You will be presented with a collection of medical randomized controlled trial (RCT) reports addressing a shared clinical question -- for instance, the efficacy of a medical intervention on a disease or condition. Given the titles and abstracts of these reports, your task is to generate the conclusion of the systematic review article synthesizing the key findings. Your conclusion should be a few sentences long. In your response, include only the conclusion and no other text. The RCT reports are below.



Title 1:
An evaluation of enhanced self-regulation training in the treatment of childhood obesity.
Abstract 1:
Obese children ( 8 - 13 years old ) and at least one of their parents participated in a behaviorally oriented treatment program .  Participants in a st and ard treatment condition experienced a multicomponent intervention in which parents were given primary responsibility for following program prescriptions . An enhanced child involvement condition provided the same basic intervention but with greater emphasis on , and training in , child self-regulation .  Children in both conditions achieved a significant reduction in percentage overweight and triceps skin-fold during the 6-month treatment period . Overall , the follow-up period of 3 years was characterized by increases above posttreatment levels . There was , however , some suggestion in the 3-year follow-up results and the long-term patterns over a 6 1/2-year period of the benefits of the enhanced child involvement approach . Findings are discussed in terms of suggestions for reconsideration of treatment goals , improved interventions , and refinements in the assessment of self-regulatory behavior


Title 2:
Treatment of obese children with and without their mothers: changes in weight and blood pressure.
Abstract 2:
Weight and blood pressure changes were evaluated in a 16-month controlled trial comparing three methods of involving mothers in the treatment of their obese adolescents ( aged 12 to 16 years ) . The treatments were : ( 1 )  Mother-Child Separately -- children and mothers attended separate groups ; ( 2 ) Mother-Child Together -- the children and mothers met together in the same group ; and ( 3 ) Child Alone -- the children met in groups and mothers were not involved . The program consisted of behavior modification , social support , nutrition , and exercise . The Mother-Child Separately group lost more weight ( 8.4 kg ) during treatment than did the other two groups ( 5.3 and 3.3 kg ) . Differences between the groups increased at the 1-year follow-up : compared to pretreatment weight , the Mother-Child Separately group lost 7.7 kg compared with gains of approximately 3 kg in the other two groups . Blood pressures of children with the highest initial pressures decreased by 16/9 mm Hg at the end of treatment and by 16/5 mm Hg at the 1-year follow-up . These results suggest that a program of behavior modification and parent involvement can lead to significant weight losses in obese children , and that the nature of parent involvement may be important


Title 3:
Goal-setting and spouse involvement in the treatment of obesity.
Abstract 3:
Two types of goal - setting ( daily vs weekly ) and two levels of spouse involvement ( couples vs individual treatment ) were evaluated in a 19-week behavioral weight-control program .  Forty-seven married Ss with spouses willing to participate were r and omly assigned to one of four treatments : Couples/Weekly Goals , Couples/Daily Goals , Individual/Weekly Goals , Individual/Daily Goals . At posttreatment , Ss had lost an average of 171b and reduced their percent over ideal weight from 49 to 36 % . Losses were maintained at the 6-month clinic follow-up . Weight losses for the two goal - setting conditions and the two spouse treatments did not differ . Improvements were observed in resting pulse , blood pressure and step-test time , and these were maintained at the 6-month follow-up . Adherence to caloric self-monitoring , self-reported exercise adherence and marital satisfaction were significantly correlated with weight loss . Decreases in depression and improvements in body-image satisfaction were also observed . Mail and telephone follow-up at 12 and 30 months posttreatment indicated satisfactory maintenance for the majority of Ss . Factors associated with maintenance and relapse during long-term follow up are discussed


Title 4:
Prevention of progression to severe obesity in a group of obese schoolchildren treated with family therapy.
Abstract 4:
STUDY OBJECTIVE To evaluate the effect of family therapy on  childhood obesity .  DESIGN Clinical trial . One year follow-up . SETTING Referral from school after screening . PARTICIPANTS Of 1774 children ( aged 10 to 11 ) , screened for obesity , 44 obese children were divided into two treatment groups . In an untreated control group of 50 obese children , screened in the same manner , body mass index ( BMI ) values were recorded twice , at 10 to 11 and at 14 years of age . INTERVENTION Both treatment groups received comparable dietary counseling and medical checkups for a period of 14 to 18 months , while one of the groups also received family therapy . RESULTS At the 1-year follow-up , when the children were 14 years of age , intention-to-treat analyses were made of the weight and height data for 39 of 44 children in the two treatment groups and for 48 of the 50 control children . The increase of BMI in the family therapy group was less than in the conventional treatment group at the end of treatment , and less than in the control group ( P = .04 and P = .02 , respectively ) . Moreover , mean BMI was significantly lower in the family therapy group than in the control group ( P < .05 ) , and the family therapy group also had fewer children with BMI > 30 than the control group ( P = .02 ) . The reduction of triceps , subscapular , and suprailiac skinfold thicknesses , expressed as percentages of the initial values , was significantly greater in the family therapy group than in the conventional treatment group ( P = .03 , P = .005 and P = .002 , respectively ) , and their physical fitness was significantly better ( P < .05 ) . CONCLUSIONS Family therapy seems to be effective in preventing progression to severe obesity during adolescence if the treatment starts at 10 to 11 years of age


Title 5:
Spouse involvement and a possible long-term follow-up trap in weight loss.
Abstract 5:
Abstract The present study was conducted to determine if husb and attendance at treatment sessions and participation in behavioral contracting would produce greater weight losses than two other levels of spouse involvement . The three treatment groups investigated did not significantly differ at post-treatment but by 1-yr follow-up female S s who attended  treatment sessions alone and contracted with the counselor ( HA )  lost significantly more weight than women who attended sessions with their husb and s and also contracted with the counselor ( HNC ) . The S s who attended sessions with their husb and s and contracted with them ( HC ) did not significantly differ from S s in the other two conditions . The total amount lost by S s in the HA , HNC and HC conditions by 1-yr follow-up was 16.4 , 4.4 and 15.5 lb , respectively . The study was also conducted to collect preliminary data about procedures S s used during long-term follow-up to ascertain if weight losses during follow-up could be attributed to the behavioral weight-loss techniques learned during the treatment program . At all follow-up periods , many S s reported using behavioral weight-loss techniques but 4 of the 36 S s ( 11.1 % ) at 1-yr follow-up , 15 of the 23 ( 65.2 % ) and 24 of the 25 ( 96.0 % ) who responded , respectively , at 3- and 4-yr follow-up had used other weight-loss programs or methods . A possible confound for follow-up data was identified and suggestions for future research were presented


Title 6:
A controlled comparison of family versus individual therapy for adolescents with anorexia nervosa.
Abstract 6:
OBJECTIVE To compare the effectiveness of behavioral family systems therapy ( BFST ) with that of ego-oriented individual therapy ( EOIT ) as treatments for adolescents with anorexia nervosa . METHOD Thirty-seven adolescents meeting DSM-III-R criteria for anorexia nervosa were r and omly assigned to receive BFST or EOIT , in addition to a common medical and dietary regimen . In BFST , the family was seen conjointly , the parents were placed in control of the adolescent 's eating , distorted beliefs were targeted through cognitive restructuring , and strategic/behavioral interventions were used to change family interactions . In EOIT , the adolescent was seen individually , with an emphasis on building ego strength and uncovering the dynamics blocking eating ; parents were seen collaterally . Measures administered before , after , and at 1-year follow-up tapped body mass index , menstruation , eating attitudes , ego functioning , depression , and family interactions . RESULTS BFST produced greater weight gain and higher rates of resumption of menstruation than EOIT . Both treatments produced comparably large improvements in eating attitudes , depression , and eating-related family conflict , but very few changes occurred on ego functioning . CONCLUSIONS BFST and EOIT proved to be effective treatments for adolescents with anorexia nervosa , but BFST produced a faster return to health


Title 7:
Ten-year follow-up of behavioral, family-based treatment for obese children.
Abstract 7:
Using a prospect i ve , r and omized , controlled design , we examined the effects of behavioral family-based treatment on percent overweight and growth over 10 years in obese 6- to 12-year-old children . Obese children and their parents were r and omized to three groups that were provided similar diet , exercise , and behavior management training but differed in the reinforcement for weight loss and behavior change . The child and parent group reinforced parent and child behavior change and weight loss , the child group reinforced child behavior change and weight loss  , and the nonspecific control group reinforced families for attendance .  Children in the child and parent group showed significantly greater decreases in percent overweight after 5 and 10 years ( -11.2 % and -7.5 % , respectively ) than children in the nonspecific control group ( + 7.9 % and + 14.3 % , respectively ) . Children in the child group showed increases in percent overweight after 5 and 10 years ( + 2.7 % and + 4.5 % , respectively ) that were midway between those for the child and parent and nonspecific groups and not significantly different from either . At 10 years , child height was related strongly to the height of the parent of the same sex ( r = .78 children were 1.8 cm taller than their parents , with no differences in height between groups


Title 8:
Effects of mastery criteria and contingent reinforcement for family-based child weight control.
Abstract 8:
This study tested the effects of mastery criteria and contingent reinforcement in a family-based behavioral weight control program for obese children and their parents over two years . Families with obese children were r and omized to one of two groups . The experimental group was targeted and reinforced for mastery of diet , exercise , weight loss , and parenting skills . The control group was taught behavior-change strategies and provided noncontingent reinforcement at a pace yoked to the experimental group . Both groups received the same behavioral family-based educational components over 6 months of weekly meetings and six monthly follow-up meetings . Results showed significantly better relative weight change at 6 months and 1 year for children in the experimental compared to the control group , but these effects were not maintained at 2 years . These results suggest the introduction of  mastery criteria  and contingent reinforcement for mastery can improve outcome during treatment in behavioral treatments for childhood obesity


Title 9:
A "family-based" approach to the treatment of obese type II diabetic patients.
Abstract 9:
Forty-nine obese diabetic patients with obese spouses ( diabetic or nondiabetic ) were r and omly assigned to an alone or together condition . Patients in the alone group participated by themselves in a 20-week behavioral weight control program ; their spouses attended assessment sessions only . Patients in the together group attended the program with their spouses ; both were targeted for weight loss and taught social support strategies .  Weight losses of patients treated alone and together did not differ significantly at posttreatment ( 19.9 vs. 19.1 lb ) or 1-year follow-up ( 11.6 vs. 7.0 lb ) . However , there was a significant interaction of treatment and gender ; women did better when treated with their spouses , whereas men did better when treated alone . A " family-based " approach was not effective for these obese Type II diabetic patients as a whole but may be helpful for women


Title 10:
Husband involvement in the behavioral treatment of overweight women: initial effects and long-term follow-up.
Abstract 10:
This study investigated whether husb and participation would augment the effectieness of the Sturart & Davis ( 1972 ) weight-reduction program for 37 obese women . Following a five-week baseline period , participants were taught behavioral weight-control techniques in eight 90-minute sessions over a 16-week period . R and om assignment was made to conditions that required husb and s to participate in all treatment sessions , the first four sessions , or not at all . Results indicated that although women in all three conditions lost significant amounts of weight and developed more adaptive eating habits , husb and involvement fostered reliably greater weight loss , which was maintained through a six-week post-treatment assessment . Participant husb and s became more accurate observers of changes in their wives ' eating habits and were viewed as being more helpful than were noninvolved husb and s. A three-year follow-up indicated that the wives had maintained their initial weight losses and reported changes in eating habits , while the effects engendered by husb and involvement had dissipated


Title 11:
Behavioral weight-loss for multiply-handicapped adults: assessing caretaker involvement and measures of behavior change.
Abstract 11:
Two groups of cerebral palsied , mentally retarded , overweight adults received training in seven behavioral self-control techniques for reducing caloric intake and increasing activity levels over the course of 19 weeks . One group 's parents/caretakers had frequent contacts from the diet leader , ( Home-Help Group ) ; the other group , balanced with the first for degree of h and icap , had no caretaker-directed communications other than initial notification ( No Help Group ) . Measures of adherence were included to assess the process of behavioral change during the diet program . A significant treatment effect accrued for all participants in the diet program , with the Home-Help Group of dieters showing clinical ly , though not statistically superior weight loss at treatment end and at follow-ups through one year . Specific behaviors taught , such as replacing utensils after each bite and eating slowly , showed significant changes in the expected directions with weight change . Implication s of the data for future treatment programs are discussed
There was a suggestion that spouse involvement increased effectiveness but that adolescents achieved greater weight loss when treated alone .
In studies including children , beneficial effects were seen when greater numbers of behaviour change techniques were taught to both parents and children .
: Relatively few intervention studies exist in this important area , particularly studies targeting adolescents , and they highlight continued uncertainty about how best to involve family members .
The studies provide limited support for the involvement of spouses .
They suggest that parental involvement is associated with weight loss in children , and that use of a greater range of behaviour change techniques improves weight outcomes for both parents and children .