TEENFIT: A Self-Management Health Program for Adolescents with Obesity – Study Protocol and Pilot Study Findings

TEENFIT: A Self-Management Health Program for Adolescents with Obesity – Study Protocol and Pilot Study Findings | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article TEENFIT: A Self-Management Health Program for Adolescents with Obesity – Study Protocol and Pilot Study Findings Miriam G. Leão, Afonso M. Jerónimo, Rita Calado, Elisa Galo, Júlia Galhardo, and 8 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6991234/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Introduction: Childhood obesity represents a significant global public health challenge, associated with a multitude of severe comorbidities that impact various physiological and mental systems. This study describes the TeenFit program, an interdisciplinary intervention focused on health self-management for adolescents with obesity and presents the findings of its pilot study. Methods: The TeenFit program was developed using self-determination theory, self-regulation, and the COM-B model. The study sample comprised seven adolescents aged 12 to 14, representing the upper 95th percentile of BMI for age and sex. This intervention was delivered by an interdisciplinary team of medical doctors, nutritionists, psychologists, and exercise physiologists. The program's duration was established at six months, incorporating two theoretical and practical exercise sessions each week and monthly workshops designed for the participant's parents. Data collection occurred at the three-month mark of the intervention. Results: The satisfaction levels reported by participants and their guardians were markedly high, underscoring the critical importance of multidisciplinary approaches and the consistent frequency of the sessions. Identified facilitators, the adaptability of the session structures, the positive dynamics within the group, and the supportive involvement of parents. Conversely, the primary barriers encountered pertained to logistical challenges and communication issues. Conclusions: The findings suggest that implementing interventions aimed at health self-management is feasible and well-accepted among adolescents with obesity, demonstrating the potential to facilitate substantial and enduring behavioral changes. The effectiveness of this intervention warrants evaluation through a randomized controlled trial. Childhood obesity Interdisciplinary intervention Health self-management Adolescent health Pilot study Figures Figure 1 Figure 2 Introduction Childhood obesity poses a global public health crisis (Ogden et al., 2014 ), with rising rates linked to serious comorbidities affecting the endocrine, gastrointestinal, pulmonary, cardiovascular, and musculoskeletal systems (Dietz & Robinson, 2005 ; Skinner et al., 2015 ). Additionally, emerging evidence reveals a correlation between reduced sleep duration/quality and obesity (Jiang et al., 2015). Psychosocial and emotional distress contribute to childhood weight gain through maladaptive strategies, such as emotional eating and appetite dysregulation (Hemmingsson, 2014 ). Parental eating styles and parental stress further affect children's eating habits, increasing obesity risk (El-Behadli et al., 2015 ). These interconnected factors lead to outcomes like low self-esteem, anxiety, depression, and reduced health-related quality of life (Sawyer et al., 2011 ). Additionally, children with obesity are at an increased risk of bullying and discrimination (Griffiths, L. J., 2005). International guidelines (Chaput et al., 2020 ) recommend that children and adolescents engage in at least 60 minutes of moderate to vigorous physical activity daily, with vigorous aerobic and muscle-strengthening exercises included at least three times a week. Combined diet and physical activity interventions yield significant weight loss (White et al.). Sustained behavior change is crucial, as highlighted by various theoretical frameworks. Self-Determination Theory identifies three key psychological needs—autonomy, competence, and positive relationships—that, when met, enhance autonomous motivation and behavior sustainability (Deci & Ryan, 2004 ). Self-Regulation Theory involves planning, monitoring, evaluating, and adjusting actions to achieve goals (Ryan et al., 2021 ). The COM-B Model focuses on three components—capability, opportunity, and motivation—proposing that behavior stems from their interaction (Michie et al., 2011 ). Implementing health self-management programs with patient participation and healthcare team collaboration can successfully drive behavioral change and enhance health outcomes (Balduino et al., 2021). This research describes the TeenFit program, an interdisciplinary intervention focusing on diet quality, physical activity, and self-concept in adolescents aged 12 to 14 with obesity, and presents findings from a pilot test evaluating the intervention's feasibility and acceptability. Methods The TeenFit intervention was developed based on a logical model (Fig. 1 ) that integrates the theories of self-determination (Ryan, 2023 ), self-regulation (Ryan et al., 2021 ) and the COM-B model (Michie et al., 2011 ). Participants Eligible participants for the study are aged 12 to 14 and have a body mass index (BMI) over the 95th percentile for their age and gender (de Onis et al., 2009). They must provide written informed consent, have no severe orthopedic limitations affecting moderate to vigorous physical activity (MVPA), and be free from medical conditions detrimental to MVPA as well as severe untreated psychological disorders such as psychosis or clinical depression. Participants and their guardians must agree to make necessary lifestyle changes and maintain at least 80% attendance over a six-month TeenFit program. Exclusion criteria consist of: failure to attend the initial assessment; inability to comprehend written or spoken Portuguese; plans to travel for over two weeks within six months of program initiation; or intentions to emigrate. Additionally, those using obesity-related medication, experiencing significant injuries during the study, having a documented history of cardiac issues, or a family history of obstructive cardiomyopathy or chronic illnesses—such as renal disease, respiratory disorders, and orthopedic or neurological conditions affecting physical activity—are excluded. Project Teen Fit aimed at helping adolescents with obesity adopt healthier lifestyle habits. It emphasized motivation, knowledge acquisition, habit formation, self-monitoring, parental involvement, and support. Conducted at a private hospital in xxx from January to July 2024, this 24-week program was led by a team of nutritionists, exercise physiologists, psychologists, and clinicians. Sessions included group interventions in classrooms and gyms, plus outdoor exercises tailored to participants' capabilities. Healthy snacks were provided before sessions, and monthly workshops for parents addressed youth obesity, covering health impacts, diet, physical activity, and psychological support, with some workshops encouraging joint participation to foster consistency in behaviors between parents and teens. From July 2023, participants were recruited from adolescent obesity clinics and standard clinical settings, undergoing evaluations at baseline, three months, six months, and follow-ups at twelve and eighteen months. The six-month intervention ran from January to July 2024, totaling 24 weeks. The program featured a comprehensive medical and nutritional assessment performed before and during individual sessions, which informed a tailored action plan. Participants underwent holistic evaluations that included measurements of weight, height, body composition (InBody570), and waist circumference. Blood pressure was tracked using the OMRON device, alongside laboratory tests for glucose, insulin, and HbA1c levels. Demographic data were obtained from hospital records. Secondary outcomes included psychological needs satisfaction via the Psychological Needs Satisfaction in Exercise Scale (Wilson et al., 2006) and behavioral regulation assessed by the Behavioral Regulation in Exercise Questionnaire − 4 (Teixeira et al., 2022). Self-regulation was measured through action planning, coping planning, and action control scales (Sniehotta et al., 2005). Quality of life was evaluated using the Kidscreen-52 (Gaspar, 2010; Ravens-Sieberer et al., 2005), and body figure perception was assessed with Collins' pictorial instrument (1991). Physical activity was monitored using mobile phones and wearables, aggregated via the google platform. Eating behaviors were evaluated with the Kidmed Index (Rei et al., 2021). The intervention's quality, appropriateness, acceptability, adherence, barriers, and facilitators were assessed through interviews with staff and focus groups with participants, parents, and health professionals. Focus group discussions with health professionals, participants, and parents addressed four research objectives: 1) assessing program satisfaction and identifying strengths and weaknesses; 2) identifying barriers and facilitators to program implementation; 3) examining obstacles and enablers to behavioral modification; and 4) evaluating necessary changes. Conducted three months into the study in a controlled environment, discussions were guided by moderators who introduced themselves, outlined the study's aims, set participation rules, and informed participants about audio recording. They ensured focused dialogue and equal opportunities for contributions. Transcripts underwent thematic analysis using a codebook developed by the research team, and NVIVO v1.7.1 software (Lumivero, USA) facilitated efficient data analysis. The study follows the Helsinki Declaration for Human Studies (World Medical Association, 2013 ) and was approved by the Ethics Committee of Faculdade de Educação Física e Desporto, Universidade Lusófona, Lisboa (D0924). Results Satisfaction with the program Information Parents noted areas for improvement in the organization of information related to the TeenFit program, leading to confusion over schedules, workshops, breaks, and program availability. Effective communication with parents is crucial in adolescent weight management programs. Research shows that active parental involvement correlates with better health outcomes for youth (Smith et al., 2015 ). Clear, consistent communication can enhance adolescents' adherence to programs and support lasting lifestyle changes (Resnicow et al., 2015 ). Communication strategies must ensure parents understand program goals and requirements (Davison et al., 2013 ). Employing diverse channels such as in-person meetings, emails, and digital platforms can enhance information accessibility (Borrelli et al., 2007 ). Parents play a key role in promoting healthy behaviors in their children (Kitzman-Ulrich et al., 2013). Group dynamics Concerns have been raised about the behavior of a specific group member and its impact on the session objectives. Participants expressed that such behavior caused discomfort and disruption, undermining the learning environment. However, this behavior has improved as the program progressed. Disruptive actions, such as disrespect and negative attitudes, negatively affect individual and collective learning, ultimately diminishing motivation and commitment (Whatnall et al., 2021 ). These behaviors create tension, hindering positive interactions essential for successful weight management programs (Davison et al., 2013 ). In contrast, similarities among parents, children, and researchers indicate that a homogenous group increases comfort. Evidence from parents' workshops shows high interest and engagement, reflecting positive relationships with educators. Literature indicates that a supportive group dynamic enhances program outcomes, fostering an inspiring environment (Pbert et al., 2016 ). Positive interactions correlate with improved program adherence, reduced disordered eating, and increased physical activity. As adolescents are heavily influenced by peers, a positive group environment significantly boosts the adoption and maintenance of healthy habits (Ufholz, 2020 ). Moreover, group dynamics provide essential emotional support for adolescents experiencing stigma and isolation due to obesity, which can enhance self-esteem and psychological well-being (Warnick et al.). Academic performance Both parents and children noted the positive effects of the health management and exercise program on academic performance and behavior. This concurs with existing research that shows regular physical activity boosts cognitive functions, attention, and academic success, while also alleviating depression in adolescents (Zhong et al., 2024 ). Moreover, daily moderate to vigorous physical activity within classes enhances performance in reading, spelling, and math (Singh et al., 2019 ). Additionally, adherence to physical activity guidelines is linked to better classroom behavior and especially improved mathematics performance (Yang et al.). Multidisciplinary Parents and participants see the multidisciplinary approach as valuable, enhancing skill acquisition and understanding of healthier lifestyle choices related to nutrition, sleep, and physical activity. Effective adolescent weight management goes beyond calorie tracking and exercise; it requires a comprehensive strategy involving multiple fields (Story et al., 2006 ). Literature indicates that successful programs employ a multidisciplinary framework, engaging professionals from nutrition, psychology, medicine, physical education, and social care (Hoelscher et al., 2013 ). This collaboration promotes knowledge sharing and co-development of intervention strategies (Fan Qi et al., 2023 ). Research confirms that integrated methodologies lead to better long-term outcomes in weight maintenance and active lifestyles (Kumar & Kelly, 2017 ). Therefore, these holistic approaches are essential for designing future interventions to address adolescent overweight challenges (Lloyd-Richardson et al.). Regularity Parents generally support regular weight management sessions, but some question their effectiveness. Consistency is vital for success, promoting healthy habits and sustaining motivation (Buru et al., 2020 ). Research shows that regular sessions improve adolescents' adherence and result in better long-term weight reduction and health outcomes (Ho et al., 2012 ). Additionally, regular follow-ups allow for timely adjustments to interventions, addressing individual challenges like psychosocial barriers to weight loss (Amianto, 2018 ). Adolescents involved in these consistent programs report significant weight loss improvements, enhanced self-efficacy, body image, and quality of life (Davis et al., 2012 ). Literature suggests that weekly or bi-weekly sessions are linked to higher success rates than less frequent meetings (Homs et al., 2012). Satisfaction Evaluations from parents, participants, and health professionals were analyzed, yielding two primary domains: General Manifestations of Satisfaction and Physical and Psychological Outcomes. Respondents expressed satisfaction with both the program and the professionals' expertise, favoring theoretical sessions, physical training, and parental workshops. Despite no measurable physiological changes, participants reported improved body image, weight loss, enhanced physical fitness, and the acquisition of new health habits, as well as increased psychological and academic knowledge. Developing new friendships was also a significant source of satisfaction. Research indicates that participant satisfaction correlates with greater adherence to programs and improved long-term outcomes (Braet & Beyers, 2009 ). Effective programs foster positive adolescent experiences, thus facilitating sustainable behavioral changes (De Miguel-Etayo et al., 2013 ). Participation in structured weight management programs further yields significant health improvements, such as reduced body mass index (BMI), better glycemic control, and lower cardiovascular risks (Kelly et al., 2013 ). Psychological benefits include elevated self-esteem, enhanced body image, and overall quality of life, alongside reduced depression and anxiety symptoms, thereby supporting young people's emotional well-being (Gunawardana et al., 2021 ; Pont et al., 2017 ). Barriers and facilitators to implementing the program Mobile phone Health professionals frequently criticize participants, particularly during initial sessions, for their excessive use of mobile phones, even amidst physical exercise, contrary to trainers' guidance. This behavior, however, demonstrated notable improvement throughout the program. Literature identifies adolescents' overuse of cell phones as a barrier to behavioral modification interventions (Przybylski & Weinstein, 2013 ). This issue is particularly pertinent in the context of adolescent obesity, where mobile device distraction may undermine intervention effectiveness, as seen in programs like TeenFit. Persistent cell phone use can distract adolescents from program activities, ultimately diminishing their effectiveness (Wilmer et al., 2017 ). Furthermore, adolescent cell phone addiction is linked to sedentary behaviors that contribute to obesity. Research has shown a significant correlation between increased cell phone usage and decreased physical activity, suggesting that adolescents engaged with mobile devices are less likely to participate in physical activities (Lepp et al., 2013 ). Educating on responsible cell phone use and instituting “mobile-free” periods during sessions may enhance attention and participation (Liao et al., 2015 ). Logistics Healthcare professionals have reported challenges related to limited spatial availability during exercise sessions, particularly with multiple practitioners on-site. However, improved weather conditions have allowed for the use of outdoor spaces, somewhat alleviating this issue. Access to suitable locations for physical activity and the misalignment of session timings with school and family schedules continue to be significant barriers (Martins et al., 2021 ). Limited access to gyms and community centers, along with restricted operational hours, can hinder adolescents' participation in organized activities (Hu et al., 2021 ). Establishing partnerships with educational institutions and communities to ensure appropriate space access and adapting session times to better fit adolescents' schedules are essential strategies for addressing these challenges (Chriqui et al., 2012 ). Group dynamics Research indicates that a specific participant in the classroom environment negatively impacts the learning process, acting as an impediment to behavioral modification among peers. In weight management programs, group cohesion and support are essential for success. Conversely, adverse group dynamics may foster a hostile atmosphere that obstructs adolescents' active participation and commitment (Brown et al., 2013 ). Therefore, it is imperative for programs to implement strategies that enhance positive group cohesion and mutual support to alleviate these detrimental effects. Effective interventions may include social skills training, conflict mediation, and team-building activities (Kitzman-Ulrich et al., 2010 ). Establishing a supportive environment improves weight management outcomes while also fostering participants' emotional well-being, ultimately promoting sustainable behavioral change (Loth et al., 2013 ). Adaptability The adaptability of professionals regarding class dynamics, spatial arrangements, scheduling, and feedback mechanisms is essential for the program's success. Research shows that customizing programs to match the unique traits of the target demographic significantly improves intervention effectiveness. Teachers who modify their pedagogical strategies to suit class dynamics and utilize available spaces effectively foster better adolescent engagement (Durlak & DuPre, 2008 ). Furthermore, accommodating tight school and extracurricular schedules by adjusting program timelines enhances participation rates (Rhodes et al., 2020 ). Dynamic sessions Health professionals assert that the dynamic sessions within this program significantly enhance implementation and learning outcomes. The use of interactive and collaborative activities encourages adolescents' active engagement, thereby improving the effectiveness of weight management interventions (Kumar & Kelly, 2017 ). The success of these sessions is further attributed to their adaptability to individual needs. Recent research highlights that incorporating playful activities and digital technologies boosts engagement and motivation among young participants (M. Jones et al., 2008 ). Experiential learning, where knowledge and skills are developed through direct experience, proves particularly effective in health programs, facilitating the practical application of theoretical concepts for behavioral change (Inguva et al., 2021 ). Strategies to implement dynamic theoretical sessions include educational games that simulate health-related decisions, cooking workshops, and supervised physical activities, rendering learning more relevant and engaging (Hulya & Ay En, 2015). Students involved in experiential activities demonstrate higher intrinsic motivation and commitment to the program (Xiao et al., 2022 ). Implementation plan Strategic planning is regarded by health professionals as an essential tool for effectively implementing programs, facilitating a comprehensive assessment of progress and necessary adjustments over time. Comprehensive pre-implementation planning significantly enhances program execution, promoting adherence and favorable long-term outcomes (Damschroder et al., 2009 ). A structured plan allows for the identification and mitigation of potential implementation barriers, including participant resistance and resource constraints (Durlak & DuPre, 2008 ). Additionally, ongoing evaluation and feedback are critical components of the implementation plan, enabling continuous program adjustments and improvements. The inclusion of robust monitoring and evaluation tools from the outset ensures the plan's adaptability, maintaining its effectiveness and relevance (Houle et al., 2013 ). Social Support Health professionals observed considerable parental engagement, evident through diverse inquiries during workshops and email correspondences. They emphasized the critical role of parental motivation in optimizing children's weight management interventions. Research indicates that parental involvement in behavioral weight loss programs correlates with improved weight loss and maintenance outcomes, encompassing the establishment of an environment conducive to healthy eating and shared physical activities (Berge, 2009 ). Furthermore, parental emotional support enhances adolescents' self-esteem and motivation (Haines et al., 2016 ). Programs that integrate parental strategies are more effective than those targeting adolescents alone. Studies suggest that educating parents on nutrition, physical activity, and emotional support techniques is essential for success. Implementing educational sessions for parents alongside practical activities has demonstrated promising results in reducing adolescents' BMI (Faith et al., 2012 ). Group dynamics Research demonstrates that adherence to specific behavioral practices and lifestyle choices among adolescents is significantly enhanced when they cultivate positive relationships with influential figures, such as educators and peers. Engaging in groups with peers facing similar challenges can boost self-esteem and motivation while mitigating the stigma associated with obesity (Trigueros et al., 2019 ). Additionally, group dynamics contribute to improved program adherence; a sense of belonging fosters greater participation and commitment to activities, leading to superior weight loss results. Furthermore, studies identify peer support, self-efficacy, and self-regulation as mediating factors that facilitate engagement in exercise and weight loss programs among adolescents (Al-Daghri et al., 2023 ). Pressure for results Health professionals argue that participation in this course demands a higher level of rigor and discipline to achieve optimal outcomes, particularly in physical fitness. This enhanced adherence significantly boosts the effectiveness of program interventions. Participants who set realistic goals and received constructive feedback showed marked progress in weight loss and improved health behaviors, including personal accountability and increased physical activity (Behr et al., 2022 ). Additionally, a study examining the relationship between self-esteem, body image, and eating attitudes in adolescents revealed that higher self-esteem and a positive body image correlate with healthier eating behaviors and superior cardiorespiratory performance (Petrovics et al., 2021 ). Focus on behavior Experts highlight the significance of behavioral modification, especially when individuals may not completely change their physiological health indicators. Weight management programs emphasizing behavioral change aim to foster sustainable healthy habits to improve long-term health outcomes in adolescents (Goldschmidt et al., 2013 ). Recent research establishes that positive behavior change is vital for these programs' success; employing positive reinforcement and fostering a supportive environment correlate with improved weight loss and maintenance (Puhl et al., 2020 ). A key element of such interventions is nutrition education, which informs adolescents about healthy choices and incorporates practical activities—such as cooking and meal organization—leading to better adoption of healthy eating behaviors (Nguyen et al., 2011 ). Additionally, programs offering diverse physical activity options, from team sports to individual workouts, demonstrate greater effectiveness in maintaining adolescent engagement (Biddle & Asare, 2011 ). Barriers and facilitators to behavioral modification Physical condition Participants identified inadequate physical fitness as a significant barrier to increasing engagement in physical activity. The perception that such participation is daunting and unattainable exacerbates reluctance to adopt more active lifestyles. Adolescents with obesity often have lower fitness levels, hindering their ability to engage in strenuous or prolonged activities. Studies show that those with diminished physical fitness report higher exertion levels during exercise, reducing the likelihood of consistent participation (Okely et al., 2004 ). Additionally, insufficient muscular fitness limits physical capabilities and negatively impacts self-efficacy and motivation to engage in physical activity (Smith et al., 2014 ). Low physical fitness is a prevalent barrier for children and adolescents, as it can lead to discomfort and a lack of perceived competence, further entrenching inactivity and contributing to weight gain (Janssen & LeBlanc, 2010 ). Family logistics Concerns arise among parents regarding the coordination of schedules, management of snacks, and adherence to timely arrivals for various activities. Participants express a desire for increased physical activity; however, parents often lack sufficient time to meet these needs. Logistical barriers include insufficient time for parents to accompany children to appointments, transportation challenges, and the necessity to balance multiple family responsibilities. Such barriers frequently lead to decreased attendance at weight management programs, thereby undermining the effectiveness of interventions. Additionally, conflicts between parental and adolescent goals—such as weight loss versus self-confidence enhancement—can engender feelings of demotivation and frustration (Twiddy et al., 2012 ). Parental challenges, including resistance from adolescents and insufficient knowledge regarding nutrition and physical activity, further complicate the implementation of behavioral changes at home (Amiri et al., 2022 ). Conversely, a supportive family environment, characterized by emotional and practical support from parents, can enhance adolescents' engagement with weight management programs (Carbert et al., 2019 ). Contingency strategies Participants adapted their lifestyles to integrate increased physical activity into their daily routines, enhancing their behavioral modification capacity. Research indicates that factors such as educational obligations, family responsibilities, and social activities often hinder adolescents' ongoing involvement in physical activity programs (Brown et al., 2013 ). Commitments both academic and extracurricular are significant barriers to participation. Social support from family and peers is vital for promoting consistent engagement, highlighting the need to consider adolescents' social contexts and daily responsibilities in behavioral health interventions (Hills et al., 2015 ). Adolescents with well-structured and less burdensome schedules are more likely to regularly attend programs. Studies suggest that effective time management and prioritizing activities can improve adherence, underscoring the importance of strong social support and self-efficacy in fostering regular participation (Zou et al., 2023 ). Social influence Parental and participant feedback demonstrates a significant increase in interest in physical activity and nutrition among participants, leading to enhancements in their overall well-being and positively impacting their immediate family and social circles. Research indicates that behavioral modification interventions targeting adolescents can markedly influence their home environments. For example, adolescents participating in physical activity and nutrition programs may motivate their family members to adopt similar healthy behaviors, promoting a more active lifestyle within the household. This transition may result in a higher prevalence of physical activity and healthier eating practices among family members, fostering a more healthful lifestyle (Berge et al., 2010 ). Adolescents who improved their diets through behavioral interventions also positively impacted their peers, facilitating collective enhancements in eating habits. This social influence is vital for the sustainability of behavioral changes (Sawka et al., 2013 ). Additionally, positive social support from family and friends during behavioral modifications correlates with increased self-esteem and body satisfaction among adolescents. This emotional reinforcement is essential for maintaining behavioral changes, creating a supportive environment that minimizes the risk of reverting to detrimental habits (Donlan et al., 2015 ). Stimulus control Both participants and guardians reported significant improvements in understanding and regulating unhealthy behaviors, particularly regarding the frequency and intensity of eating and physical activities. A randomized controlled trial utilizing a broad range of visual and auditory cues, combined with reminders, showed a notable reduction in unhealthy snack consumption and screen time within the home, fostering conditions for healthier lifestyle choices (Medeiros et al., 2022 ). Additionally, research corroborated that environmental modifications, such as increased visibility of healthy foods, elevate consumption rates among adolescents (Van Lieshout et al., 2023 ). Moreover, the presence of cardiovascular and strength training equipment at home correlates with enhanced intentions, planning, and habits regarding physical activity. This study indicated that making such equipment visible promotes consistent engagement in physical activities (Kaushal et al., 2020 ). Group dynamics Parents noted that participants showed motivation and comfort in the intervention setting, attributed to similar group characteristics and the consistent presence of supportive professionals. Social support and group cohesion facilitated the intervention, leading to meaningful behavioral changes. Enhanced interactions among members improved adherence to the program and significantly benefited physical and mental health. A sense of belonging and mutual support were crucial for success (Staiano et al., 2016 ). Cohesive groups further encourage behavior change by providing a safe space for adolescents to share experiences (Smith et al., 2006 ). Social interactions increased motivation and self-efficacy in exercise, with peers modeling positive behaviors and reinforcing habit formation (Lubans et al., 2016). Future plans After the program, participants showed a strong commitment to maintaining engagement in physical activity and sports. The adolescents expressed interest in developing strategies for the future, reflecting necessary mindset and behavior shifts—key elements for effective interventions aimed at obese adolescents. A future-oriented mindset, recognizing the long-term benefits of healthy living, is crucial for behavioral change (Pearson et al., 2014 ). Research highlights that self-efficacy and perceived control are vital for sustaining healthy behaviors: adolescents confident in their ability to make healthy choices are more likely to implement lasting positive changes (Beauchamp et al., 2018 ). Interventions using Self-Determination Theory promote autonomy and intrinsic motivation, reducing dependence on external rewards. When adolescents feel they have agency over their choices and these resonate with their intrinsic values, they are more likely to adopt and sustain healthier lifestyle practices (Hagger & Hardcastle, 2014 ). What you would change about the program Food Parents have raised concerns about the availability of healthy snacks for participants prior to theoretical sessions, particularly regarding portion control and autonomy. This issue is crucial for participants who may have already eaten at school and are offered additional snacks during the program. Interventions that enhance dietary quality, including nutritious snacks, have effectively reduced weight gain and improved health in adolescents with obesity (Yu et al., 2020 ). Substituting caloric snacks with healthy options like fruits and vegetables has resulted in better program adherence and weight loss outcomes (Pearson et al., 2010 ). Research indicates that limited access to healthy foods, established preferences, and resistance to dietary changes are significant barriers (Subramaniam et al., 2022 ), but factors such as parental support, nutrition education, and school involvement can aid in dietary adherence (Donin et al., 2024 ). Programs combining nutrition education, family engagement, and improved access to healthy foods have proven more effective. For example, healthy food baskets and cooking workshops have successfully promoted sustainable dietary changes among adolescents with obesity (Liu et al., 2024). Exclusive space Health professionals have expressed concerns about limitations in the designated area for exercise sessions, which may hinder their effectiveness. Exclusive environments can mitigate these issues by providing a space where adolescents can build self-confidence and enhance social skills without fear of judgment (Chiumento et al., 2018 ). Moreover, these settings allow for more personalized support, enabling professionals to address individual barriers faced by adolescents, thereby improving program outcomes (Sahoo et al., 2015 ). Communication Parents emphasize the importance of enhanced communication for clearer information dissemination and reduced reliance on automated notifications. While increased communication can lead to scheduling ambiguities, structured messages significantly improve understanding of the program's objectives and activities. Research shows that frequent, well-constructed emails enhance perceptions of transparency and trust between parents and program administrators, resulting in greater support and participation (Thornberg et al., 2017 ). Mobile applications offer real-time notifications, access to activity calendars, progress tracking, and educational resources, which enhances participant engagement (Cafazzo et al., 2012 ). Text messaging effectively sends reminders, promotes healthy behaviors, and offers positive feedback, with regular and personalized messages boosting parental involvement (Fjeldsoe et al., 2009 ). Improved communication with parents benefits TeenFit implementation by raising awareness of the program's significance, promoting adherence, and strengthening relationships among parents, program organizers, and adolescents, thereby fostering a supportive environment for behavioral change (Lindsay et al., 2017). Duration Healthcare professionals suggest optimizing program duration by reducing both time and session frequency in response to the demand for weight loss services. Research indicates that programs lasting six to twelve months result in significant weight loss and improved metabolic health markers such as body mass index (BMI) and insulin sensitivity. This duration fosters sustainable dietary and exercise habits critical for long-term weight management (Reinehr, 2011 ). Qualitative analyses suggest that interventions shorter than six months may fail to achieve lasting behavioral changes, increasing the risk of weight regain. While short-term programs offer immediate benefits, they often lack effectiveness in promoting long-term weight maintenance, highlighting the necessity for longer interventions (Tay et al., 2023 ). Additionally, intervention durations should facilitate adolescents' complete cycles of learning and adaptation (Mazzeo et al., 2012 ) Exercise Parents argue that physical activity should extend beyond traditional settings like parks, promoting additional challenges at home for enjoyment and health benefits. This perspective, while seemingly contradictory, is supported by literature emphasizing exercise's role in weight loss and improving health metrics such as blood pressure and cholesterol (Ho et al., 2013). Moreover, physical activity offers psychological benefits, notably reducing depression and anxiety symptoms in obese adolescents (Lubans et al., 2012 ). Self-determination theory highlights autonomy as crucial for intrinsic motivation, essential for effective weight management (Ryan & Deci, 2000 ). Adolescents who choose their physical activities are more likely to develop sustainable exercise habits (Standage et al., 2012 ). Programs that foster autonomy through varied options and goal-setting involvement tend to be more effective (Ng et al., 2012 ). Nevertheless, barriers like limited access to safe environments, inadequate peer and family support, and low self-efficacy hinder participation (Ding et al., 2011 ). Furthermore, negative past experiences can impede ongoing engagement in physical activity (Pearson et al., 2014 ). Health professionals can improve this by creating supportive environments and implementing engaging programs, with trained educators playing a key role (Salmon et al., 2007 ). Group homogeneity Health professionals suggest that increased homogeneity within groups may improve outcomes, particularly in reducing psychological disorders and enhancing motivation. A key initiative is to create a supportive environment where participants share similar experiences, reinforcing belongingness and decreasing isolation (Foster et al., 2003 ). Research indicates that adolescents in homogeneous groups show greater commitment through peer identification (Stevens et al., 2007 ). Additionally, homogeneity facilitates tailored interventions for participants facing similar challenges (Gately et al., 2000 ). Although heterogeneous groups may struggle with cohesion, they offer diverse solutions that enrich learning experiences (Stice et al., 2006 ). However, a lack of diversity can perpetuate harmful behaviors due to shared contexts (Wadden et al., 2012 ). Thus, it's essential to balance the benefits of homogeneity with the inclusion of diverse perspectives to enhance behavioral change. A hybrid approach combining both elements may lead to more effective programs. MomsFit The authors argue that fathers' involvement in physical activities significantly influences behavioral changes in both participants and their families. Research shows that parental participation in childhood obesity interventions leads to improved weight loss and maintenance in children and adolescents. When parents engage in physical activities, they model healthy behaviors, contributing to a supportive family environment that encourages change (Golan et al., 1998 ). Programs that incorporate educational sessions and parent involvement enhance the effectiveness of child weight loss initiatives. Co-participation strengthens bonds and mutual support during the weight loss journey (Epstein et al., 2023 ). Programs including parents generally achieve higher adherence and long-term success (Berge et al., 2013 ), while also addressing psychosocial factors for a more comprehensive treatment approach (Golan & Crow). Transition to the real world Both parents and children often ask about post-program experiences and outcomes. While many individuals initially lose weight, a considerable number regain it within five years, particularly concerning for adolescents. This age group, marked by hormonal and behavioral shifts, may struggle to maintain new habits (Wing & Phelan, 2005 ). After intervention programs, adolescents often revert to unhealthy eating and reduced physical activity, contributing to weight regain. This cycle is linked to insufficient ongoing support and ineffective maintenance strategies (Epstein et al., 2023 ). Moreover, family involvement is essential for the long-term success of weight loss interventions in adolescents (Golan & Crow, 2023). Attendance The research objectives from the focus groups were supplemented by an analysis of the program's attendance rate, which was recorded at 82%. In health self-management programs, attendance refers to participants' adherence to scheduled sessions. An attendance rate exceeding 70% is deemed satisfactory, indicating a strong commitment and potential effectiveness of the program (Gauci et al., 2022 ). Conclusion The TeenFit intervention was developed and pilot-tested, demonstrating feasibility, acceptability, and positive attendance rates in a health self-management program for adolescents with obesity. Grounded in behavioral change theories, particularly self-determination theory, self-regulation, and the COM-B model, the intervention fosters adherence and satisfaction among participants, caregivers, and health professionals. Key success factors include session frequency, a multidisciplinary approach, and a strong supportive group dynamic. Nonetheless, logistical barriers and the need for improved communication have been identified as areas for enhancement. These findings suggest that interventions like TeenFit may effectively facilitate healthy lifestyle changes in adolescents with obesity, provided that adaptations address the identified challenges. Limitations The variability during the sessions, compounded by logistical and organizational challenges, adversely impacted the consistency of the meetings. Insufficient communication regarding schedules and venues significantly influenced outcomes and should be addressed in future program implementations. Additionally, technological barriers, notably the pervasive use of mobile phones among adolescents, were identified as impediments. It is advisable that future programs incorporate strategies to mitigate these distractions by utilizing technology in a constructive and regulated manner. These findings and recommendations create a foundational framework for enhancing health self-management programs for youth with obesity, thereby contributing to a more effective approach to combatting childhood obesity. Declarations Funding The authors formally declare that no financial support, grants, or any other form of assistance were received during the development and preparation of this manuscript. Author Contribution M.L. and H.V.P. wrote the main manuscript text, and R.C. prepared figures 1-2.All authors reviewed the manuscript References Al-Daghri NM, Amer OE, Khattak MNK, Hussain SD, Alkhaldi G, Alfawaz HA, Elsaid MA, Sabico S (2023) Attendance-Based Adherence and Outcomes of Obesity Management Program in Arab Adolescents. Children 10(9):1449. https://doi.org/10.3390/children10091449 Amianto F (2018) Non-surgical Weight Loss and Body Image Changes in Children, Adolescents, and Adults. Em M. Cuzzolaro & S. Fassino (Eds.), Body Image, Eating, and Weight (pp. 219–232). Springer International Publishing. https://doi.org/10.1007/978-3-319-90817-5_16 Amiri P, Mansouri-Tehrani MM, Khalili-Chelik A, Karimi M, Jalali-Farahani S, Amouzegar A, Kazemian E (2022) Does Motivational Interviewing Improve the Weight Management Process in Adolescents? A Systematic Review and Meta-analysis. Int J Behav Med 29(1):78–103. https://doi.org/10.1007/s12529-021-09994-w Balduino ADFA, Mantovani MDF, Lacerda MR, Meier MJ (2013) Conceptual analysis of self-management of hypertensive individuals. Revista Gaúcha de Enfermagem 34(4):37–44. https://doi.org/10.1590/S1983-14472013000400005 Beauchamp MR, Ruissen GR, Dunlop WL, Estabrooks PA, Harden SM, Wolf SA, Liu Y, Schmader T, Puterman E, Sheel AW, Rhodes RE (2018) Group-based physical activity for older adults (GOAL) randomized controlled trial: Exercise adherence outcomes. Health Psychol 37(5):451–461. https://doi.org/10.1037/hea0000615 Behr H, Earl S, Ho AS, Lee J, Mitchell ES, McCallum M, May CN, Michaelides A (2022) Changes in Health-Promoting Behaviors and Their Association with Weight Loss, Retention, and Engagement on a Digital Program: Prospective Study. Nutrients 14(22):4812. https://doi.org/10.3390/nu14224812 Berge JM, Wall M, Larson N, Loth KA, Neumark-Sztainer D (2013) Family Functioning: Associations With Weight Status, Eating Behaviors, and Physical Activity in Adolescents. J Adolesc Health 52(3):351–357. https://doi.org/10.1016/j.jadohealth.2012.07.006 Berge JM, Wall M, Neumark-Sztainer D, Larson N, Story M (2010) Parenting Style and Family Meals: Cross-Sectional and 5-Year Longitudinal Associations. J Am Diet Assoc 110(7):1036–1042. https://doi.org/10.1016/j.jada.2010.04.011 Berge JΜ (2009) A review of familial correlates of child and adolescent obesity: What has the 21st Century taught us so far? Int J Adolesc Med Health 21(4). https://doi.org/10.1515/IJAMH.2009.21.4.457 Biddle SJH, Asare M (2011) Physical activity and mental health in children and adolescents: A review of reviews. Br J Sports Med 45(11):886–895. https://doi.org/10.1136/bjsports-2011-090185 Biddle SJH, Braithwaite R, Pearson N (2014) The effectiveness of interventions to increase physical activity among young girls: A meta-analysis. Prev Med 62:119–131. https://doi.org/10.1016/j.ypmed.2014.02.009 Borrelli B, Riekert KA, Weinstein A, Rathier L (2007) Brief motivational interviewing as a clinical strategy to promote asthma medication adherence. J Allergy Clin Immunol 120(5):1023–1030. https://doi.org/10.1016/j.jaci.2007.08.017 Braet C, Beyers W (2009) Subtyping children and adolescents who are overweight: Different symptomatology and treatment outcomes. J Consult Clin Psychol 77(5):814–824. https://doi.org/10.1037/a0016304 Brown HE, Pearson N, Braithwaite RE, Brown WJ, Biddle SJH (2013) Physical Activity Interventions and Depression in Children and Adolescents: A Systematic Review and Meta-Analysis. Sports Med 43(3):195–206. https://doi.org/10.1007/s40279-012-0015-8 Buru K, Emeto TI, Malau-Aduli AEO, Malau-Aduli BS (2020) The Efficacy of School-Based Interventions in Preventing Adolescent Obesity in Australia. Healthcare 8(4):514. https://doi.org/10.3390/healthcare8040514 Cafazzo JA, Casselman M, Hamming N, Katzman DK, Palmert MR (2012) Design of an mHealth App for the Self-management of Adolescent Type 1 Diabetes: A Pilot Study. J Med Internet Res 14(3):e70. https://doi.org/10.2196/jmir.2058 Carbert NS, Brussoni M, Geller J, Mâsse LC (2019) Familial Environment and Overweight/Obese Adolescents’ Physical Activity. Int J Environ Res Public Health 16(14):2558. https://doi.org/10.3390/ijerph16142558 Chaput J-P, Willumsen J, Bull F, Chou R, Ekelund U, Firth J, Jago R, Ortega FB, Katzmarzyk PT (2020) 2020 WHO guidelines on physical activity and sedentary behaviour for children and adolescents aged 5–17 years: Summary of the evidence. Int J Behav Nutr Phys Activity 17(1):141. https://doi.org/10.1186/s12966-020-01037-z Chiumento A, Mukherjee I, Chandna J, Dutton C, Rahman A, Bristow K (2018) A haven of green space: Learning from a pilot pre-post evaluation of a school-based social and therapeutic horticulture intervention with children. BMC Public Health 18(1):836. https://doi.org/10.1186/s12889-018-5661-9 Chriqui JF, Taber DR, Slater SJ, Turner L, Lowrey KM, Chaloupka FJ (2012) The impact of state safe routes to school-related laws on active travel to school policies and practices in U.S. elementary schools. Health Place 18(1):8–15. https://doi.org/10.1016/j.healthplace.2011.08.006 Damschroder LJ, Aron DC, Keith RE, Kirsh SR, Alexander JA, Lowery JC (2009) Fostering implementation of health services research findings into practice: A consolidated framework for advancing implementation science. Implement Sci 4(1):50. https://doi.org/10.1186/1748-5908-4-50 Davis CL, Pollock NK, Waller JL, Allison JD, Dennis BA, Bassali R, Meléndez A, Boyle CA, Gower BA (2012) Exercise Dose and Diabetes Risk in Overweight and Obese Children: A Randomized Controlled Trial. JAMA 308(11):1103. https://doi.org/10.1001/2012.jama.10762 Davison KK, Jurkowski JM, Li K, Kranz S, Lawson HA (2013) A childhood obesity intervention developed by families for families: Results from a pilot study. Int J Behav Nutr Phys Activity 10(1):3. https://doi.org/10.1186/1479-5868-10-3 De Miguel-Etayo P, Bueno G, Garagorri JM, Moreno LA (2013) Interventions for Treating Obesity in Children. Em H. Szajewska & R. Shamir (Eds.), World Review of Nutrition and Dietetics (Vol. 108, pp. 98–106). S. Karger AG. https://doi.org/10.1159/000351493 Deci EL, Ryan RM (eds) (2004) Handbook of self-determination research. Softcover edition. University of Rochester Dietz WH, Robinson TN (2005) Overweight Children and Adolescents. N Engl J Med 352(20):2100–2109. https://doi.org/10.1056/NEJMcp043052 Ding D, Sallis JF, Kerr J, Lee S, Rosenberg DE (2011) Neighborhood Environment and Physical Activity Among Youth. Am J Prev Med 41(4):442–455. https://doi.org/10.1016/j.amepre.2011.06.036 Donin AS, Goldsmith LP, Sharp C, Wahlich C, Whincup PH, Ussher MH (2024) Identifying barriers and facilitators to increase fibre intakes in UK primary school children and exploring the acceptability of intervention components: A UK qualitative study. Public Health Nutr 27(1):e59. https://doi.org/10.1017/S1368980024000089 Donlan AE, Lynch AD, Lerner RM (2015) Peer Relationships and Positive Youth Development. Em E. P. Bowers, G. J. Geldhof, S. K. Johnson, L. J. Hilliard, R. M. Hershberg, J. V. Lerner, & R. M. Lerner (Eds.), Promoting Positive Youth Development (pp. 121–136). Springer International Publishing. https://doi.org/10.1007/978-3-319-17166-1_7 Durlak JA, DuPre EP (2008) Implementation Matters: A Review of Research on the Influence of Implementation on Program Outcomes and the Factors Affecting Implementation. Am J Community Psychol 41(3–4):327–350. https://doi.org/10.1007/s10464-008-9165-0 El-Behadli AF, Sharp C, Hughes SO, Obasi EM, Nicklas TA (2015) Maternal depression, stress and feeding styles: Towards a framework for theory and research in child obesity. Br J Nutr 113(S1):S55–S71. https://doi.org/10.1017/S000711451400333X Epstein LH, Wilfley DE, Kilanowski C, Quattrin T, Cook SR, Eneli IU, Geller N, Lew D, Wallendorf M, Dore P, Paluch RA, Schechtman KB (2023) Family-Based Behavioral Treatment for Childhood Obesity Implemented in Pediatric Primary Care: A Randomized Clinical Trial. JAMA , 329 (22), 1947. https://doi.org/10.1001/jama.2023.8061 Faith MS, Van Horn L, Appel LJ, Burke LE, Carson JAS, Franch HA, Jakicic JM, Kral TVE, Odoms-Young A, Wansink B, Wylie-Rosett J (2012) Evaluating Parents and Adult Caregivers as Agents of Change for Treating Obese Children: Evidence for Parent Behavior Change Strategies and Research Gaps: A Scientific Statement From the American Heart Association. Circulation 125(9):1186–1207. https://doi.org/10.1161/CIR.0b013e31824607ee Qi F, Zhou H, Sun B, Lin Zhang (2023) Ying Huang, &. How do boundary-crossing researchers contribute to the interdisciplinary knowledge flows? Evidence from physics . https://doi.org/10.5281/ZENODO.8305942 Fjeldsoe BS, Marshall AL, Miller YD (2009) Behavior Change Interventions Delivered by Mobile Telephone Short-Message Service. Am J Prev Med 36(2):165–173. https://doi.org/10.1016/j.amepre.2008.09.040 Foster GD, Wadden TA, Makris AP, Davidson D, Sanderson RS, Allison DB, Kessler A (2003) Primary Care Physicians’ Attitudes about Obesity and Its Treatment. Obes Res 11(10):1168–1177. https://doi.org/10.1038/oby.2003.161 Gately P, Cooke C, Butterly R, Mackreth P, Carroll S (2000) The effects of a children’s summer camp programme on weight loss, with a 10 month follow-up. Int J Obes 24(11):1445–1452. https://doi.org/10.1038/sj.ijo.0801405 Gauci J, Bloomfield J, Lawn S, Towns S, Hobbs A, Steinbeck K (2022) A randomized controlled trial evaluating the effectiveness of a self-management program for adolescents with a chronic condition: A study protocol. Trials 23(1):850. https://doi.org/10.1186/s13063-022-06740-9 Golan M, Crow S (2004) Targeting Parents Exclusively in the Treatment of Childhood Obesity: Long-Term Results. Obes Res 12(2):357–361. https://doi.org/10.1038/oby.2004.45 Golan M, Weizman A, Apter A, Fainaru M (1998) Parents as the exclusive agents of change in the treatment of childhood obesity. Am J Clin Nutr 67(6):1130–1135. https://doi.org/10.1093/ajcn/67.6.1130 Goldschmidt AB, Wilfley DE, Paluch RA, Roemmich JN, Epstein LH (2013) Indicated Prevention of Adult Obesity: How Much Weight Change Is Necessary for Normalization of Weight Status in Children? JAMA Pediatr 167(1):21. https://doi.org/10.1001/jamapediatrics.2013.416 Griffiths LJ (2005) Obesity and bullying: Different effects for boys and girls. Arch Dis Child 91(2):121–125. https://doi.org/10.1136/adc.2005.072314 Gunawardana S, Gunasinghe CB, Harshani MS, Seneviratne SN (2021) Physical and psychosocial quality of life in children with overweight and obesity from Sri Lanka. BMC Public Health 21(1):86. https://doi.org/10.1186/s12889-020-10104-w Hagger MS, Hardcastle SJ (2014) Interpersonal style should be included in taxonomies of behavior change techniques. Frontiers in Psychology , 5 . https://doi.org/10.3389/fpsyg.2014.00254 Haines J, Rifas-Shiman SL, Horton NJ, Kleinman K, Bauer KW, Davison KK, Walton K, Austin SB, Field AE, Gillman MW (2016) Family functioning and quality of parent-adolescent relationship: Cross-sectional associations with adolescent weight-related behaviors and weight status. Int J Behav Nutr Phys Activity 13(1):68. https://doi.org/10.1186/s12966-016-0393-7 Hemmingsson E (2014) A new model of the role of psychological and emotional distress in promoting obesity: Conceptual review with implications for treatment and prevention. Obes Rev 15(9):769–779. https://doi.org/10.1111/obr.12197 Hills AP, Dengel DR, Lubans DR (2015) Supporting Public Health Priorities: Recommendations for Physical Education and Physical Activity Promotion in Schools. Prog Cardiovasc Dis 57(4):368–374. https://doi.org/10.1016/j.pcad.2014.09.010 Ho M, Garnett SP, Baur L, Burrows T, Stewart L, Neve M, Collins C (2012) Effectiveness of Lifestyle Interventions in Child Obesity: Systematic Review With Meta-analysis. Pediatrics 130(6):e1647–e1671. https://doi.org/10.1542/peds.2012-1176 Hoelscher DM, Kirk S, Ritchie L, Cunningham-Sabo L (2013) Position of the Academy of Nutrition and Dietetics: Interventions for the Prevention and Treatment of Pediatric Overweight and Obesity. J Acad Nutr Dietetics 113(10):1375–1394. https://doi.org/10.1016/j.jand.2013.08.004 Homs C, Berruezo P, Según G, Estrada L, De Bont J, Riera-Romaní J, Carrillo-Álvarez E, Schröder H, Milà R, Gómez SF (2021) Family-based intervention to prevent childhood obesity among school-age children of low socioeconomic status: Study protocol of the FIVALIN project. BMC Pediatr 21(1):246. https://doi.org/10.1186/s12887-021-02697-x Houle J, Gascon-Depatie M, Bélanger-Dumontier G, Cardinal C (2013) Depression self-management support: A systematic review. Patient Educ Couns 91(3):271–279. https://doi.org/10.1016/j.pec.2013.01.012 Hu D, Zhou S, Crowley-McHattan ZJ, Liu Z (2021) Factors That Influence Participation in Physical Activity in School-Aged Children and Adolescents: A Systematic Review from the Social Ecological Model Perspective. Int J Environ Res Public Health 18(6):3147. https://doi.org/10.3390/ijerph18063147 Hulya G, En A, K (2015) A SHORT REVIEW of TPACK for TEACHER EDUCATION. Educational Res Reviews 10(7):777–789. https://doi.org/10.5897/ERR2014.1982 Inguva P, Shah P, Shah U, Brechtelsbauer C (2021) How to Design Experiential Learning Resources for Independent Learning. J Chem Educ 98(4):1182–1192. https://doi.org/10.1021/acs.jchemed.0c00990 Institute of Medicine (US) Committee on an Evidence Framework for Obesity Prevention Decision Making (2010) In: Kumanyika SK, Parker L, Sim LJ (eds) Bridging the Evidence Gap in Obesity Prevention: A Framework to Inform Decision Making. National Academies Press (US. http://www.ncbi.nlm.nih.gov/books/NBK220184/ Janssen I, LeBlanc AG (2010) Systematic review of the health benefits of physical activity and fitness in school-aged children and youth. Int J Behav Nutr Phys Activity 7(1):40. https://doi.org/10.1186/1479-5868-7-40 Jiang F, Zhu S, Yan C, Jin X, Bandla H, Shen X (2009) Sleep and Obesity in Preschool Children. J Pediatr 154(6):814–818. https://doi.org/10.1016/j.jpeds.2008.12.043 Jones M, Luce KH, Osborne MI, Taylor K, Cunning D, Doyle AC, Wilfley DE, Taylor CB (2008) Randomized, Controlled Trial of an Internet-Facilitated Intervention for Reducing Binge Eating and Overweight in Adolescents. Pediatrics 121(3):453–462. https://doi.org/10.1542/peds.2007-1173 Kaushal N, Keith N, Aguiñaga S, Hagger MS (2020) Social Cognition and Socioecological Predictors of Home-Based Physical Activity Intentions, Planning, and Habits during the COVID-19 Pandemic. Behav Sci 10(9):133. https://doi.org/10.3390/bs10090133 Kelly AS, Barlow SE, Rao G, Inge TH, Hayman LL, Steinberger J, Urbina EM, Ewing LJ, Daniels SR (2013) Severe Obesity in Children and Adolescents: Identification, Associated Health Risks, and Treatment Approaches: A Scientific Statement From the American Heart Association. Circulation 128(15):1689–1712. https://doi.org/10.1161/CIR.0b013e3182a5cfb3 Kitzman-Ulrich H, Wilson DK, St. George SM, Lawman H, Segal M, Fairchild A (2010) The Integration of a Family Systems Approach for Understanding Youth Obesity, Physical Activity, and Dietary Programs. Clin Child Fam Psychol Rev 13(3):231–253. https://doi.org/10.1007/s10567-010-0073-0 Kumar S, Kelly AS (2017) Review of Childhood Obesity. Mayo Clinic Proceedings , 92 (2), 251–265. https://doi.org/10.1016/j.mayocp.2016.09.017 Lepp A, Barkley JE, Sanders GJ, Rebold M, Gates P (2013) The relationship between cell phone use, physical and sedentary activity, and cardiorespiratory fitness in a sample of U.S. college students. Int J Behav Nutr Phys Activity 10(1):79. https://doi.org/10.1186/1479-5868-10-79 Liao Y, Shonkoff ET, Dunton GF (2015) The Acute Relationships Between Affect, Physical Feeling States, and Physical Activity in Daily Life: A Review of Current Evidence. Frontiers in Psychology , 6 . https://doi.org/10.3389/fpsyg.2015.01975 Lindsay AC, Sussner KM, Kim J, Gortmaker SL (2006) The Role of Parents in Preventing Childhood Obesity. Future Child 16(1):169–186. https://doi.org/10.1353/foc.2006.0006 Liu KSN, Chen JY, Ng MYC, Yeung MHY, Bedford LE, Lam CLK (2021) How Does the Family Influence Adolescent Eating Habits in Terms of Knowledge, Attitudes and Practices? A Global Systematic Review of Qualitative Studies. Nutrients 13(11):3717. https://doi.org/10.3390/nu13113717 Lloyd-Richardson EE, Jelalian E, Sato AF, Hart CN, Mehlenbeck R, Wing RR (2012) Two-Year Follow-up of an Adolescent Behavioral Weight Control Intervention. Pediatrics 130(2):e281–e288. https://doi.org/10.1542/peds.2011-3283 Loth KA, MacLehose RF, Fulkerson JA, Crow S, Neumark-Sztainer D (2013) Food-Related Parenting Practices and Adolescent Weight Status: A Population-Based Study. Pediatrics 131(5):e1443–e1450. https://doi.org/10.1542/peds.2012-3073 Lubans DR, Plotnikoff RC, Lubans NJ (2012) Review: A systematic review of the impact of physical activity programmes on social and emotional well-being in at‐risk youth. Child Adolesc Mental Health 17(1):2–13. https://doi.org/10.1111/j.1475-3588.2011.00623.x Martins J, Costa J, Sarmento H, Marques A, Farias C, Onofre M, Valeiro MG (2021) Adolescents’ Perspectives on the Barriers and Facilitators of Physical Activity: An Updated Systematic Review of Qualitative Studies. Int J Environ Res Public Health 18(9):4954. https://doi.org/10.3390/ijerph18094954 Mazzeo SE, Kelly NR, Stern M, Gow RW, Serdar K, Evans RK, Jones RM, Bulik CM (2012) Nourishing Our Understanding of Role Modeling to Improve Support and Health (NOURISH): Design and methods. Contemp Clin Trials 33(3):515–522. https://doi.org/10.1016/j.cct.2012.01.003 Medeiros GCBSD, Azevedo KPMD, Garcia D, Oliveira Segundo VH, Mata ÁNDS, Fernandes AKP, Santos RPD, Trindade DDBDB, Moreno IM, Guillén Martínez D, Piuvezam G (2022) Effect of School-Based Food and Nutrition Education Interventions on the Food Consumption of Adolescents: A Systematic Review and Meta-Analysis. Int J Environ Res Public Health 19(17):10522. https://doi.org/10.3390/ijerph191710522 Michie S, Van Stralen MM, West R (2011) The behaviour change wheel: A new method for characterising and designing behaviour change interventions. Implement Sci 6(1):42. https://doi.org/10.1186/1748-5908-6-42 Ng JYY, Ntoumanis N, Thøgersen-Ntoumani C, Deci EL, Ryan RM, Duda JL, Williams GC (2012) Self-Determination Theory Applied to Health Contexts: A Meta-Analysis. Perspect Psychol Sci 7(4):325–340. https://doi.org/10.1177/1745691612447309 Nguyen B, Kornman KP, Baur LA (2011) A review of electronic interventions for prevention and treatment of overweight and obesity in young people. Obes Rev 12(5). https://doi.org/10.1111/j.1467-789X.2010.00830.x Ogden CL, Carroll MD, Kit BK, Flegal KM (2014) Prevalence of Childhood and Adult Obesity in the United States, 2011–2012. JAMA 311(8):806. https://doi.org/10.1001/jama.2014.732 Okely AD, Booth ML, Chey T (2004) Relationships between Body Composition and Fundamental Movement Skills among Children and Adolescents. Res Q Exerc Sport 75(3):238–247. https://doi.org/10.1080/02701367.2004.10609157 Pbert L, Druker S, Barton B, Schneider KL, Olendzki B, Gapinski MA, Kurtz S, Osganian S (2016) A School-Based Program for Overweight and Obese Adolescents: A Randomized Controlled Trial. J Sch Health 86(10):699–708. https://doi.org/10.1111/josh.12428 Pearson N, Atkin AJ, Biddle SJ, Gorely T (2010) A family-based intervention to increase fruit and vegetable consumption in adolescents: A pilot study. Public Health Nutr 13(06):876–885. https://doi.org/10.1017/S1368980010000121 Pearson N, Braithwaite RE, Biddle SJH, Van Sluijs EMF, Atkin AJ (2014) Associations between sedentary behaviour and physical activity in children and adolescents: A meta-analysis. Obes Rev 15(8):666–675. https://doi.org/10.1111/obr.12188 Petrovics P, Nagy A, Sandor B, Palfi A, Szekeres Z, Toth K, Szabados E (2021) Examination of Self-Esteem, Body Image, Eating Attitudes and Cardiorespiratory Performance in Adolescents. Int J Environ Res Public Health 18(24):13172. https://doi.org/10.3390/ijerph182413172 Pont SJ, Puhl R, Cook SR, Slusser W, SECTION ON OBESITY, & THE OBESITY SOCIETY (2017) Stigma Experienced by Children and Adolescents With Obesity. Pediatrics 140(6):e20173034. https://doi.org/10.1542/peds.2017-3034 Przybylski AK, Weinstein N (2013) Can you connect with me now? How the presence of mobile communication technology influences face-to-face conversation quality. J Social Personal Relationships 30(3):237–246. https://doi.org/10.1177/0265407512453827 Puhl RM, Himmelstein MS, Pearl RL (2020) Weight stigma as a psychosocial contributor to obesity. Am Psychol 75(2):274–289. https://doi.org/10.1037/amp0000538 Reinehr T (2011) Effectiveness of lifestyle intervention in overweight children. Proceedings of the Nutrition Society , 70 (4), 494–505. https://doi.org/10.1017/S0029665111000577 Resnicow K, McMaster F, Bocian A, Harris D, Zhou Y, Snetselaar L, Schwartz R, Myers E, Gotlieb J, Foster J, Hollinger D, Smith K, Woolford S, Mueller D, Wasserman RC (2015) Motivational Interviewing and Dietary Counseling for Obesity in Primary Care: An RCT. Pediatrics 135(4):649–657. https://doi.org/10.1542/peds.2014-1880 Rhodes RE, Guerrero MD, Vanderloo LM, Barbeau K, Birken CS, Chaput J-P, Faulkner G, Janssen I, Madigan S, Mâsse LC, McHugh T-L, Perdew M, Stone K, Shelley J, Spinks N, Tamminen KA, Tomasone JR, Ward H, Welsh F, Tremblay MS (2020) Development of a consensus statement on the role of the family in the physical activity, sedentary, and sleep behaviours of children and youth. Int J Behav Nutr Phys Activity 17(1):74. https://doi.org/10.1186/s12966-020-00973-0 Ryan RM (ed) (2023) The Oxford handbook of self-determination theory. Oxford University Press Ryan RM, Deci EL (2000) Self-determination theory and the facilitation of intrinsic motivation, social development, and well-being. Am Psychol 55(1):68–78. https://doi.org/10.1037/0003-066X.55.1.68 Ryan RM, Deci EL, Vansteenkiste M, Soenens B (2021) Building a science of motivated persons: Self-determination theory’s empirical approach to human experience and the regulation of behavior. Motivation Sci 7(2):97–110. https://doi.org/10.1037/mot0000194 Sahoo K, Sahoo B, Choudhury A, Sofi N, Kumar R, Bhadoria A (2015) Childhood obesity: Causes and consequences. J Family Med Prim Care 4(2):187. https://doi.org/10.4103/2249-4863.154628 Salmon J, Booth ML, Phongsavan P, Murphy N, Timperio A (2007) Promoting Physical Activity Participation among Children and Adolescents. Epidemiol Rev 29(1):144–159. https://doi.org/10.1093/epirev/mxm010 Sawka KJ, McCormack GR, Nettel-Aguirre A, Hawe P, Doyle-Baker PK (2013) Friendship networks and physical activity and sedentary behavior among youth: A systematized review. Int J Behav Nutr Phys Activity 10(1):130. https://doi.org/10.1186/1479-5868-10-130 Sawyer MG, Harchak T, Wake M, Lynch J (2011) Four-Year Prospective Study of BMI and Mental Health Problems in Young Children. Pediatrics 128(4):677–684. https://doi.org/10.1542/peds.2010-3132 Singh AS, Saliasi E, Van Den Berg V, Uijtdewilligen L, De Groot RHM, Jolles J, Andersen LB, Bailey R, Chang Y-K, Diamond A, Ericsson I, Etnier JL, Fedewa AL, Hillman CH, McMorris T, Pesce C, Pühse U, Tomporowski PD, Chinapaw MJM (2019) Effects of physical activity interventions on cognitive and academic performance in children and adolescents: A novel combination of a systematic review and recommendations from an expert panel. Br J Sports Med 53(10):640–647. https://doi.org/10.1136/bjsports-2017-098136 Skinner AC, Perrin EM, Moss LA, Skelton JA (2015) Cardiometabolic Risks and Severity of Obesity in Children and Young Adults. N Engl J Med 373(14):1307–1317. https://doi.org/10.1056/NEJMoa1502821 Smith AL, Ullrich-French S, Walker E, Hurley KS (2006) Peer Relationship Profiles and Motivation in Youth Sport. J Sport Exerc Psychol 28(3):362–382. https://doi.org/10.1123/jsep.28.3.362 Smith JD, Montaño Z, Dishion TJ, Shaw DS, Wilson MN (2015) Preventing Weight Gain and Obesity: Indirect Effects of the Family Check-Up in Early Childhood. Prev Sci 16(3):408–419. https://doi.org/10.1007/s11121-014-0505-z Smith JJ, Eather N, Morgan PJ, Plotnikoff RC, Faigenbaum AD, Lubans DR (2014) The Health Benefits of Muscular Fitness for Children and Adolescents: A Systematic Review and Meta-Analysis. Sports Med 44(9):1209–1223. https://doi.org/10.1007/s40279-014-0196-4 Staiano AE, Marker AM, Martin CK, Katzmarzyk PT (2016) Physical activity, mental health, and weight gain in a longitudinal observational cohort of nonobese young adults. Obesity 24(9):1969–1975. https://doi.org/10.1002/oby.21567 Standage M, Gillison FB, Ntoumanis N, Treasure DC (2012) Predicting Students’ Physical Activity and Health-Related Well-Being: A Prospective Cross-Domain Investigation of Motivation Across School Physical Education and Exercise Settings. J Sport Exerc Psychol 34(1):37–60. https://doi.org/10.1123/jsep.34.1.37 Stevens J, Taber DR, Murray DM, Ward DS (2007) Advances and Controversies in the Design of Obesity Prevention Trials. Obesity 15(9):2163–2170. https://doi.org/10.1038/oby.2007.257 Stice E, Shaw H, Marti CN (2006) A meta-analytic review of obesity prevention programs for children and adolescents: The skinny on interventions that work. Psychol Bull 132(5):667–691. https://doi.org/10.1037/0033-2909.132.5.667 Story M, Kaphingst PD, K. M., French S (2006) The Role of Schools in Obesity Prevention. Future Child 16(1):109–142. https://doi.org/10.1353/foc.2006.0007 Subramaniam M, Devi F, AshaRani PV, Zhang Y, Wang P, Jeyagurunathan A, Roystonn K, Vaingankar JA, Chong SA (2022) Barriers and facilitators for adopting a healthy lifestyle in a multi-ethnic population: A qualitative study. PLoS ONE 17(11):e0277106. https://doi.org/10.1371/journal.pone.0277106 Tay A, Hoeksema H, Murphy R (2023) Uncovering Barriers and Facilitators of Weight Loss and Weight Loss Maintenance: Insights from Qualitative Research. Nutrients 15(5):1297. https://doi.org/10.3390/nu15051297 Thornberg R, Wänström L, Hong JS, Espelage DL (2017) Classroom relationship qualities and social-cognitive correlates of defending and passive bystanding in school bullying in Sweden: A multilevel analysis. J Sch Psychol 63:49–62. https://doi.org/10.1016/j.jsp.2017.03.002 Trigueros R, Aguilar-Parra JM, Cangas AJ, Bermejo R, Ferrandiz C, López-Liria R (2019) Influence of Emotional Intelligence, Motivation and Resilience on Academic Performance and the Adoption of Healthy Lifestyle Habits among Adolescents. Int J Environ Res Public Health 16(16):2810. https://doi.org/10.3390/ijerph16162810 Twiddy M, Wilson I, Bryant M, Rudolf M (2012) Lessons learned from a family-focused weight management intervention for obese and overweight children. Public Health Nutr 15(7):1310–1317. https://doi.org/10.1017/S1368980011003211 Ufholz K (2020) Peer Support Groups for Weight Loss. Curr Cardiovasc Risk Rep 14(10):19. https://doi.org/10.1007/s12170-020-00654-4 Van Lieshout M, Scholtes-Bos W, Van Der Horst-Graat JM, Van Holsteijn P, De Vries SI (2023) Development of the Food Boost Challenge: A Participatory Action Research Approach to Enhance Vegetable and Fruit Consumption among Adolescents. Nutrients 15(23):4921. https://doi.org/10.3390/nu15234921 Wadden TA, Webb VL, Moran CH, Bailer BA (2012) Lifestyle Modification for Obesity: New Developments in Diet, Physical Activity, and Behavior Therapy. Circulation 125(9):1157–1170. https://doi.org/10.1161/CIRCULATIONAHA.111.039453 Warnick JL, Darling KE, West CE, Jones L, Jelalian E (2022) Weight Stigma and Mental Health in Youth: A Systematic Review and Meta-Analysis. J Pediatr Psychol 47(3):237–255. https://doi.org/10.1093/jpepsy/jsab110 Whatnall MC, Hutchesson MJ, Sharkey T, Haslam RL, Bezzina A, Collins CE, Tzelepis F, Ashton LM (2021) Recruiting and retaining young adults: What can we learn from behavioural interventions targeting nutrition, physical activity and/or obesity? A systematic review of the literature. Public Health Nutr 24(17):5686–5703. https://doi.org/10.1017/S1368980021001129 White LJ, McCoy SC, Castellano V, Gutierrez G, Stevens JE, Walter GA, Vandenborne K (2004) Resistance training improves strength and functional capacity in persons with multiple sclerosis. Multiple Scler J 10(6):668–674. https://doi.org/10.1191/1352458504ms1088oa Wilmer HH, Sherman LE, Chein JM (2017) Smartphones and Cognition: A Review of Research Exploring the Links between Mobile Technology Habits and Cognitive Functioning. Front Psychol 8:605. https://doi.org/10.3389/fpsyg.2017.00605 Wing RR, Phelan S (2005) Long-term weight loss maintenance. Am J Clin Nutr 82(1):222S–225S. https://doi.org/10.1093/ajcn/82.1.222S World Medical Association (2013) World Medical Association Declaration of Helsinki: Ethical Principles for Medical Research Involving. Hum Subj JAMA 310(20):2191. https://doi.org/10.1001/jama.2013.281053 Xiao W, Wu J, Yip J, Shi Q, Peng L, Lei QE, Ren Z (2022) The Relationship Between Physical Activity and Mobile Phone Addiction Among Adolescents and Young Adults: Systematic Review and Meta-analysis of Observational Studies. JMIR Public Health Surveillance 8(12):e41606. https://doi.org/10.2196/41606 Yang J, Wang H, Luo L (2023) The association between meeting physical activity guidelines and academic performance among junior high school adolescents in China-evidence from the China education tracking survey. Front Psychol 14:1002839. https://doi.org/10.3389/fpsyg.2023.1002839 Yu H, Li F, Hu Y, Li C, Yuan S, Song Y, Zheng M, Gong J, He Q (2020) Improving the Metabolic and Mental Health of Children with Obesity: A School-Based Nutrition Education and Physical Activity Intervention in Wuhan, China. Nutrients 12(1):194. https://doi.org/10.3390/nu12010194 Zhong B, Sun H, Wang G, Junwen S, Tang S, Gao Y, Chen H, Lu T, Yan J (2024) Physical activity on the mental health of children and adolescents during COVID-19 pandemic-induced school closures—A systematic review. PLoS ONE 19(6):e0299158. https://doi.org/10.1371/journal.pone.0299158 Zou Y, Liu S, Guo S, Zhao Q, Cai Y (2023) Peer Support and Exercise Adherence in Adolescents: The Chain-Mediated Effects of Self-Efficacy and Self-Regulation. Children 10(2):401. https://doi.org/10.3390/children10020401 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6991234","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":479759608,"identity":"d3e55292-c8b0-4cd8-824f-e933968b51c4","order_by":0,"name":"Miriam G. Leão","email":"","orcid":"","institution":"CIDEFES, Universidade Lusófona","correspondingAuthor":false,"prefix":"","firstName":"Miriam","middleName":"G.","lastName":"Leão","suffix":""},{"id":479759609,"identity":"46c5e772-6ac7-4cd0-8d54-5d4f0acdb387","order_by":1,"name":"Afonso M. Jerónimo","email":"","orcid":"","institution":"CIDEFES, Universidade Lusófona","correspondingAuthor":false,"prefix":"","firstName":"Afonso","middleName":"M.","lastName":"Jerónimo","suffix":""},{"id":479759610,"identity":"aa2b611f-0aad-4a04-a43c-18f02f04da2d","order_by":2,"name":"Rita Calado","email":"","orcid":"","institution":"Hospital da Luz","correspondingAuthor":false,"prefix":"","firstName":"Rita","middleName":"","lastName":"Calado","suffix":""},{"id":479759611,"identity":"bbeb9371-71da-4fa3-a926-df820c0e8940","order_by":3,"name":"Elisa Galo","email":"","orcid":"","institution":"Hospital da Luz","correspondingAuthor":false,"prefix":"","firstName":"Elisa","middleName":"","lastName":"Galo","suffix":""},{"id":479759613,"identity":"c8d98c89-23b4-49d7-ad11-7b60a5dc4a96","order_by":4,"name":"Júlia Galhardo","email":"","orcid":"","institution":"Hospital da Luz","correspondingAuthor":false,"prefix":"","firstName":"Júlia","middleName":"","lastName":"Galhardo","suffix":""},{"id":479759616,"identity":"2177e515-3d1c-429c-9954-8eeabab098df","order_by":5,"name":"João Farela Neves","email":"","orcid":"","institution":"Hospital da Luz","correspondingAuthor":false,"prefix":"","firstName":"João","middleName":"Farela","lastName":"Neves","suffix":""},{"id":479759619,"identity":"89cc7083-77eb-4e7b-b1a0-3751e98ca16e","order_by":6,"name":"Mónica Sousa","email":"","orcid":"","institution":"Hospital da Luz","correspondingAuthor":false,"prefix":"","firstName":"Mónica","middleName":"","lastName":"Sousa","suffix":""},{"id":479759621,"identity":"a59f88c7-1471-4fe1-9597-bcddf3601cce","order_by":7,"name":"Inês Carvalho","email":"","orcid":"","institution":"Hospital da Luz","correspondingAuthor":false,"prefix":"","firstName":"Inês","middleName":"","lastName":"Carvalho","suffix":""},{"id":479759623,"identity":"534a8aa2-2d1c-4c68-8da4-a375a577175f","order_by":8,"name":"Marta Andrada","email":"","orcid":"","institution":"Hospital da Luz","correspondingAuthor":false,"prefix":"","firstName":"Marta","middleName":"","lastName":"Andrada","suffix":""},{"id":479759624,"identity":"b331656c-3f63-4861-8c02-2740909fe026","order_by":9,"name":"Mónica Santos","email":"","orcid":"","institution":"Hospital da Luz","correspondingAuthor":false,"prefix":"","firstName":"Mónica","middleName":"","lastName":"Santos","suffix":""},{"id":479759625,"identity":"8118f67a-1253-4175-8888-2a7dc0a0d2df","order_by":10,"name":"João Faria","email":"","orcid":"","institution":"Hospital da Luz","correspondingAuthor":false,"prefix":"","firstName":"João","middleName":"","lastName":"Faria","suffix":""},{"id":479759626,"identity":"b8744263-8b04-4573-9efc-74fcfd96a167","order_by":11,"name":"Rodrigo Moreira","email":"","orcid":"","institution":"Hospital da Luz","correspondingAuthor":false,"prefix":"","firstName":"Rodrigo","middleName":"","lastName":"Moreira","suffix":""},{"id":479759627,"identity":"87b4bdaf-6169-4d6a-a107-63a3e408ca67","order_by":12,"name":"Hugo Vieira Pereira","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABBklEQVRIiWNgGAWjYBACAziLGYg/MFgAScYHxGthnMEgAWJBBHkIagGp5SFGi7lE+sUHjDts8vnZeR9+tm2TSJzf3sz4uKCGIc8ehxbLGTnFBoxn0ixnNrMbS+cCtWw4c5jZeMYxhmKcDruRkybB2HbYwOAwGwNEi0T+MWkeNobEHvxa/hvYH2Zj/m0JctiMZDZpnn/4tKQfA2o5YGDAzMYmzQjU0nADqIW3DY+WM2+YDRLPJBtIHGZjs+w5J2EM9gtvn0QxzwEcWo6nP3zwcYedAX//MeYbP8psZMEhxvPNJo+9AYc1DDwGDIlYJCUScGlgYGB/wMCIzTw8WkbBKBgFo2CEAQBhqlIKZq6W9wAAAABJRU5ErkJggg==","orcid":"","institution":"CIDEFES, Universidade Lusófona","correspondingAuthor":true,"prefix":"","firstName":"Hugo","middleName":"Vieira","lastName":"Pereira","suffix":""}],"badges":[],"createdAt":"2025-06-27 11:38:15","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6991234/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6991234/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":86136206,"identity":"6745ad8c-76d3-494e-a3c8-2cbe08a29ce3","added_by":"auto","created_at":"2025-07-07 07:48:53","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":160818,"visible":true,"origin":"","legend":"\u003cp\u003eProgram logic model\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-6991234/v1/24adc5e4cb52d1c0e83b1c3f.jpeg"},{"id":86136199,"identity":"6ebc33a1-41af-4df3-bd3d-8c3d865972eb","added_by":"auto","created_at":"2025-07-07 07:48:53","extension":"jpeg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":54988,"visible":true,"origin":"","legend":"\u003cp\u003eTimeline of the program (M, month; HR, heart rate; BP, blood pressure; BMI, body mass index; ECG, electrocardiogram)\u003c/p\u003e","description":"","filename":"floatimage2.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-6991234/v1/b83bc154fcd156ffacabdc93.jpeg"},{"id":87594467,"identity":"71d06b08-7afb-484e-95ba-238dab90e127","added_by":"auto","created_at":"2025-07-25 15:31:47","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":891429,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6991234/v1/a3cab7db-b78a-4b39-b025-ae7146a45933.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"TEENFIT: A Self-Management Health Program for Adolescents with Obesity – Study Protocol and Pilot Study Findings","fulltext":[{"header":"Introduction","content":"\u003cp\u003eChildhood obesity poses a global public health crisis (Ogden et al., \u003cspan citationid=\"CR76\" class=\"CitationRef\"\u003e2014\u003c/span\u003e), with rising rates linked to serious comorbidities affecting the endocrine, gastrointestinal, pulmonary, cardiovascular, and musculoskeletal systems (Dietz \u0026amp; Robinson, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2005\u003c/span\u003e; Skinner et al., \u003cspan citationid=\"CR96\" class=\"CitationRef\"\u003e2015\u003c/span\u003e). Additionally, emerging evidence reveals a correlation between reduced sleep duration/quality and obesity (Jiang et al., 2015). Psychosocial and emotional distress contribute to childhood weight gain through maladaptive strategies, such as emotional eating and appetite dysregulation (Hemmingsson, \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e2014\u003c/span\u003e). Parental eating styles and parental stress further affect children's eating habits, increasing obesity risk (El-Behadli et al., \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e2015\u003c/span\u003e). These interconnected factors lead to outcomes like low self-esteem, anxiety, depression, and reduced health-related quality of life (Sawyer et al., \u003cspan citationid=\"CR94\" class=\"CitationRef\"\u003e2011\u003c/span\u003e). Additionally, children with obesity are at an increased risk of bullying and discrimination (Griffiths, L. J., 2005).\u003c/p\u003e \u003cp\u003eInternational guidelines (Chaput et al., \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2020\u003c/span\u003e) recommend that children and adolescents engage in at least 60 minutes of moderate to vigorous physical activity daily, with vigorous aerobic and muscle-strengthening exercises included at least three times a week. Combined diet and physical activity interventions yield significant weight loss (White et al.).\u003c/p\u003e \u003cp\u003eSustained behavior change is crucial, as highlighted by various theoretical frameworks. Self-Determination Theory identifies three key psychological needs—autonomy, competence, and positive relationships—that, when met, enhance autonomous motivation and behavior sustainability (Deci \u0026amp; Ryan, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2004\u003c/span\u003e). Self-Regulation Theory involves planning, monitoring, evaluating, and adjusting actions to achieve goals (Ryan et al., \u003cspan citationid=\"CR90\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). The COM-B Model focuses on three components—capability, opportunity, and motivation—proposing that behavior stems from their interaction (Michie et al., \u003cspan citationid=\"CR73\" class=\"CitationRef\"\u003e2011\u003c/span\u003e). Implementing health self-management programs with patient participation and healthcare team collaboration can successfully drive behavioral change and enhance health outcomes (Balduino et al., 2021).\u003c/p\u003e \u003cp\u003eThis research describes the TeenFit program, an interdisciplinary intervention focusing on diet quality, physical activity, and self-concept in adolescents aged 12 to 14 with obesity, and presents findings from a pilot test evaluating the intervention's feasibility and acceptability.\u003c/p\u003e "},{"header":"Methods","content":"\u003cp\u003eThe TeenFit intervention was developed based on a logical model (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e) that integrates the theories of self-determination (Ryan, \u003cspan citationid=\"CR88\" class=\"CitationRef\"\u003e2023\u003c/span\u003e), self-regulation (Ryan et al., \u003cspan citationid=\"CR90\" class=\"CitationRef\"\u003e2021\u003c/span\u003e) and the COM-B model (Michie et al., \u003cspan citationid=\"CR73\" class=\"CitationRef\"\u003e2011\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e \u003cb\u003eParticipants\u003c/b\u003e \u003c/p\u003e\u003cp\u003eEligible participants for the study are aged 12 to 14 and have a body mass index (BMI) over the 95th percentile for their age and gender (de Onis et al., 2009). They must provide written informed consent, have no severe orthopedic limitations affecting moderate to vigorous physical activity (MVPA), and be free from medical conditions detrimental to MVPA as well as severe untreated psychological disorders such as psychosis or clinical depression. Participants and their guardians must agree to make necessary lifestyle changes and maintain at least 80% attendance over a six-month TeenFit program.\u003c/p\u003e\u003cp\u003eExclusion criteria consist of: failure to attend the initial assessment; inability to comprehend written or spoken Portuguese; plans to travel for over two weeks within six months of program initiation; or intentions to emigrate. Additionally, those using obesity-related medication, experiencing significant injuries during the study, having a documented history of cardiac issues, or a family history of obstructive cardiomyopathy or chronic illnesses—such as renal disease, respiratory disorders, and orthopedic or neurological conditions affecting physical activity—are excluded.\u003c/p\u003e\u003cp\u003eProject Teen Fit aimed at helping adolescents with obesity adopt healthier lifestyle habits. It emphasized motivation, knowledge acquisition, habit formation, self-monitoring, parental involvement, and support. Conducted at a private hospital in xxx from January to July 2024, this 24-week program was led by a team of nutritionists, exercise physiologists, psychologists, and clinicians. Sessions included group interventions in classrooms and gyms, plus outdoor exercises tailored to participants' capabilities. Healthy snacks were provided before sessions, and monthly workshops for parents addressed youth obesity, covering health impacts, diet, physical activity, and psychological support, with some workshops encouraging joint participation to foster consistency in behaviors between parents and teens. From July 2023, participants were recruited from adolescent obesity clinics and standard clinical settings, undergoing evaluations at baseline, three months, six months, and follow-ups at twelve and eighteen months. The six-month intervention ran from January to July 2024, totaling 24 weeks.\u003c/p\u003e\u003cp\u003eThe program featured a comprehensive medical and nutritional assessment performed before and during individual sessions, which informed a tailored action plan. Participants underwent holistic evaluations that included measurements of weight, height, body composition (InBody570), and waist circumference. Blood pressure was tracked using the OMRON device, alongside laboratory tests for glucose, insulin, and HbA1c levels.\u003c/p\u003e\u003cp\u003eDemographic data were obtained from hospital records. Secondary outcomes included psychological needs satisfaction via the Psychological Needs Satisfaction in Exercise Scale (Wilson et al., 2006) and behavioral regulation assessed by the Behavioral Regulation in Exercise Questionnaire − 4 (Teixeira et al., 2022). Self-regulation was measured through action planning, coping planning, and action control scales (Sniehotta et al., 2005). Quality of life was evaluated using the Kidscreen-52 (Gaspar, 2010; Ravens-Sieberer et al., 2005), and body figure perception was assessed with Collins' pictorial instrument (1991). Physical activity was monitored using mobile phones and wearables, aggregated via the google platform. Eating behaviors were evaluated with the Kidmed Index (Rei et al., 2021). The intervention's quality, appropriateness, acceptability, adherence, barriers, and facilitators were assessed through interviews with staff and focus groups with participants, parents, and health professionals.\u003c/p\u003e\u003cp\u003eFocus group discussions with health professionals, participants, and parents addressed four research objectives: 1) assessing program satisfaction and identifying strengths and weaknesses; 2) identifying barriers and facilitators to program implementation; 3) examining obstacles and enablers to behavioral modification; and 4) evaluating necessary changes. Conducted three months into the study in a controlled environment, discussions were guided by moderators who introduced themselves, outlined the study's aims, set participation rules, and informed participants about audio recording. They ensured focused dialogue and equal opportunities for contributions. Transcripts underwent thematic analysis using a codebook developed by the research team, and NVIVO v1.7.1 software (Lumivero, USA) facilitated efficient data analysis.\u003c/p\u003e\u003cp\u003eThe study follows the Helsinki Declaration for Human Studies (World Medical Association, \u003cspan citationid=\"CR118\" class=\"CitationRef\"\u003e2013\u003c/span\u003e) and was approved by the Ethics Committee of Faculdade de Educação Física e Desporto, Universidade Lusófona, Lisboa (D0924).\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e \u003cb\u003eSatisfaction with the program\u003c/b\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003eInformation\u003c/em\u003e \u003c/p\u003e \u003cp\u003eParents noted areas for improvement in the organization of information related to the TeenFit program, leading to confusion over schedules, workshops, breaks, and program availability. Effective communication with parents is crucial in adolescent weight management programs. Research shows that active parental involvement correlates with better health outcomes for youth (Smith et al., \u003cspan citationid=\"CR98\" class=\"CitationRef\"\u003e2015\u003c/span\u003e). Clear, consistent communication can enhance adolescents' adherence to programs and support lasting lifestyle changes (Resnicow et al., \u003cspan citationid=\"CR86\" class=\"CitationRef\"\u003e2015\u003c/span\u003e). Communication strategies must ensure parents understand program goals and requirements (Davison et al., \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2013\u003c/span\u003e). Employing diverse channels such as in-person meetings, emails, and digital platforms can enhance information accessibility (Borrelli et al., \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2007\u003c/span\u003e). Parents play a key role in promoting healthy behaviors in their children (Kitzman-Ulrich et al., 2013).\u003c/p\u003e \u003cp\u003e \u003cem\u003eGroup dynamics\u003c/em\u003e \u003c/p\u003e \u003cp\u003eConcerns have been raised about the behavior of a specific group member and its impact on the session objectives. Participants expressed that such behavior caused discomfort and disruption, undermining the learning environment. However, this behavior has improved as the program progressed. Disruptive actions, such as disrespect and negative attitudes, negatively affect individual and collective learning, ultimately diminishing motivation and commitment (Whatnall et al., \u003cspan citationid=\"CR114\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). These behaviors create tension, hindering positive interactions essential for successful weight management programs (Davison et al., \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2013\u003c/span\u003e). In contrast, similarities among parents, children, and researchers indicate that a homogenous group increases comfort. Evidence from parents' workshops shows high interest and engagement, reflecting positive relationships with educators. Literature indicates that a supportive group dynamic enhances program outcomes, fostering an inspiring environment (Pbert et al., \u003cspan citationid=\"CR78\" class=\"CitationRef\"\u003e2016\u003c/span\u003e). Positive interactions correlate with improved program adherence, reduced disordered eating, and increased physical activity. As adolescents are heavily influenced by peers, a positive group environment significantly boosts the adoption and maintenance of healthy habits (Ufholz, \u003cspan citationid=\"CR110\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). Moreover, group dynamics provide essential emotional support for adolescents experiencing stigma and isolation due to obesity, which can enhance self-esteem and psychological well-being (Warnick et al.).\u003c/p\u003e \u003cp\u003e \u003cem\u003eAcademic performance\u003c/em\u003e \u003c/p\u003e \u003cp\u003eBoth parents and children noted the positive effects of the health management and exercise program on academic performance and behavior. This concurs with existing research that shows regular physical activity boosts cognitive functions, attention, and academic success, while also alleviating depression in adolescents (Zhong et al., \u003cspan citationid=\"CR122\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). Moreover, daily moderate to vigorous physical activity within classes enhances performance in reading, spelling, and math (Singh et al., \u003cspan citationid=\"CR95\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). Additionally, adherence to physical activity guidelines is linked to better classroom behavior and especially improved mathematics performance (Yang et al.).\u003c/p\u003e \u003cp\u003e \u003cem\u003eMultidisciplinary\u003c/em\u003e \u003c/p\u003e \u003cp\u003eParents and participants see the multidisciplinary approach as valuable, enhancing skill acquisition and understanding of healthier lifestyle choices related to nutrition, sleep, and physical activity. Effective adolescent weight management goes beyond calorie tracking and exercise; it requires a comprehensive strategy involving multiple fields (Story et al., \u003cspan citationid=\"CR104\" class=\"CitationRef\"\u003e2006\u003c/span\u003e). Literature indicates that successful programs employ a multidisciplinary framework, engaging professionals from nutrition, psychology, medicine, physical education, and social care (Hoelscher et al., \u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e2013\u003c/span\u003e). This collaboration promotes knowledge sharing and co-development of intervention strategies (Fan Qi et al., \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). Research confirms that integrated methodologies lead to better long-term outcomes in weight maintenance and active lifestyles (Kumar \u0026amp; Kelly, \u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). Therefore, these holistic approaches are essential for designing future interventions to address adolescent overweight challenges (Lloyd-Richardson et al.).\u003c/p\u003e \u003cp\u003e \u003cem\u003eRegularity\u003c/em\u003e \u003c/p\u003e \u003cp\u003eParents generally support regular weight management sessions, but some question their effectiveness. Consistency is vital for success, promoting healthy habits and sustaining motivation (Buru et al., \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). Research shows that regular sessions improve adolescents' adherence and result in better long-term weight reduction and health outcomes (Ho et al., \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e2012\u003c/span\u003e). Additionally, regular follow-ups allow for timely adjustments to interventions, addressing individual challenges like psychosocial barriers to weight loss (Amianto, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). Adolescents involved in these consistent programs report significant weight loss improvements, enhanced self-efficacy, body image, and quality of life (Davis et al., \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2012\u003c/span\u003e). Literature suggests that weekly or bi-weekly sessions are linked to higher success rates than less frequent meetings (Homs et al., 2012).\u003c/p\u003e \u003cp\u003e \u003cem\u003eSatisfaction\u003c/em\u003e \u003c/p\u003e \u003cp\u003eEvaluations from parents, participants, and health professionals were analyzed, yielding two primary domains: General Manifestations of Satisfaction and Physical and Psychological Outcomes. Respondents expressed satisfaction with both the program and the professionals' expertise, favoring theoretical sessions, physical training, and parental workshops. Despite no measurable physiological changes, participants reported improved body image, weight loss, enhanced physical fitness, and the acquisition of new health habits, as well as increased psychological and academic knowledge. Developing new friendships was also a significant source of satisfaction. Research indicates that participant satisfaction correlates with greater adherence to programs and improved long-term outcomes (Braet \u0026amp; Beyers, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2009\u003c/span\u003e). Effective programs foster positive adolescent experiences, thus facilitating sustainable behavioral changes (De Miguel-Etayo et al., \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2013\u003c/span\u003e). Participation in structured weight management programs further yields significant health improvements, such as reduced body mass index (BMI), better glycemic control, and lower cardiovascular risks (Kelly et al., \u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e2013\u003c/span\u003e). Psychological benefits include elevated self-esteem, enhanced body image, and overall quality of life, alongside reduced depression and anxiety symptoms, thereby supporting young people's emotional well-being (Gunawardana et al., \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Pont et al., \u003cspan citationid=\"CR82\" class=\"CitationRef\"\u003e2017\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cb\u003eBarriers and facilitators to implementing the program\u003c/b\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003eMobile phone\u003c/em\u003e \u003c/p\u003e \u003cp\u003eHealth professionals frequently criticize participants, particularly during initial sessions, for their excessive use of mobile phones, even amidst physical exercise, contrary to trainers' guidance. This behavior, however, demonstrated notable improvement throughout the program. Literature identifies adolescents' overuse of cell phones as a barrier to behavioral modification interventions (Przybylski \u0026amp; Weinstein, \u003cspan citationid=\"CR83\" class=\"CitationRef\"\u003e2013\u003c/span\u003e). This issue is particularly pertinent in the context of adolescent obesity, where mobile device distraction may undermine intervention effectiveness, as seen in programs like TeenFit. Persistent cell phone use can distract adolescents from program activities, ultimately diminishing their effectiveness (Wilmer et al., \u003cspan citationid=\"CR116\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). Furthermore, adolescent cell phone addiction is linked to sedentary behaviors that contribute to obesity. Research has shown a significant correlation between increased cell phone usage and decreased physical activity, suggesting that adolescents engaged with mobile devices are less likely to participate in physical activities (Lepp et al., \u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e2013\u003c/span\u003e). Educating on responsible cell phone use and instituting \u0026ldquo;mobile-free\u0026rdquo; periods during sessions may enhance attention and participation (Liao et al., \u003cspan citationid=\"CR64\" class=\"CitationRef\"\u003e2015\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cem\u003eLogistics\u003c/em\u003e \u003c/p\u003e \u003cp\u003eHealthcare professionals have reported challenges related to limited spatial availability during exercise sessions, particularly with multiple practitioners on-site. However, improved weather conditions have allowed for the use of outdoor spaces, somewhat alleviating this issue. Access to suitable locations for physical activity and the misalignment of session timings with school and family schedules continue to be significant barriers (Martins et al., \u003cspan citationid=\"CR70\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). Limited access to gyms and community centers, along with restricted operational hours, can hinder adolescents' participation in organized activities (Hu et al., \u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). Establishing partnerships with educational institutions and communities to ensure appropriate space access and adapting session times to better fit adolescents' schedules are essential strategies for addressing these challenges (Chriqui et al., \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2012\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cem\u003eGroup dynamics\u003c/em\u003e \u003c/p\u003e \u003cp\u003eResearch indicates that a specific participant in the classroom environment negatively impacts the learning process, acting as an impediment to behavioral modification among peers. In weight management programs, group cohesion and support are essential for success. Conversely, adverse group dynamics may foster a hostile atmosphere that obstructs adolescents' active participation and commitment (Brown et al., \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2013\u003c/span\u003e). Therefore, it is imperative for programs to implement strategies that enhance positive group cohesion and mutual support to alleviate these detrimental effects. Effective interventions may include social skills training, conflict mediation, and team-building activities (Kitzman-Ulrich et al., \u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e2010\u003c/span\u003e). Establishing a supportive environment improves weight management outcomes while also fostering participants' emotional well-being, ultimately promoting sustainable behavioral change (Loth et al., \u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e2013\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cem\u003eAdaptability\u003c/em\u003e \u003c/p\u003e \u003cp\u003eThe adaptability of professionals regarding class dynamics, spatial arrangements, scheduling, and feedback mechanisms is essential for the program's success. Research shows that customizing programs to match the unique traits of the target demographic significantly improves intervention effectiveness. Teachers who modify their pedagogical strategies to suit class dynamics and utilize available spaces effectively foster better adolescent engagement (Durlak \u0026amp; DuPre, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e2008\u003c/span\u003e). Furthermore, accommodating tight school and extracurricular schedules by adjusting program timelines enhances participation rates (Rhodes et al., \u003cspan citationid=\"CR87\" class=\"CitationRef\"\u003e2020\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cem\u003eDynamic sessions\u003c/em\u003e \u003c/p\u003e \u003cp\u003eHealth professionals assert that the dynamic sessions within this program significantly enhance implementation and learning outcomes. The use of interactive and collaborative activities encourages adolescents' active engagement, thereby improving the effectiveness of weight management interventions (Kumar \u0026amp; Kelly, \u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). The success of these sessions is further attributed to their adaptability to individual needs. Recent research highlights that incorporating playful activities and digital technologies boosts engagement and motivation among young participants (M. Jones et al., \u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e2008\u003c/span\u003e). Experiential learning, where knowledge and skills are developed through direct experience, proves particularly effective in health programs, facilitating the practical application of theoretical concepts for behavioral change (Inguva et al., \u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). Strategies to implement dynamic theoretical sessions include educational games that simulate health-related decisions, cooking workshops, and supervised physical activities, rendering learning more relevant and engaging (Hulya \u0026amp; Ay En, 2015). Students involved in experiential activities demonstrate higher intrinsic motivation and commitment to the program (Xiao et al., \u003cspan citationid=\"CR119\" class=\"CitationRef\"\u003e2022\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cem\u003eImplementation plan\u003c/em\u003e \u003c/p\u003e \u003cp\u003eStrategic planning is regarded by health professionals as an essential tool for effectively implementing programs, facilitating a comprehensive assessment of progress and necessary adjustments over time. Comprehensive pre-implementation planning significantly enhances program execution, promoting adherence and favorable long-term outcomes (Damschroder et al., \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2009\u003c/span\u003e). A structured plan allows for the identification and mitigation of potential implementation barriers, including participant resistance and resource constraints (Durlak \u0026amp; DuPre, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e2008\u003c/span\u003e). Additionally, ongoing evaluation and feedback are critical components of the implementation plan, enabling continuous program adjustments and improvements. The inclusion of robust monitoring and evaluation tools from the outset ensures the plan's adaptability, maintaining its effectiveness and relevance (Houle et al., \u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e2013\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cem\u003eSocial Support\u003c/em\u003e \u003c/p\u003e \u003cp\u003eHealth professionals observed considerable parental engagement, evident through diverse inquiries during workshops and email correspondences. They emphasized the critical role of parental motivation in optimizing children's weight management interventions. Research indicates that parental involvement in behavioral weight loss programs correlates with improved weight loss and maintenance outcomes, encompassing the establishment of an environment conducive to healthy eating and shared physical activities (Berge, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2009\u003c/span\u003e). Furthermore, parental emotional support enhances adolescents' self-esteem and motivation (Haines et al., \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e2016\u003c/span\u003e). Programs that integrate parental strategies are more effective than those targeting adolescents alone. Studies suggest that educating parents on nutrition, physical activity, and emotional support techniques is essential for success. Implementing educational sessions for parents alongside practical activities has demonstrated promising results in reducing adolescents' BMI (Faith et al., \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e2012\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cem\u003eGroup dynamics\u003c/em\u003e \u003c/p\u003e \u003cp\u003eResearch demonstrates that adherence to specific behavioral practices and lifestyle choices among adolescents is significantly enhanced when they cultivate positive relationships with influential figures, such as educators and peers. Engaging in groups with peers facing similar challenges can boost self-esteem and motivation while mitigating the stigma associated with obesity (Trigueros et al., \u003cspan citationid=\"CR108\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). Additionally, group dynamics contribute to improved program adherence; a sense of belonging fosters greater participation and commitment to activities, leading to superior weight loss results. Furthermore, studies identify peer support, self-efficacy, and self-regulation as mediating factors that facilitate engagement in exercise and weight loss programs among adolescents (Al-Daghri et al., \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2023\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cem\u003ePressure for results\u003c/em\u003e \u003c/p\u003e \u003cp\u003eHealth professionals argue that participation in this course demands a higher level of rigor and discipline to achieve optimal outcomes, particularly in physical fitness. This enhanced adherence significantly boosts the effectiveness of program interventions. Participants who set realistic goals and received constructive feedback showed marked progress in weight loss and improved health behaviors, including personal accountability and increased physical activity (Behr et al., \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). Additionally, a study examining the relationship between self-esteem, body image, and eating attitudes in adolescents revealed that higher self-esteem and a positive body image correlate with healthier eating behaviors and superior cardiorespiratory performance (Petrovics et al., \u003cspan citationid=\"CR81\" class=\"CitationRef\"\u003e2021\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cem\u003eFocus on behavior\u003c/em\u003e \u003c/p\u003e \u003cp\u003eExperts highlight the significance of behavioral modification, especially when individuals may not completely change their physiological health indicators. Weight management programs emphasizing behavioral change aim to foster sustainable healthy habits to improve long-term health outcomes in adolescents (Goldschmidt et al., \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e2013\u003c/span\u003e). Recent research establishes that positive behavior change is vital for these programs' success; employing positive reinforcement and fostering a supportive environment correlate with improved weight loss and maintenance (Puhl et al., \u003cspan citationid=\"CR84\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). A key element of such interventions is nutrition education, which informs adolescents about healthy choices and incorporates practical activities\u0026mdash;such as cooking and meal organization\u0026mdash;leading to better adoption of healthy eating behaviors (Nguyen et al., \u003cspan citationid=\"CR75\" class=\"CitationRef\"\u003e2011\u003c/span\u003e). Additionally, programs offering diverse physical activity options, from team sports to individual workouts, demonstrate greater effectiveness in maintaining adolescent engagement (Biddle \u0026amp; Asare, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2011\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cb\u003eBarriers and facilitators to behavioral modification\u003c/b\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003ePhysical condition\u003c/em\u003e \u003c/p\u003e \u003cp\u003eParticipants identified inadequate physical fitness as a significant barrier to increasing engagement in physical activity. The perception that such participation is daunting and unattainable exacerbates reluctance to adopt more active lifestyles. Adolescents with obesity often have lower fitness levels, hindering their ability to engage in strenuous or prolonged activities. Studies show that those with diminished physical fitness report higher exertion levels during exercise, reducing the likelihood of consistent participation (Okely et al., \u003cspan citationid=\"CR77\" class=\"CitationRef\"\u003e2004\u003c/span\u003e). Additionally, insufficient muscular fitness limits physical capabilities and negatively impacts self-efficacy and motivation to engage in physical activity (Smith et al., \u003cspan citationid=\"CR99\" class=\"CitationRef\"\u003e2014\u003c/span\u003e). Low physical fitness is a prevalent barrier for children and adolescents, as it can lead to discomfort and a lack of perceived competence, further entrenching inactivity and contributing to weight gain (Janssen \u0026amp; LeBlanc, \u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e2010\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cem\u003eFamily logistics\u003c/em\u003e \u003c/p\u003e \u003cp\u003eConcerns arise among parents regarding the coordination of schedules, management of snacks, and adherence to timely arrivals for various activities. Participants express a desire for increased physical activity; however, parents often lack sufficient time to meet these needs. Logistical barriers include insufficient time for parents to accompany children to appointments, transportation challenges, and the necessity to balance multiple family responsibilities. Such barriers frequently lead to decreased attendance at weight management programs, thereby undermining the effectiveness of interventions. Additionally, conflicts between parental and adolescent goals\u0026mdash;such as weight loss versus self-confidence enhancement\u0026mdash;can engender feelings of demotivation and frustration (Twiddy et al., \u003cspan citationid=\"CR109\" class=\"CitationRef\"\u003e2012\u003c/span\u003e). Parental challenges, including resistance from adolescents and insufficient knowledge regarding nutrition and physical activity, further complicate the implementation of behavioral changes at home (Amiri et al., \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). Conversely, a supportive family environment, characterized by emotional and practical support from parents, can enhance adolescents' engagement with weight management programs (Carbert et al., \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2019\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cem\u003eContingency strategies\u003c/em\u003e \u003c/p\u003e \u003cp\u003e Participants adapted their lifestyles to integrate increased physical activity into their daily routines, enhancing their behavioral modification capacity. Research indicates that factors such as educational obligations, family responsibilities, and social activities often hinder adolescents' ongoing involvement in physical activity programs (Brown et al., \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2013\u003c/span\u003e). Commitments both academic and extracurricular are significant barriers to participation. Social support from family and peers is vital for promoting consistent engagement, highlighting the need to consider adolescents' social contexts and daily responsibilities in behavioral health interventions (Hills et al., \u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e2015\u003c/span\u003e). Adolescents with well-structured and less burdensome schedules are more likely to regularly attend programs. Studies suggest that effective time management and prioritizing activities can improve adherence, underscoring the importance of strong social support and self-efficacy in fostering regular participation (Zou et al., \u003cspan citationid=\"CR123\" class=\"CitationRef\"\u003e2023\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cem\u003eSocial influence\u003c/em\u003e \u003c/p\u003e \u003cp\u003eParental and participant feedback demonstrates a significant increase in interest in physical activity and nutrition among participants, leading to enhancements in their overall well-being and positively impacting their immediate family and social circles. Research indicates that behavioral modification interventions targeting adolescents can markedly influence their home environments. For example, adolescents participating in physical activity and nutrition programs may motivate their family members to adopt similar healthy behaviors, promoting a more active lifestyle within the household. This transition may result in a higher prevalence of physical activity and healthier eating practices among family members, fostering a more healthful lifestyle (Berge et al., \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2010\u003c/span\u003e). Adolescents who improved their diets through behavioral interventions also positively impacted their peers, facilitating collective enhancements in eating habits. This social influence is vital for the sustainability of behavioral changes (Sawka et al., \u003cspan citationid=\"CR93\" class=\"CitationRef\"\u003e2013\u003c/span\u003e). Additionally, positive social support from family and friends during behavioral modifications correlates with increased self-esteem and body satisfaction among adolescents. This emotional reinforcement is essential for maintaining behavioral changes, creating a supportive environment that minimizes the risk of reverting to detrimental habits (Donlan et al., \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2015\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cem\u003eStimulus control\u003c/em\u003e \u003c/p\u003e \u003cp\u003eBoth participants and guardians reported significant improvements in understanding and regulating unhealthy behaviors, particularly regarding the frequency and intensity of eating and physical activities. A randomized controlled trial utilizing a broad range of visual and auditory cues, combined with reminders, showed a notable reduction in unhealthy snack consumption and screen time within the home, fostering conditions for healthier lifestyle choices (Medeiros et al., \u003cspan citationid=\"CR72\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). Additionally, research corroborated that environmental modifications, such as increased visibility of healthy foods, elevate consumption rates among adolescents (Van Lieshout et al., \u003cspan citationid=\"CR111\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). Moreover, the presence of cardiovascular and strength training equipment at home correlates with enhanced intentions, planning, and habits regarding physical activity. This study indicated that making such equipment visible promotes consistent engagement in physical activities (Kaushal et al., \u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e2020\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cem\u003eGroup dynamics\u003c/em\u003e \u003c/p\u003e \u003cp\u003e Parents noted that participants showed motivation and comfort in the intervention setting, attributed to similar group characteristics and the consistent presence of supportive professionals. Social support and group cohesion facilitated the intervention, leading to meaningful behavioral changes. Enhanced interactions among members improved adherence to the program and significantly benefited physical and mental health. A sense of belonging and mutual support were crucial for success (Staiano et al., \u003cspan citationid=\"CR100\" class=\"CitationRef\"\u003e2016\u003c/span\u003e). Cohesive groups further encourage behavior change by providing a safe space for adolescents to share experiences (Smith et al., \u003cspan citationid=\"CR97\" class=\"CitationRef\"\u003e2006\u003c/span\u003e). Social interactions increased motivation and self-efficacy in exercise, with peers modeling positive behaviors and reinforcing habit formation (Lubans et al., 2016).\u003c/p\u003e \u003cp\u003e \u003cem\u003eFuture plans\u003c/em\u003e \u003c/p\u003e \u003cp\u003eAfter the program, participants showed a strong commitment to maintaining engagement in physical activity and sports. The adolescents expressed interest in developing strategies for the future, reflecting necessary mindset and behavior shifts\u0026mdash;key elements for effective interventions aimed at obese adolescents. A future-oriented mindset, recognizing the long-term benefits of healthy living, is crucial for behavioral change (Pearson et al., \u003cspan citationid=\"CR80\" class=\"CitationRef\"\u003e2014\u003c/span\u003e). Research highlights that self-efficacy and perceived control are vital for sustaining healthy behaviors: adolescents confident in their ability to make healthy choices are more likely to implement lasting positive changes (Beauchamp et al., \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). Interventions using Self-Determination Theory promote autonomy and intrinsic motivation, reducing dependence on external rewards. When adolescents feel they have agency over their choices and these resonate with their intrinsic values, they are more likely to adopt and sustain healthier lifestyle practices (Hagger \u0026amp; Hardcastle, \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e2014\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cb\u003eWhat you would change about the program\u003c/b\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003eFood\u003c/em\u003e \u003c/p\u003e \u003cp\u003eParents have raised concerns about the availability of healthy snacks for participants prior to theoretical sessions, particularly regarding portion control and autonomy. This issue is crucial for participants who may have already eaten at school and are offered additional snacks during the program. Interventions that enhance dietary quality, including nutritious snacks, have effectively reduced weight gain and improved health in adolescents with obesity (Yu et al., \u003cspan citationid=\"CR121\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). Substituting caloric snacks with healthy options like fruits and vegetables has resulted in better program adherence and weight loss outcomes (Pearson et al., \u003cspan citationid=\"CR79\" class=\"CitationRef\"\u003e2010\u003c/span\u003e). Research indicates that limited access to healthy foods, established preferences, and resistance to dietary changes are significant barriers (Subramaniam et al., \u003cspan citationid=\"CR105\" class=\"CitationRef\"\u003e2022\u003c/span\u003e), but factors such as parental support, nutrition education, and school involvement can aid in dietary adherence (Donin et al., \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). Programs combining nutrition education, family engagement, and improved access to healthy foods have proven more effective. For example, healthy food baskets and cooking workshops have successfully promoted sustainable dietary changes among adolescents with obesity (Liu et al., 2024).\u003c/p\u003e \u003cp\u003e \u003cem\u003eExclusive space\u003c/em\u003e \u003c/p\u003e \u003cp\u003eHealth professionals have expressed concerns about limitations in the designated area for exercise sessions, which may hinder their effectiveness. Exclusive environments can mitigate these issues by providing a space where adolescents can build self-confidence and enhance social skills without fear of judgment (Chiumento et al., \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). Moreover, these settings allow for more personalized support, enabling professionals to address individual barriers faced by adolescents, thereby improving program outcomes (Sahoo et al., \u003cspan citationid=\"CR91\" class=\"CitationRef\"\u003e2015\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cem\u003eCommunication\u003c/em\u003e \u003c/p\u003e \u003cp\u003eParents emphasize the importance of enhanced communication for clearer information dissemination and reduced reliance on automated notifications. While increased communication can lead to scheduling ambiguities, structured messages significantly improve understanding of the program's objectives and activities. Research shows that frequent, well-constructed emails enhance perceptions of transparency and trust between parents and program administrators, resulting in greater support and participation (Thornberg et al., \u003cspan citationid=\"CR107\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). Mobile applications offer real-time notifications, access to activity calendars, progress tracking, and educational resources, which enhances participant engagement (Cafazzo et al., \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2012\u003c/span\u003e). Text messaging effectively sends reminders, promotes healthy behaviors, and offers positive feedback, with regular and personalized messages boosting parental involvement (Fjeldsoe et al., \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e2009\u003c/span\u003e). Improved communication with parents benefits TeenFit implementation by raising awareness of the program's significance, promoting adherence, and strengthening relationships among parents, program organizers, and adolescents, thereby fostering a supportive environment for behavioral change (Lindsay et al., 2017).\u003c/p\u003e \u003cp\u003e \u003cem\u003eDuration\u003c/em\u003e \u003c/p\u003e \u003cp\u003eHealthcare professionals suggest optimizing program duration by reducing both time and session frequency in response to the demand for weight loss services. Research indicates that programs lasting six to twelve months result in significant weight loss and improved metabolic health markers such as body mass index (BMI) and insulin sensitivity. This duration fosters sustainable dietary and exercise habits critical for long-term weight management (Reinehr, \u003cspan citationid=\"CR85\" class=\"CitationRef\"\u003e2011\u003c/span\u003e). Qualitative analyses suggest that interventions shorter than six months may fail to achieve lasting behavioral changes, increasing the risk of weight regain. While short-term programs offer immediate benefits, they often lack effectiveness in promoting long-term weight maintenance, highlighting the necessity for longer interventions (Tay et al., \u003cspan citationid=\"CR106\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). Additionally, intervention durations should facilitate adolescents' complete cycles of learning and adaptation (Mazzeo et al., \u003cspan citationid=\"CR71\" class=\"CitationRef\"\u003e2012\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e \u003cem\u003eExercise\u003c/em\u003e \u003c/p\u003e \u003cp\u003eParents argue that physical activity should extend beyond traditional settings like parks, promoting additional challenges at home for enjoyment and health benefits. This perspective, while seemingly contradictory, is supported by literature emphasizing exercise's role in weight loss and improving health metrics such as blood pressure and cholesterol (Ho et al., 2013). Moreover, physical activity offers psychological benefits, notably reducing depression and anxiety symptoms in obese adolescents (Lubans et al., \u003cspan citationid=\"CR69\" class=\"CitationRef\"\u003e2012\u003c/span\u003e). Self-determination theory highlights autonomy as crucial for intrinsic motivation, essential for effective weight management (Ryan \u0026amp; Deci, \u003cspan citationid=\"CR89\" class=\"CitationRef\"\u003e2000\u003c/span\u003e). Adolescents who choose their physical activities are more likely to develop sustainable exercise habits (Standage et al., \u003cspan citationid=\"CR101\" class=\"CitationRef\"\u003e2012\u003c/span\u003e). Programs that foster autonomy through varied options and goal-setting involvement tend to be more effective (Ng et al., \u003cspan citationid=\"CR74\" class=\"CitationRef\"\u003e2012\u003c/span\u003e). Nevertheless, barriers like limited access to safe environments, inadequate peer and family support, and low self-efficacy hinder participation (Ding et al., \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2011\u003c/span\u003e). Furthermore, negative past experiences can impede ongoing engagement in physical activity (Pearson et al., \u003cspan citationid=\"CR80\" class=\"CitationRef\"\u003e2014\u003c/span\u003e). Health professionals can improve this by creating supportive environments and implementing engaging programs, with trained educators playing a key role (Salmon et al., \u003cspan citationid=\"CR92\" class=\"CitationRef\"\u003e2007\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cem\u003eGroup homogeneity\u003c/em\u003e \u003c/p\u003e \u003cp\u003eHealth professionals suggest that increased homogeneity within groups may improve outcomes, particularly in reducing psychological disorders and enhancing motivation. A key initiative is to create a supportive environment where participants share similar experiences, reinforcing belongingness and decreasing isolation (Foster et al., \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e2003\u003c/span\u003e). Research indicates that adolescents in homogeneous groups show greater commitment through peer identification (Stevens et al., \u003cspan citationid=\"CR102\" class=\"CitationRef\"\u003e2007\u003c/span\u003e). Additionally, homogeneity facilitates tailored interventions for participants facing similar challenges (Gately et al., \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e2000\u003c/span\u003e). Although heterogeneous groups may struggle with cohesion, they offer diverse solutions that enrich learning experiences (Stice et al., \u003cspan citationid=\"CR103\" class=\"CitationRef\"\u003e2006\u003c/span\u003e). However, a lack of diversity can perpetuate harmful behaviors due to shared contexts (Wadden et al., \u003cspan citationid=\"CR112\" class=\"CitationRef\"\u003e2012\u003c/span\u003e). Thus, it's essential to balance the benefits of homogeneity with the inclusion of diverse perspectives to enhance behavioral change. A hybrid approach combining both elements may lead to more effective programs.\u003c/p\u003e \u003cp\u003e \u003cem\u003eMomsFit\u003c/em\u003e \u003c/p\u003e \u003cp\u003eThe authors argue that fathers' involvement in physical activities significantly influences behavioral changes in both participants and their families. Research shows that parental participation in childhood obesity interventions leads to improved weight loss and maintenance in children and adolescents. When parents engage in physical activities, they model healthy behaviors, contributing to a supportive family environment that encourages change (Golan et al., \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e1998\u003c/span\u003e). Programs that incorporate educational sessions and parent involvement enhance the effectiveness of child weight loss initiatives. Co-participation strengthens bonds and mutual support during the weight loss journey (Epstein et al., \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). Programs including parents generally achieve higher adherence and long-term success (Berge et al., \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2013\u003c/span\u003e), while also addressing psychosocial factors for a more comprehensive treatment approach (Golan \u0026amp; Crow).\u003c/p\u003e \u003cp\u003e \u003cem\u003eTransition to the real world\u003c/em\u003e \u003c/p\u003e \u003cp\u003e Both parents and children often ask about post-program experiences and outcomes. While many individuals initially lose weight, a considerable number regain it within five years, particularly concerning for adolescents. This age group, marked by hormonal and behavioral shifts, may struggle to maintain new habits (Wing \u0026amp; Phelan, \u003cspan citationid=\"CR117\" class=\"CitationRef\"\u003e2005\u003c/span\u003e). After intervention programs, adolescents often revert to unhealthy eating and reduced physical activity, contributing to weight regain. This cycle is linked to insufficient ongoing support and ineffective maintenance strategies (Epstein et al., \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). Moreover, family involvement is essential for the long-term success of weight loss interventions in adolescents (Golan \u0026amp; Crow, 2023).\u003c/p\u003e \u003cp\u003e \u003cb\u003eAttendance\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThe research objectives from the focus groups were supplemented by an analysis of the program's attendance rate, which was recorded at 82%. In health self-management programs, attendance refers to participants' adherence to scheduled sessions. An attendance rate exceeding 70% is deemed satisfactory, indicating a strong commitment and potential effectiveness of the program (Gauci et al., \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e2022\u003c/span\u003e).\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe TeenFit intervention was developed and pilot-tested, demonstrating feasibility, acceptability, and positive attendance rates in a health self-management program for adolescents with obesity. Grounded in behavioral change theories, particularly self-determination theory, self-regulation, and the COM-B model, the intervention fosters adherence and satisfaction among participants, caregivers, and health professionals. Key success factors include session frequency, a multidisciplinary approach, and a strong supportive group dynamic. Nonetheless, logistical barriers and the need for improved communication have been identified as areas for enhancement. These findings suggest that interventions like TeenFit may effectively facilitate healthy lifestyle changes in adolescents with obesity, provided that adaptations address the identified challenges.\u003c/p\u003e \u003cp\u003e \u003cb\u003eLimitations\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThe variability during the sessions, compounded by logistical and organizational challenges, adversely impacted the consistency of the meetings. Insufficient communication regarding schedules and venues significantly influenced outcomes and should be addressed in future program implementations. Additionally, technological barriers, notably the pervasive use of mobile phones among adolescents, were identified as impediments. It is advisable that future programs incorporate strategies to mitigate these distractions by utilizing technology in a constructive and regulated manner. These findings and recommendations create a foundational framework for enhancing health self-management programs for youth with obesity, thereby contributing to a more effective approach to combatting childhood obesity.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eThe authors formally declare that no financial support, grants, or any other form of assistance were received during the development and preparation of this manuscript.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eM.L. and H.V.P. wrote the main manuscript text, and R.C. prepared figures 1-2.All authors reviewed the manuscript\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAl-Daghri NM, Amer OE, Khattak MNK, Hussain SD, Alkhaldi G, Alfawaz HA, Elsaid MA, Sabico S (2023) Attendance-Based Adherence and Outcomes of Obesity Management Program in Arab Adolescents. Children 10(9):1449. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3390/children10091449\u003c/span\u003e\u003cspan address=\"10.3390/children10091449\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAmianto F (2018) Non-surgical Weight Loss and Body Image Changes in Children, Adolescents, and Adults. Em M. Cuzzolaro \u0026amp; S. Fassino (Eds.), \u003cem\u003eBody Image, Eating, and Weight\u003c/em\u003e (pp. 219\u0026ndash;232). Springer International Publishing. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/978-3-319-90817-5_16\u003c/span\u003e\u003cspan address=\"10.1007/978-3-319-90817-5_16\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAmiri P, Mansouri-Tehrani MM, Khalili-Chelik A, Karimi M, Jalali-Farahani S, Amouzegar A, Kazemian E (2022) Does Motivational Interviewing Improve the Weight Management Process in Adolescents? A Systematic Review and Meta-analysis. Int J Behav Med 29(1):78\u0026ndash;103. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s12529-021-09994-w\u003c/span\u003e\u003cspan address=\"10.1007/s12529-021-09994-w\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBalduino ADFA, Mantovani MDF, Lacerda MR, Meier MJ (2013) Conceptual analysis of self-management of hypertensive individuals. Revista Ga\u0026uacute;cha de Enfermagem 34(4):37\u0026ndash;44. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1590/S1983-14472013000400005\u003c/span\u003e\u003cspan address=\"10.1590/S1983-14472013000400005\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBeauchamp MR, Ruissen GR, Dunlop WL, Estabrooks PA, Harden SM, Wolf SA, Liu Y, Schmader T, Puterman E, Sheel AW, Rhodes RE (2018) Group-based physical activity for older adults (GOAL) randomized controlled trial: Exercise adherence outcomes. Health Psychol 37(5):451\u0026ndash;461. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1037/hea0000615\u003c/span\u003e\u003cspan address=\"10.1037/hea0000615\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBehr H, Earl S, Ho AS, Lee J, Mitchell ES, McCallum M, May CN, Michaelides A (2022) Changes in Health-Promoting Behaviors and Their Association with Weight Loss, Retention, and Engagement on a Digital Program: Prospective Study. Nutrients 14(22):4812. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3390/nu14224812\u003c/span\u003e\u003cspan address=\"10.3390/nu14224812\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBerge JM, Wall M, Larson N, Loth KA, Neumark-Sztainer D (2013) Family Functioning: Associations With Weight Status, Eating Behaviors, and Physical Activity in Adolescents. J Adolesc Health 52(3):351\u0026ndash;357. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.jadohealth.2012.07.006\u003c/span\u003e\u003cspan address=\"10.1016/j.jadohealth.2012.07.006\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBerge JM, Wall M, Neumark-Sztainer D, Larson N, Story M (2010) Parenting Style and Family Meals: Cross-Sectional and 5-Year Longitudinal Associations. J Am Diet Assoc 110(7):1036\u0026ndash;1042. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.jada.2010.04.011\u003c/span\u003e\u003cspan address=\"10.1016/j.jada.2010.04.011\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBerge JΜ (2009) A review of familial correlates of child and adolescent obesity: What has the 21st Century taught us so far? Int J Adolesc Med Health 21(4). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1515/IJAMH.2009.21.4.457\u003c/span\u003e\u003cspan address=\"10.1515/IJAMH.2009.21.4.457\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBiddle SJH, Asare M (2011) Physical activity and mental health in children and adolescents: A review of reviews. Br J Sports Med 45(11):886\u0026ndash;895. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1136/bjsports-2011-090185\u003c/span\u003e\u003cspan address=\"10.1136/bjsports-2011-090185\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBiddle SJH, Braithwaite R, Pearson N (2014) The effectiveness of interventions to increase physical activity among young girls: A meta-analysis. Prev Med 62:119\u0026ndash;131. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.ypmed.2014.02.009\u003c/span\u003e\u003cspan address=\"10.1016/j.ypmed.2014.02.009\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBorrelli B, Riekert KA, Weinstein A, Rathier L (2007) Brief motivational interviewing as a clinical strategy to promote asthma medication adherence. J Allergy Clin Immunol 120(5):1023\u0026ndash;1030. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.jaci.2007.08.017\u003c/span\u003e\u003cspan address=\"10.1016/j.jaci.2007.08.017\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBraet C, Beyers W (2009) Subtyping children and adolescents who are overweight: Different symptomatology and treatment outcomes. J Consult Clin Psychol 77(5):814\u0026ndash;824. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1037/a0016304\u003c/span\u003e\u003cspan address=\"10.1037/a0016304\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBrown HE, Pearson N, Braithwaite RE, Brown WJ, Biddle SJH (2013) Physical Activity Interventions and Depression in Children and Adolescents: A Systematic Review and Meta-Analysis. Sports Med 43(3):195\u0026ndash;206. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s40279-012-0015-8\u003c/span\u003e\u003cspan address=\"10.1007/s40279-012-0015-8\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBuru K, Emeto TI, Malau-Aduli AEO, Malau-Aduli BS (2020) The Efficacy of School-Based Interventions in Preventing Adolescent Obesity in Australia. Healthcare 8(4):514. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3390/healthcare8040514\u003c/span\u003e\u003cspan address=\"10.3390/healthcare8040514\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCafazzo JA, Casselman M, Hamming N, Katzman DK, Palmert MR (2012) Design of an mHealth App for the Self-management of Adolescent Type 1 Diabetes: A Pilot Study. J Med Internet Res 14(3):e70. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.2196/jmir.2058\u003c/span\u003e\u003cspan address=\"10.2196/jmir.2058\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCarbert NS, Brussoni M, Geller J, M\u0026acirc;sse LC (2019) Familial Environment and Overweight/Obese Adolescents\u0026rsquo; Physical Activity. Int J Environ Res Public Health 16(14):2558. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3390/ijerph16142558\u003c/span\u003e\u003cspan address=\"10.3390/ijerph16142558\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChaput J-P, Willumsen J, Bull F, Chou R, Ekelund U, Firth J, Jago R, Ortega FB, Katzmarzyk PT (2020) 2020 WHO guidelines on physical activity and sedentary behaviour for children and adolescents aged 5\u0026ndash;17 years: Summary of the evidence. Int J Behav Nutr Phys Activity 17(1):141. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/s12966-020-01037-z\u003c/span\u003e\u003cspan address=\"10.1186/s12966-020-01037-z\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChiumento A, Mukherjee I, Chandna J, Dutton C, Rahman A, Bristow K (2018) A haven of green space: Learning from a pilot pre-post evaluation of a school-based social and therapeutic horticulture intervention with children. BMC Public Health 18(1):836. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/s12889-018-5661-9\u003c/span\u003e\u003cspan address=\"10.1186/s12889-018-5661-9\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChriqui JF, Taber DR, Slater SJ, Turner L, Lowrey KM, Chaloupka FJ (2012) The impact of state safe routes to school-related laws on active travel to school policies and practices in U.S. elementary schools. Health Place 18(1):8\u0026ndash;15. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.healthplace.2011.08.006\u003c/span\u003e\u003cspan address=\"10.1016/j.healthplace.2011.08.006\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDamschroder LJ, Aron DC, Keith RE, Kirsh SR, Alexander JA, Lowery JC (2009) Fostering implementation of health services research findings into practice: A consolidated framework for advancing implementation science. Implement Sci 4(1):50. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/1748-5908-4-50\u003c/span\u003e\u003cspan address=\"10.1186/1748-5908-4-50\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDavis CL, Pollock NK, Waller JL, Allison JD, Dennis BA, Bassali R, Mel\u0026eacute;ndez A, Boyle CA, Gower BA (2012) Exercise Dose and Diabetes Risk in Overweight and Obese Children: A Randomized Controlled Trial. JAMA 308(11):1103. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1001/2012.jama.10762\u003c/span\u003e\u003cspan address=\"10.1001/2012.jama.10762\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDavison KK, Jurkowski JM, Li K, Kranz S, Lawson HA (2013) A childhood obesity intervention developed by families for families: Results from a pilot study. Int J Behav Nutr Phys Activity 10(1):3. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/1479-5868-10-3\u003c/span\u003e\u003cspan address=\"10.1186/1479-5868-10-3\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDe Miguel-Etayo P, Bueno G, Garagorri JM, Moreno LA (2013) Interventions for Treating Obesity in Children. Em H. Szajewska \u0026amp; R. Shamir (Eds.), \u003cem\u003eWorld Review of Nutrition and Dietetics\u003c/em\u003e (Vol. 108, pp. 98\u0026ndash;106). S. Karger AG. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1159/000351493\u003c/span\u003e\u003cspan address=\"10.1159/000351493\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDeci EL, Ryan RM (eds) (2004) Handbook of self-determination research. Softcover edition. University of Rochester\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDietz WH, Robinson TN (2005) Overweight Children and Adolescents. N Engl J Med 352(20):2100\u0026ndash;2109. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1056/NEJMcp043052\u003c/span\u003e\u003cspan address=\"10.1056/NEJMcp043052\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDing D, Sallis JF, Kerr J, Lee S, Rosenberg DE (2011) Neighborhood Environment and Physical Activity Among Youth. Am J Prev Med 41(4):442\u0026ndash;455. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.amepre.2011.06.036\u003c/span\u003e\u003cspan address=\"10.1016/j.amepre.2011.06.036\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDonin AS, Goldsmith LP, Sharp C, Wahlich C, Whincup PH, Ussher MH (2024) Identifying barriers and facilitators to increase fibre intakes in UK primary school children and exploring the acceptability of intervention components: A UK qualitative study. Public Health Nutr 27(1):e59. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1017/S1368980024000089\u003c/span\u003e\u003cspan address=\"10.1017/S1368980024000089\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDonlan AE, Lynch AD, Lerner RM (2015) Peer Relationships and Positive Youth Development. Em E. P. Bowers, G. J. Geldhof, S. K. Johnson, L. J. Hilliard, R. M. Hershberg, J. V. Lerner, \u0026amp; R. M. Lerner (Eds.), \u003cem\u003ePromoting Positive Youth Development\u003c/em\u003e (pp. 121\u0026ndash;136). Springer International Publishing. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/978-3-319-17166-1_7\u003c/span\u003e\u003cspan address=\"10.1007/978-3-319-17166-1_7\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDurlak JA, DuPre EP (2008) Implementation Matters: A Review of Research on the Influence of Implementation on Program Outcomes and the Factors Affecting Implementation. Am J Community Psychol 41(3\u0026ndash;4):327\u0026ndash;350. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s10464-008-9165-0\u003c/span\u003e\u003cspan address=\"10.1007/s10464-008-9165-0\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEl-Behadli AF, Sharp C, Hughes SO, Obasi EM, Nicklas TA (2015) Maternal depression, stress and feeding styles: Towards a framework for theory and research in child obesity. Br J Nutr 113(S1):S55\u0026ndash;S71. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1017/S000711451400333X\u003c/span\u003e\u003cspan address=\"10.1017/S000711451400333X\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEpstein LH, Wilfley DE, Kilanowski C, Quattrin T, Cook SR, Eneli IU, Geller N, Lew D, Wallendorf M, Dore P, Paluch RA, Schechtman KB (2023) Family-Based Behavioral Treatment for Childhood Obesity Implemented in Pediatric Primary Care: A Randomized Clinical Trial. \u003cem\u003eJAMA\u003c/em\u003e, \u003cem\u003e329\u003c/em\u003e(22), 1947. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1001/jama.2023.8061\u003c/span\u003e\u003cspan address=\"10.1001/jama.2023.8061\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFaith MS, Van Horn L, Appel LJ, Burke LE, Carson JAS, Franch HA, Jakicic JM, Kral TVE, Odoms-Young A, Wansink B, Wylie-Rosett J (2012) Evaluating Parents and Adult Caregivers as Agents of Change for Treating Obese Children: Evidence for Parent Behavior Change Strategies and Research Gaps: A Scientific Statement From the American Heart Association. Circulation 125(9):1186\u0026ndash;1207. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1161/CIR.0b013e31824607ee\u003c/span\u003e\u003cspan address=\"10.1161/CIR.0b013e31824607ee\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eQi F, Zhou H, Sun B, Lin Zhang (2023) Ying Huang, \u0026amp;. \u003cem\u003eHow do boundary-crossing researchers contribute to the interdisciplinary knowledge flows? Evidence from physics\u003c/em\u003e. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.5281/ZENODO.8305942\u003c/span\u003e\u003cspan address=\"10.5281/ZENODO.8305942\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFjeldsoe BS, Marshall AL, Miller YD (2009) Behavior Change Interventions Delivered by Mobile Telephone Short-Message Service. Am J Prev Med 36(2):165\u0026ndash;173. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.amepre.2008.09.040\u003c/span\u003e\u003cspan address=\"10.1016/j.amepre.2008.09.040\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFoster GD, Wadden TA, Makris AP, Davidson D, Sanderson RS, Allison DB, Kessler A (2003) Primary Care Physicians\u0026rsquo; Attitudes about Obesity and Its Treatment. Obes Res 11(10):1168\u0026ndash;1177. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1038/oby.2003.161\u003c/span\u003e\u003cspan address=\"10.1038/oby.2003.161\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGately P, Cooke C, Butterly R, Mackreth P, Carroll S (2000) The effects of a children\u0026rsquo;s summer camp programme on weight loss, with a 10 month follow-up. Int J Obes 24(11):1445\u0026ndash;1452. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1038/sj.ijo.0801405\u003c/span\u003e\u003cspan address=\"10.1038/sj.ijo.0801405\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGauci J, Bloomfield J, Lawn S, Towns S, Hobbs A, Steinbeck K (2022) A randomized controlled trial evaluating the effectiveness of a self-management program for adolescents with a chronic condition: A study protocol. Trials 23(1):850. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/s13063-022-06740-9\u003c/span\u003e\u003cspan address=\"10.1186/s13063-022-06740-9\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGolan M, Crow S (2004) Targeting Parents Exclusively in the Treatment of Childhood Obesity: Long-Term Results. Obes Res 12(2):357\u0026ndash;361. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1038/oby.2004.45\u003c/span\u003e\u003cspan address=\"10.1038/oby.2004.45\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGolan M, Weizman A, Apter A, Fainaru M (1998) Parents as the exclusive agents of change in the treatment of childhood obesity. Am J Clin Nutr 67(6):1130\u0026ndash;1135. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1093/ajcn/67.6.1130\u003c/span\u003e\u003cspan address=\"10.1093/ajcn/67.6.1130\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGoldschmidt AB, Wilfley DE, Paluch RA, Roemmich JN, Epstein LH (2013) Indicated Prevention of Adult Obesity: How Much Weight Change Is Necessary for Normalization of Weight Status in Children? JAMA Pediatr 167(1):21. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1001/jamapediatrics.2013.416\u003c/span\u003e\u003cspan address=\"10.1001/jamapediatrics.2013.416\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGriffiths LJ (2005) Obesity and bullying: Different effects for boys and girls. Arch Dis Child 91(2):121\u0026ndash;125. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1136/adc.2005.072314\u003c/span\u003e\u003cspan address=\"10.1136/adc.2005.072314\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGunawardana S, Gunasinghe CB, Harshani MS, Seneviratne SN (2021) Physical and psychosocial quality of life in children with overweight and obesity from Sri Lanka. BMC Public Health 21(1):86. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/s12889-020-10104-w\u003c/span\u003e\u003cspan address=\"10.1186/s12889-020-10104-w\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHagger MS, Hardcastle SJ (2014) Interpersonal style should be included in taxonomies of behavior change techniques. \u003cem\u003eFrontiers in Psychology\u003c/em\u003e, \u003cem\u003e5\u003c/em\u003e. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3389/fpsyg.2014.00254\u003c/span\u003e\u003cspan address=\"10.3389/fpsyg.2014.00254\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHaines J, Rifas-Shiman SL, Horton NJ, Kleinman K, Bauer KW, Davison KK, Walton K, Austin SB, Field AE, Gillman MW (2016) Family functioning and quality of parent-adolescent relationship: Cross-sectional associations with adolescent weight-related behaviors and weight status. Int J Behav Nutr Phys Activity 13(1):68. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/s12966-016-0393-7\u003c/span\u003e\u003cspan address=\"10.1186/s12966-016-0393-7\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHemmingsson E (2014) A new model of the role of psychological and emotional distress in promoting obesity: Conceptual review with implications for treatment and prevention. Obes Rev 15(9):769\u0026ndash;779. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1111/obr.12197\u003c/span\u003e\u003cspan address=\"10.1111/obr.12197\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHills AP, Dengel DR, Lubans DR (2015) Supporting Public Health Priorities: Recommendations for Physical Education and Physical Activity Promotion in Schools. Prog Cardiovasc Dis 57(4):368\u0026ndash;374. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.pcad.2014.09.010\u003c/span\u003e\u003cspan address=\"10.1016/j.pcad.2014.09.010\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHo M, Garnett SP, Baur L, Burrows T, Stewart L, Neve M, Collins C (2012) Effectiveness of Lifestyle Interventions in Child Obesity: Systematic Review With Meta-analysis. Pediatrics 130(6):e1647\u0026ndash;e1671. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1542/peds.2012-1176\u003c/span\u003e\u003cspan address=\"10.1542/peds.2012-1176\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHoelscher DM, Kirk S, Ritchie L, Cunningham-Sabo L (2013) Position of the Academy of Nutrition and Dietetics: Interventions for the Prevention and Treatment of Pediatric Overweight and Obesity. J Acad Nutr Dietetics 113(10):1375\u0026ndash;1394. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.jand.2013.08.004\u003c/span\u003e\u003cspan address=\"10.1016/j.jand.2013.08.004\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHoms C, Berruezo P, Seg\u0026uacute;n G, Estrada L, De Bont J, Riera-Roman\u0026iacute; J, Carrillo-\u0026Aacute;lvarez E, Schr\u0026ouml;der H, Mil\u0026agrave; R, G\u0026oacute;mez SF (2021) Family-based intervention to prevent childhood obesity among school-age children of low socioeconomic status: Study protocol of the FIVALIN project. BMC Pediatr 21(1):246. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/s12887-021-02697-x\u003c/span\u003e\u003cspan address=\"10.1186/s12887-021-02697-x\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHoule J, Gascon-Depatie M, B\u0026eacute;langer-Dumontier G, Cardinal C (2013) Depression self-management support: A systematic review. Patient Educ Couns 91(3):271\u0026ndash;279. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.pec.2013.01.012\u003c/span\u003e\u003cspan address=\"10.1016/j.pec.2013.01.012\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHu D, Zhou S, Crowley-McHattan ZJ, Liu Z (2021) Factors That Influence Participation in Physical Activity in School-Aged Children and Adolescents: A Systematic Review from the Social Ecological Model Perspective. Int J Environ Res Public Health 18(6):3147. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3390/ijerph18063147\u003c/span\u003e\u003cspan address=\"10.3390/ijerph18063147\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHulya G, En A, K (2015) A SHORT REVIEW of TPACK for TEACHER EDUCATION. Educational Res Reviews 10(7):777\u0026ndash;789. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.5897/ERR2014.1982\u003c/span\u003e\u003cspan address=\"10.5897/ERR2014.1982\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eInguva P, Shah P, Shah U, Brechtelsbauer C (2021) How to Design Experiential Learning Resources for Independent Learning. J Chem Educ 98(4):1182\u0026ndash;1192. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1021/acs.jchemed.0c00990\u003c/span\u003e\u003cspan address=\"10.1021/acs.jchemed.0c00990\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eInstitute of Medicine (US) Committee on an Evidence Framework for Obesity Prevention Decision Making (2010) In: Kumanyika SK, Parker L, Sim LJ (eds) Bridging the Evidence Gap in Obesity Prevention: A Framework to Inform Decision Making. National Academies Press (US. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://www.ncbi.nlm.nih.gov/books/NBK220184/\u003c/span\u003e\u003cspan address=\"http://www.ncbi.nlm.nih.gov/books/NBK220184/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJanssen I, LeBlanc AG (2010) Systematic review of the health benefits of physical activity and fitness in school-aged children and youth. Int J Behav Nutr Phys Activity 7(1):40. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/1479-5868-7-40\u003c/span\u003e\u003cspan address=\"10.1186/1479-5868-7-40\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJiang F, Zhu S, Yan C, Jin X, Bandla H, Shen X (2009) Sleep and Obesity in Preschool Children. J Pediatr 154(6):814\u0026ndash;818. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.jpeds.2008.12.043\u003c/span\u003e\u003cspan address=\"10.1016/j.jpeds.2008.12.043\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJones M, Luce KH, Osborne MI, Taylor K, Cunning D, Doyle AC, Wilfley DE, Taylor CB (2008) Randomized, Controlled Trial of an Internet-Facilitated Intervention for Reducing Binge Eating and Overweight in Adolescents. Pediatrics 121(3):453\u0026ndash;462. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1542/peds.2007-1173\u003c/span\u003e\u003cspan address=\"10.1542/peds.2007-1173\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKaushal N, Keith N, Agui\u0026ntilde;aga S, Hagger MS (2020) Social Cognition and Socioecological Predictors of Home-Based Physical Activity Intentions, Planning, and Habits during the COVID-19 Pandemic. Behav Sci 10(9):133. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3390/bs10090133\u003c/span\u003e\u003cspan address=\"10.3390/bs10090133\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKelly AS, Barlow SE, Rao G, Inge TH, Hayman LL, Steinberger J, Urbina EM, Ewing LJ, Daniels SR (2013) Severe Obesity in Children and Adolescents: Identification, Associated Health Risks, and Treatment Approaches: A Scientific Statement From the American Heart Association. Circulation 128(15):1689\u0026ndash;1712. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1161/CIR.0b013e3182a5cfb3\u003c/span\u003e\u003cspan address=\"10.1161/CIR.0b013e3182a5cfb3\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKitzman-Ulrich H, Wilson DK, St. George SM, Lawman H, Segal M, Fairchild A (2010) The Integration of a Family Systems Approach for Understanding Youth Obesity, Physical Activity, and Dietary Programs. Clin Child Fam Psychol Rev 13(3):231\u0026ndash;253. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s10567-010-0073-0\u003c/span\u003e\u003cspan address=\"10.1007/s10567-010-0073-0\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKumar S, Kelly AS (2017) Review of Childhood Obesity. \u003cem\u003eMayo Clinic Proceedings\u003c/em\u003e, \u003cem\u003e92\u003c/em\u003e(2), 251\u0026ndash;265. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.mayocp.2016.09.017\u003c/span\u003e\u003cspan address=\"10.1016/j.mayocp.2016.09.017\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLepp A, Barkley JE, Sanders GJ, Rebold M, Gates P (2013) The relationship between cell phone use, physical and sedentary activity, and cardiorespiratory fitness in a sample of U.S. college students. Int J Behav Nutr Phys Activity 10(1):79. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/1479-5868-10-79\u003c/span\u003e\u003cspan address=\"10.1186/1479-5868-10-79\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLiao Y, Shonkoff ET, Dunton GF (2015) The Acute Relationships Between Affect, Physical Feeling States, and Physical Activity in Daily Life: A Review of Current Evidence. \u003cem\u003eFrontiers in Psychology\u003c/em\u003e, \u003cem\u003e6\u003c/em\u003e. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3389/fpsyg.2015.01975\u003c/span\u003e\u003cspan address=\"10.3389/fpsyg.2015.01975\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLindsay AC, Sussner KM, Kim J, Gortmaker SL (2006) The Role of Parents in Preventing Childhood Obesity. Future Child 16(1):169\u0026ndash;186. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1353/foc.2006.0006\u003c/span\u003e\u003cspan address=\"10.1353/foc.2006.0006\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLiu KSN, Chen JY, Ng MYC, Yeung MHY, Bedford LE, Lam CLK (2021) How Does the Family Influence Adolescent Eating Habits in Terms of Knowledge, Attitudes and Practices? A Global Systematic Review of Qualitative Studies. Nutrients 13(11):3717. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3390/nu13113717\u003c/span\u003e\u003cspan address=\"10.3390/nu13113717\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLloyd-Richardson EE, Jelalian E, Sato AF, Hart CN, Mehlenbeck R, Wing RR (2012) Two-Year Follow-up of an Adolescent Behavioral Weight Control Intervention. Pediatrics 130(2):e281\u0026ndash;e288. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1542/peds.2011-3283\u003c/span\u003e\u003cspan address=\"10.1542/peds.2011-3283\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLoth KA, MacLehose RF, Fulkerson JA, Crow S, Neumark-Sztainer D (2013) Food-Related Parenting Practices and Adolescent Weight Status: A Population-Based Study. Pediatrics 131(5):e1443\u0026ndash;e1450. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1542/peds.2012-3073\u003c/span\u003e\u003cspan address=\"10.1542/peds.2012-3073\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLubans DR, Plotnikoff RC, Lubans NJ (2012) Review: A systematic review of the impact of physical activity programmes on social and emotional well-being in at‐risk youth. Child Adolesc Mental Health 17(1):2\u0026ndash;13. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1111/j.1475-3588.2011.00623.x\u003c/span\u003e\u003cspan address=\"10.1111/j.1475-3588.2011.00623.x\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMartins J, Costa J, Sarmento H, Marques A, Farias C, Onofre M, Valeiro MG (2021) Adolescents\u0026rsquo; Perspectives on the Barriers and Facilitators of Physical Activity: An Updated Systematic Review of Qualitative Studies. Int J Environ Res Public Health 18(9):4954. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3390/ijerph18094954\u003c/span\u003e\u003cspan address=\"10.3390/ijerph18094954\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMazzeo SE, Kelly NR, Stern M, Gow RW, Serdar K, Evans RK, Jones RM, Bulik CM (2012) Nourishing Our Understanding of Role Modeling to Improve Support and Health (NOURISH): Design and methods. Contemp Clin Trials 33(3):515\u0026ndash;522. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.cct.2012.01.003\u003c/span\u003e\u003cspan address=\"10.1016/j.cct.2012.01.003\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMedeiros GCBSD, Azevedo KPMD, Garcia D, Oliveira Segundo VH, Mata \u0026Aacute;NDS, Fernandes AKP, Santos RPD, Trindade DDBDB, Moreno IM, Guill\u0026eacute;n Mart\u0026iacute;nez D, Piuvezam G (2022) Effect of School-Based Food and Nutrition Education Interventions on the Food Consumption of Adolescents: A Systematic Review and Meta-Analysis. Int J Environ Res Public Health 19(17):10522. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3390/ijerph191710522\u003c/span\u003e\u003cspan address=\"10.3390/ijerph191710522\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMichie S, Van Stralen MM, West R (2011) The behaviour change wheel: A new method for characterising and designing behaviour change interventions. Implement Sci 6(1):42. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/1748-5908-6-42\u003c/span\u003e\u003cspan address=\"10.1186/1748-5908-6-42\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNg JYY, Ntoumanis N, Th\u0026oslash;gersen-Ntoumani C, Deci EL, Ryan RM, Duda JL, Williams GC (2012) Self-Determination Theory Applied to Health Contexts: A Meta-Analysis. Perspect Psychol Sci 7(4):325\u0026ndash;340. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1177/1745691612447309\u003c/span\u003e\u003cspan address=\"10.1177/1745691612447309\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNguyen B, Kornman KP, Baur LA (2011) A review of electronic interventions for prevention and treatment of overweight and obesity in young people. Obes Rev 12(5). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1111/j.1467-789X.2010.00830.x\u003c/span\u003e\u003cspan address=\"10.1111/j.1467-789X.2010.00830.x\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOgden CL, Carroll MD, Kit BK, Flegal KM (2014) Prevalence of Childhood and Adult Obesity in the United States, 2011\u0026ndash;2012. JAMA 311(8):806. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1001/jama.2014.732\u003c/span\u003e\u003cspan address=\"10.1001/jama.2014.732\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOkely AD, Booth ML, Chey T (2004) Relationships between Body Composition and Fundamental Movement Skills among Children and Adolescents. Res Q Exerc Sport 75(3):238\u0026ndash;247. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1080/02701367.2004.10609157\u003c/span\u003e\u003cspan address=\"10.1080/02701367.2004.10609157\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePbert L, Druker S, Barton B, Schneider KL, Olendzki B, Gapinski MA, Kurtz S, Osganian S (2016) A School-Based Program for Overweight and Obese Adolescents: A Randomized Controlled Trial. J Sch Health 86(10):699\u0026ndash;708. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1111/josh.12428\u003c/span\u003e\u003cspan address=\"10.1111/josh.12428\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePearson N, Atkin AJ, Biddle SJ, Gorely T (2010) A family-based intervention to increase fruit and vegetable consumption in adolescents: A pilot study. Public Health Nutr 13(06):876\u0026ndash;885. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1017/S1368980010000121\u003c/span\u003e\u003cspan address=\"10.1017/S1368980010000121\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePearson N, Braithwaite RE, Biddle SJH, Van Sluijs EMF, Atkin AJ (2014) Associations between sedentary behaviour and physical activity in children and adolescents: A meta-analysis. Obes Rev 15(8):666\u0026ndash;675. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1111/obr.12188\u003c/span\u003e\u003cspan address=\"10.1111/obr.12188\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePetrovics P, Nagy A, Sandor B, Palfi A, Szekeres Z, Toth K, Szabados E (2021) Examination of Self-Esteem, Body Image, Eating Attitudes and Cardiorespiratory Performance in Adolescents. Int J Environ Res Public Health 18(24):13172. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3390/ijerph182413172\u003c/span\u003e\u003cspan address=\"10.3390/ijerph182413172\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePont SJ, Puhl R, Cook SR, Slusser W, SECTION ON OBESITY, \u0026amp; THE OBESITY SOCIETY (2017) Stigma Experienced by Children and Adolescents With Obesity. Pediatrics 140(6):e20173034. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1542/peds.2017-3034\u003c/span\u003e\u003cspan address=\"10.1542/peds.2017-3034\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePrzybylski AK, Weinstein N (2013) Can you connect with me now? How the presence of mobile communication technology influences face-to-face conversation quality. J Social Personal Relationships 30(3):237\u0026ndash;246. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1177/0265407512453827\u003c/span\u003e\u003cspan address=\"10.1177/0265407512453827\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePuhl RM, Himmelstein MS, Pearl RL (2020) Weight stigma as a psychosocial contributor to obesity. Am Psychol 75(2):274\u0026ndash;289. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1037/amp0000538\u003c/span\u003e\u003cspan address=\"10.1037/amp0000538\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eReinehr T (2011) Effectiveness of lifestyle intervention in overweight children. \u003cem\u003eProceedings of the Nutrition Society\u003c/em\u003e, \u003cem\u003e70\u003c/em\u003e(4), 494\u0026ndash;505. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1017/S0029665111000577\u003c/span\u003e\u003cspan address=\"10.1017/S0029665111000577\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eResnicow K, McMaster F, Bocian A, Harris D, Zhou Y, Snetselaar L, Schwartz R, Myers E, Gotlieb J, Foster J, Hollinger D, Smith K, Woolford S, Mueller D, Wasserman RC (2015) Motivational Interviewing and Dietary Counseling for Obesity in Primary Care: An RCT. Pediatrics 135(4):649\u0026ndash;657. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1542/peds.2014-1880\u003c/span\u003e\u003cspan address=\"10.1542/peds.2014-1880\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRhodes RE, Guerrero MD, Vanderloo LM, Barbeau K, Birken CS, Chaput J-P, Faulkner G, Janssen I, Madigan S, M\u0026acirc;sse LC, McHugh T-L, Perdew M, Stone K, Shelley J, Spinks N, Tamminen KA, Tomasone JR, Ward H, Welsh F, Tremblay MS (2020) Development of a consensus statement on the role of the family in the physical activity, sedentary, and sleep behaviours of children and youth. Int J Behav Nutr Phys Activity 17(1):74. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/s12966-020-00973-0\u003c/span\u003e\u003cspan address=\"10.1186/s12966-020-00973-0\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRyan RM (ed) (2023) The Oxford handbook of self-determination theory. Oxford University Press\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRyan RM, Deci EL (2000) Self-determination theory and the facilitation of intrinsic motivation, social development, and well-being. Am Psychol 55(1):68\u0026ndash;78. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1037/0003-066X.55.1.68\u003c/span\u003e\u003cspan address=\"10.1037/0003-066X.55.1.68\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRyan RM, Deci EL, Vansteenkiste M, Soenens B (2021) Building a science of motivated persons: Self-determination theory\u0026rsquo;s empirical approach to human experience and the regulation of behavior. Motivation Sci 7(2):97\u0026ndash;110. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1037/mot0000194\u003c/span\u003e\u003cspan address=\"10.1037/mot0000194\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSahoo K, Sahoo B, Choudhury A, Sofi N, Kumar R, Bhadoria A (2015) Childhood obesity: Causes and consequences. J Family Med Prim Care 4(2):187. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.4103/2249-4863.154628\u003c/span\u003e\u003cspan address=\"10.4103/2249-4863.154628\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSalmon J, Booth ML, Phongsavan P, Murphy N, Timperio A (2007) Promoting Physical Activity Participation among Children and Adolescents. Epidemiol Rev 29(1):144\u0026ndash;159. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1093/epirev/mxm010\u003c/span\u003e\u003cspan address=\"10.1093/epirev/mxm010\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSawka KJ, McCormack GR, Nettel-Aguirre A, Hawe P, Doyle-Baker PK (2013) Friendship networks and physical activity and sedentary behavior among youth: A systematized review. Int J Behav Nutr Phys Activity 10(1):130. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/1479-5868-10-130\u003c/span\u003e\u003cspan address=\"10.1186/1479-5868-10-130\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSawyer MG, Harchak T, Wake M, Lynch J (2011) Four-Year Prospective Study of BMI and Mental Health Problems in Young Children. Pediatrics 128(4):677\u0026ndash;684. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1542/peds.2010-3132\u003c/span\u003e\u003cspan address=\"10.1542/peds.2010-3132\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSingh AS, Saliasi E, Van Den Berg V, Uijtdewilligen L, De Groot RHM, Jolles J, Andersen LB, Bailey R, Chang Y-K, Diamond A, Ericsson I, Etnier JL, Fedewa AL, Hillman CH, McMorris T, Pesce C, P\u0026uuml;hse U, Tomporowski PD, Chinapaw MJM (2019) Effects of physical activity interventions on cognitive and academic performance in children and adolescents: A novel combination of a systematic review and recommendations from an expert panel. Br J Sports Med 53(10):640\u0026ndash;647. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1136/bjsports-2017-098136\u003c/span\u003e\u003cspan address=\"10.1136/bjsports-2017-098136\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSkinner AC, Perrin EM, Moss LA, Skelton JA (2015) Cardiometabolic Risks and Severity of Obesity in Children and Young Adults. N Engl J Med 373(14):1307\u0026ndash;1317. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1056/NEJMoa1502821\u003c/span\u003e\u003cspan address=\"10.1056/NEJMoa1502821\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSmith AL, Ullrich-French S, Walker E, Hurley KS (2006) Peer Relationship Profiles and Motivation in Youth Sport. J Sport Exerc Psychol 28(3):362\u0026ndash;382. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1123/jsep.28.3.362\u003c/span\u003e\u003cspan address=\"10.1123/jsep.28.3.362\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSmith JD, Monta\u0026ntilde;o Z, Dishion TJ, Shaw DS, Wilson MN (2015) Preventing Weight Gain and Obesity: Indirect Effects of the Family Check-Up in Early Childhood. Prev Sci 16(3):408\u0026ndash;419. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s11121-014-0505-z\u003c/span\u003e\u003cspan address=\"10.1007/s11121-014-0505-z\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSmith JJ, Eather N, Morgan PJ, Plotnikoff RC, Faigenbaum AD, Lubans DR (2014) The Health Benefits of Muscular Fitness for Children and Adolescents: A Systematic Review and Meta-Analysis. Sports Med 44(9):1209\u0026ndash;1223. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s40279-014-0196-4\u003c/span\u003e\u003cspan address=\"10.1007/s40279-014-0196-4\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eStaiano AE, Marker AM, Martin CK, Katzmarzyk PT (2016) Physical activity, mental health, and weight gain in a longitudinal observational cohort of nonobese young adults. Obesity 24(9):1969\u0026ndash;1975. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1002/oby.21567\u003c/span\u003e\u003cspan address=\"10.1002/oby.21567\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eStandage M, Gillison FB, Ntoumanis N, Treasure DC (2012) Predicting Students\u0026rsquo; Physical Activity and Health-Related Well-Being: A Prospective Cross-Domain Investigation of Motivation Across School Physical Education and Exercise Settings. J Sport Exerc Psychol 34(1):37\u0026ndash;60. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1123/jsep.34.1.37\u003c/span\u003e\u003cspan address=\"10.1123/jsep.34.1.37\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eStevens J, Taber DR, Murray DM, Ward DS (2007) Advances and Controversies in the Design of Obesity Prevention Trials. Obesity 15(9):2163\u0026ndash;2170. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1038/oby.2007.257\u003c/span\u003e\u003cspan address=\"10.1038/oby.2007.257\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eStice E, Shaw H, Marti CN (2006) A meta-analytic review of obesity prevention programs for children and adolescents: The skinny on interventions that work. Psychol Bull 132(5):667\u0026ndash;691. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1037/0033-2909.132.5.667\u003c/span\u003e\u003cspan address=\"10.1037/0033-2909.132.5.667\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eStory M, Kaphingst PD, K. M., French S (2006) The Role of Schools in Obesity Prevention. Future Child 16(1):109\u0026ndash;142. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1353/foc.2006.0007\u003c/span\u003e\u003cspan address=\"10.1353/foc.2006.0007\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSubramaniam M, Devi F, AshaRani PV, Zhang Y, Wang P, Jeyagurunathan A, Roystonn K, Vaingankar JA, Chong SA (2022) Barriers and facilitators for adopting a healthy lifestyle in a multi-ethnic population: A qualitative study. PLoS ONE 17(11):e0277106. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1371/journal.pone.0277106\u003c/span\u003e\u003cspan address=\"10.1371/journal.pone.0277106\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTay A, Hoeksema H, Murphy R (2023) Uncovering Barriers and Facilitators of Weight Loss and Weight Loss Maintenance: Insights from Qualitative Research. Nutrients 15(5):1297. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3390/nu15051297\u003c/span\u003e\u003cspan address=\"10.3390/nu15051297\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eThornberg R, W\u0026auml;nstr\u0026ouml;m L, Hong JS, Espelage DL (2017) Classroom relationship qualities and social-cognitive correlates of defending and passive bystanding in school bullying in Sweden: A multilevel analysis. J Sch Psychol 63:49\u0026ndash;62. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.jsp.2017.03.002\u003c/span\u003e\u003cspan address=\"10.1016/j.jsp.2017.03.002\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTrigueros R, Aguilar-Parra JM, Cangas AJ, Bermejo R, Ferrandiz C, L\u0026oacute;pez-Liria R (2019) Influence of Emotional Intelligence, Motivation and Resilience on Academic Performance and the Adoption of Healthy Lifestyle Habits among Adolescents. Int J Environ Res Public Health 16(16):2810. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3390/ijerph16162810\u003c/span\u003e\u003cspan address=\"10.3390/ijerph16162810\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTwiddy M, Wilson I, Bryant M, Rudolf M (2012) Lessons learned from a family-focused weight management intervention for obese and overweight children. Public Health Nutr 15(7):1310\u0026ndash;1317. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1017/S1368980011003211\u003c/span\u003e\u003cspan address=\"10.1017/S1368980011003211\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eUfholz K (2020) Peer Support Groups for Weight Loss. Curr Cardiovasc Risk Rep 14(10):19. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s12170-020-00654-4\u003c/span\u003e\u003cspan address=\"10.1007/s12170-020-00654-4\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVan Lieshout M, Scholtes-Bos W, Van Der Horst-Graat JM, Van Holsteijn P, De Vries SI (2023) Development of the Food Boost Challenge: A Participatory Action Research Approach to Enhance Vegetable and Fruit Consumption among Adolescents. Nutrients 15(23):4921. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3390/nu15234921\u003c/span\u003e\u003cspan address=\"10.3390/nu15234921\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWadden TA, Webb VL, Moran CH, Bailer BA (2012) Lifestyle Modification for Obesity: New Developments in Diet, Physical Activity, and Behavior Therapy. Circulation 125(9):1157\u0026ndash;1170. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1161/CIRCULATIONAHA.111.039453\u003c/span\u003e\u003cspan address=\"10.1161/CIRCULATIONAHA.111.039453\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWarnick JL, Darling KE, West CE, Jones L, Jelalian E (2022) Weight Stigma and Mental Health in Youth: A Systematic Review and Meta-Analysis. J Pediatr Psychol 47(3):237\u0026ndash;255. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1093/jpepsy/jsab110\u003c/span\u003e\u003cspan address=\"10.1093/jpepsy/jsab110\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWhatnall MC, Hutchesson MJ, Sharkey T, Haslam RL, Bezzina A, Collins CE, Tzelepis F, Ashton LM (2021) Recruiting and retaining young adults: What can we learn from behavioural interventions targeting nutrition, physical activity and/or obesity? A systematic review of the literature. Public Health Nutr 24(17):5686\u0026ndash;5703. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1017/S1368980021001129\u003c/span\u003e\u003cspan address=\"10.1017/S1368980021001129\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWhite LJ, McCoy SC, Castellano V, Gutierrez G, Stevens JE, Walter GA, Vandenborne K (2004) Resistance training improves strength and functional capacity in persons with multiple sclerosis. Multiple Scler J 10(6):668\u0026ndash;674. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1191/1352458504ms1088oa\u003c/span\u003e\u003cspan address=\"10.1191/1352458504ms1088oa\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWilmer HH, Sherman LE, Chein JM (2017) Smartphones and Cognition: A Review of Research Exploring the Links between Mobile Technology Habits and Cognitive Functioning. Front Psychol 8:605. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3389/fpsyg.2017.00605\u003c/span\u003e\u003cspan address=\"10.3389/fpsyg.2017.00605\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWing RR, Phelan S (2005) Long-term weight loss maintenance. Am J Clin Nutr 82(1):222S\u0026ndash;225S. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1093/ajcn/82.1.222S\u003c/span\u003e\u003cspan address=\"10.1093/ajcn/82.1.222S\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWorld Medical Association (2013) World Medical Association Declaration of Helsinki: Ethical Principles for Medical Research Involving. Hum Subj JAMA 310(20):2191. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1001/jama.2013.281053\u003c/span\u003e\u003cspan address=\"10.1001/jama.2013.281053\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eXiao W, Wu J, Yip J, Shi Q, Peng L, Lei QE, Ren Z (2022) The Relationship Between Physical Activity and Mobile Phone Addiction Among Adolescents and Young Adults: Systematic Review and Meta-analysis of Observational Studies. JMIR Public Health Surveillance 8(12):e41606. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.2196/41606\u003c/span\u003e\u003cspan address=\"10.2196/41606\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYang J, Wang H, Luo L (2023) The association between meeting physical activity guidelines and academic performance among junior high school adolescents in China-evidence from the China education tracking survey. Front Psychol 14:1002839. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3389/fpsyg.2023.1002839\u003c/span\u003e\u003cspan address=\"10.3389/fpsyg.2023.1002839\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYu H, Li F, Hu Y, Li C, Yuan S, Song Y, Zheng M, Gong J, He Q (2020) Improving the Metabolic and Mental Health of Children with Obesity: A School-Based Nutrition Education and Physical Activity Intervention in Wuhan, China. Nutrients 12(1):194. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3390/nu12010194\u003c/span\u003e\u003cspan address=\"10.3390/nu12010194\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhong B, Sun H, Wang G, Junwen S, Tang S, Gao Y, Chen H, Lu T, Yan J (2024) Physical activity on the mental health of children and adolescents during COVID-19 pandemic-induced school closures\u0026mdash;A systematic review. PLoS ONE 19(6):e0299158. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1371/journal.pone.0299158\u003c/span\u003e\u003cspan address=\"10.1371/journal.pone.0299158\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZou Y, Liu S, Guo S, Zhao Q, Cai Y (2023) Peer Support and Exercise Adherence in Adolescents: The Chain-Mediated Effects of Self-Efficacy and Self-Regulation. Children 10(2):401. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3390/children10020401\u003c/span\u003e\u003cspan address=\"10.3390/children10020401\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Childhood obesity, Interdisciplinary intervention, Health self-management, Adolescent health, Pilot study","lastPublishedDoi":"10.21203/rs.3.rs-6991234/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6991234/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eIntroduction: \u003c/strong\u003eChildhood obesity represents a significant global public health challenge, associated with a multitude of severe comorbidities that impact various physiological and mental systems. This study describes the TeenFit program, an interdisciplinary intervention focused on health self-management for adolescents with obesity and presents the findings of its pilot study.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eThe TeenFit program was developed using self-determination theory, self-regulation, and the COM-B model. The study sample comprised seven adolescents aged 12 to 14, representing the upper 95th percentile of BMI for age and sex. This intervention was delivered by an interdisciplinary team of medical doctors, nutritionists, psychologists, and exercise physiologists. The program's duration was established at six months, incorporating two theoretical and practical exercise sessions each week and monthly workshops designed for the participant's parents. Data collection occurred at the three-month mark of the intervention.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eThe satisfaction levels reported by participants and their guardians were markedly high, underscoring the critical importance of multidisciplinary approaches and the consistent frequency of the sessions. Identified facilitators, the adaptability of the session structures, the positive dynamics within the group, and the supportive involvement of parents. Conversely, the primary barriers encountered pertained to logistical challenges and communication issues.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions: \u003c/strong\u003eThe findings suggest that implementing interventions aimed at health self-management is feasible and well-accepted among adolescents with obesity, demonstrating the potential to facilitate substantial and enduring behavioral changes. The effectiveness of this intervention warrants evaluation through a randomized controlled trial.\u003c/p\u003e","manuscriptTitle":"TEENFIT: A Self-Management Health Program for Adolescents with Obesity – Study Protocol and Pilot Study Findings","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-07-07 07:48:48","doi":"10.21203/rs.3.rs-6991234/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"0176509c-a9f5-4dcf-b4ab-8492f4374430","owner":[],"postedDate":"July 7th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-07-25T15:23:39+00:00","versionOfRecord":[],"versionCreatedAt":"2025-07-07 07:48:48","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6991234","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6991234","identity":"rs-6991234","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}