title: Conditions of long-term success in a lifestyle intervention for overweight and obese youths.
abstract: OBJECTIVE
  Childhood lifestyle interventions usually involve the families. However, knowledge of family characteristics that promote or constrain a child's weight-reduction outcome is limited. Candidates for such factors might be family characteristics that have proven to be associated with social adjustment (development) in childhood. Thus, we analyzed whether family adversity, maternal depression, and attachment insecurity predict long-term success in children's weight reduction.
  
  
  METHODS
  Participants in the study were 111 parent-child dyads with overweight and obese children/adolescents (BMI mean: 29.07 [SD: 4.7] [range: 21.4-44.9]; BMI SD score mean: 2.43 [SD: 0.44] [range: 1.31-3.54]) aged between 7 and 15 years. The families took part in a best-practice lifestyle intervention of 1 year's duration. A longitudinal analysis with 3 assessment waves (baseline, conclusion, 1-year follow-up) was conducted.
  
  
  RESULTS
  Hierarchical regression analyses revealed that long-term success (at least 5% weight reduction by the 1-year follow-up) versus failure (dropping out or less weight reduction) was significantly predicted by the set of psychosocial variables (family adversity, maternal depression, and attachment insecurity) when we controlled for familial obesity, preintervention overweight, age, and gender of the index child and parental educational level. Maternal depression proved to be the best predictor. Maintenance of weight reduction between the conclusion of the program and the 1-year-follow-up was also predicted by the set of psychosocial variables. Maternal insecure-anxious attachment attitudes best predicted this criterion.
  
  
  CONCLUSIONS
  Although cross-validation is required, our results are the first evidence for proximal and distal family characteristics linked to long-term weight-reduction outcomes. The results suggest a need to create tailored intervention modules that address the difficulties of these families.
authors.affiliation: Institute of Medical Psychology, University of Giessen, Friedrichstrasse 36, D-35392 Giessen, Germany.
authors.forename: Georg
authors.initials: G
authors.lastname: Fröhlich
authors.forename: Wilfried
authors.initials: W
authors.lastname: Pott
authors.forename: Özgür
authors.initials: Ö
authors.lastname: Albayrak
authors.forename: Johannes
authors.initials: J
authors.lastname: Hebebrand
authors.forename: Ursula
authors.initials: U
authors.lastname: Pauli-Pott
mesh_terms: D000293:Adolescent; D015992:Body Mass Index; D002648:Child; D003863:Depression; D005195:Family Relations; D005260:Female; D006801:Humans; D008019:Life Style; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D009034:Mother-Child Relations; D009035:Mothers / Q000523:psychology; D009765:Obesity / Q000523:psychology / Q000628:therapy; D009769:Object Attachment; D050177:Overweight / Q000523:psychology* / Q000628:therapy*; D013997:Time Factors; D017211:Treatment Failure; D016896:Treatment Outcome; D015431:Weight Loss