ø						Addressing childhood obesity and overweight from a broad, multiple environmental perspective is challenging because of the potential for inadequate penetration of educational and information dissemination, relatively long lag time, and a growing trend toward obesity.
Harvey- Berino & Rourke (2003)	43 child mother pairs (93%)	Child: Ø	Child: Ø Parent: v Ø		Child: Ø Parent: Ø	Parent: Ø	Child feeding practices: *	A home-visiting program focused on changing lifestyle behaviors and improving parenting skills shows promise for obesity prevention in high- risk Native-American children.
Hopper et al. (2005)	238 3rd graders	child Ø				Child: *		The school curriculum can be adjusted and obtain minor changes in knowledge of exercise and nutrition. Adding the family component may help round out the educational content.
Janicke et al. (2008)	93 families (76%)	Child x			Child: * Parent: Ø			At 10 months children in parent only intervention and family based intervention had a greater decrease in BMI z score compared with children in control condition.
Kalavainen et al. (2007)	70 7–9 year olds (87% control; 99% intervention)				Child:*			Family-based group therapy that emphasized a healthy lifestyle and was given separately for children and adults is an effective way to treat obese children.
Müller et al. (2001)	414 children, 92 families	Child: x	Child: x		Child: *	Child: x		Health behavior education, delivered through the school setting, and social support are valuable components for future interventions.
Nemet et al. (2008)	22 children		Child: *	Child: *	Child: *			The multi-component, intensive, weight management, family-oriented intervention was effective for obese children with obese parents. The intervention led to reductions in body weight, BMI, and sedentary activity as well as improvements in fitness.
Ransdell, Eastep, Taylor, Oakland, Schmidt, Moyer- Mileur, & Shultz (2003)	34 (70% control; 100% intervention)		Parent: x Child: x	Parent: x Child: x		Parent: x Child: x		Both home-based and university-based physical activity programs for mothers and adolescent daughters may be efficacious in improving short-term physical activity levels, physical fitness levels, and mother- daughter relationships of participants.
Robinson et al. (2008)	294 girls in 271 families							Recruitment efforts for the RCT were successful. Only baseline descriptive data are currently available.
Wifley et al (2007)	150 families (81%)				Child: *	Child: *		Weight control was significantly better in the active maintenance treatments (behavioral skills maintenance group and social facilitation group) compared to the control group (usual care) in the short term (4months) but the effects diminished after 2 years.
Williams et al. (2004)	365							This intervention, The Pro Active trial, represents the first efficacy trial designed to increase physical activity in a high-risk group. No outcome data reported in this description of RCT.

^aDirection of effect for one physical fitness outcome (mile walk time) favored the control group.

Key to “Outcomes Reported” columns in Table 2:

^*-- denotes statistical significance compared to control group

^x-- denotes statistical significance compared to baseline

^Ø-- denotes no statistically significant findings