Systematic Review and Meta-Analysis: The Impact of...

Systematic Review and Meta-Analysis

The Impact of Multicomponent Weight

Management Interventions on Self-Esteem

in Overweight and Obese Adolescents

Margaret Murray BNUT(HONS) Aimee L Dordevic PHD and

Maxine P Bonham PHD

Department of Nutrition amp Dietetics Monash University

All correspondence concerning this article should be addressed to Maxine Bonham PHD Department of Nutrition

amp Dietetics Monash University Level 1 264 Ferntree Gully Rd Notting Hill Victoria 3168 Australia E-mail

maxinebonhammonashedu

Received April 24 2016 revisions received November 17 2016 accepted November 30 2016

Abstract

Objective Building self-esteem in overweight adolescents is key to long-term weight manage-

ment yet self-esteem is rarely a key outcome of adolescent weight management interventions

This systematic review investigates the impact of multicomponent weight management interven-

tions on self-esteem in overweight and obese adolescents Method Six databases were searched

in December 2014 Eligible studies met the following criteria (1) randomized controlled trial (2)

overweight or obese participants (3) adolescents (10ndash19 years) (4) multicomponent weight man-

agement intervention (5) reported self-esteem and weight changes Results Thirteen studies with

1157 overweight or obese adolescents aged 10ndash19 years were included Meta-analyses showed

no significant change in self-esteem (027 [004 059]) but body mass index z-score reduced

following intervention (017 [022 011]) Conclusion The lack of change in self-esteem sug-

gests weight loss alone is insufficient to improve self-esteem Multicomponent weight manage-

ment interventions require a specific focus on self-esteem to improve this outcome in overweight

and obese adolescents

Key words adolescent at-risk youth health promotion and prevention meta-analysis obesitysystematic review weight management

Introduction

In the United States gt20 of adolescents (12ndash19years) are classified as obese (Ogden Carroll Kit ampFlegal 2014) and at an increased risk of experiencingthe associated physiological comorbidities Howeverthe psychosocial comorbidities such as reduced self-esteem have a more immediate impact and are oftendrivers for overweight or obese adolescents to seektreatment (Lobstein Baur amp Uauy 2004)Adolescence is a critical period of physical and psy-chological development that occurs between 10 and19 years of age (World Health Organization 2014)

during which young people are at an increased risk ofexperiencing low self-esteem (Mission Australia2012) This risk is further exacerbated if they are

obese (Griffiths Parsons amp Hill 2010 McClureTanksi Kingsbury Gerrard amp Sargent 2010Sanders Han Baker amp Cobley 2015)

Global self-esteem is the sum of onersquos perceivedability or competence in comparison with onersquos aspir-

ations in domains of importance (eg physical ap-pearance cognitive ability) Low self-esteem is causedwhen there is a discrepancy between onersquos perceivedlevel of competence and aspirations in one or more

VC The Author 2017 Published by Oxford University Press on behalf of the Society of Pediatric PsychologyAll rights reserved For permissions please e-mail journalspermissionsoupcom 379

Journal of Pediatric Psychology 42(4) 2017 379ndash394

doi 101093jpepsyjsw101

Advance Access Publication Date 10 March 2017

Systematic Review

Dow

nloaded from httpsacadem

icoupcomjpepsyarticle-abstract4243793065789 by U

niversity of North C

arolina at wilm

ington user on 14 February 2019

domains that are of importance to the individual(Harter 1993) Self-esteem can fluctuate greatly dur-

ing adolescence and there is an increased risk of self-esteem being low particularly from the age of 13 years

(French Story amp Perry 1995 Strauss 2000)During adolescence self-esteem plays an important

role in metal health and development (McClure et al2010) Low self-esteem in adolescents particularly

overweight adolescents has been linked to disturbedeating and dieting behaviors a preoccupation with

body weight and shape an inactive lifestyle andpoorer performance in education and developmental

tasks (Latzer amp Stein 2013) Low self-esteem hasbeen hypothesized both as a contributing factor and

consequence of obesity (French et al 1995) Increasedself-esteem purportedly leads to better weight out-

comes in the long term (Elfhag amp Rossner 2005French et al 1995 Roberts 2006) Therefore weight-

management interventions for adolescents should aimto improve self-esteem

Multicomponent weight management interventions(MWMI) with behavioral dietary and physical activity

components are best practice for achieving successfulweight loss in overweight and obese adolescents (Kohn

et al 2006 Luttikhuis et al 2009 National Health andMedical Research Council 2013 National Institutes for

Health and Care Excellence 2013) However their im-pact on self-esteem is still not well reported (Luttikhuis

et al 2009) despite this being a recommendation froma previous review of the effect of weight management

programs on pediatric self-esteem (Lowry Sallinen ampJanicke 2007)

This systematic review and meta-analysis ofrandomized controlled trials (RCTs) examines the ef-

fect of MWMIs on self-esteem in overweight andobese adolescents A secondary outcome is the impact

of MWMIs on weight loss and whether this is associ-ated with improvements in self-esteem This review

provides an update of the literature since the reviewby Lowry et al (2007) and focuses specifically on (1)

adolescents an at-risk group for experiencing lowself-esteem and (2) MWMIs the most effective

method for weight management in children and ado-lescents (Luttikhuis et al 2009)

Methods

This review was registered with PROSPERO

International prospective register of systematic re-views (registration number CRD42015016889) and is

reported according to the Preferred Reporting Itemsfor Systematic reviews and Meta-Analysis (PRISMA)

Statement (see Table S1 in the supplement forPRISMA Checklist Moher et al 2015)

Literature SearchA literature search was conducted in December 2014in the Scopus MEDLINE PsychInfo CochraneLibrary Cumulative Index to Nursing and AlliedHealth Literature and Embase databases Searchterms were used to describe the population (eg over-weight youth) intervention (eg lifestyle health edu-cation nutrition physical activity) control (eg usualcare) outcomes (eg esteem body mass index) andstudy design (eg RCT controlled trial) Studies werelimited to English and humans where databases pro-vided that option (see Table S2 in the supplement forfull search strategy) The criteria for inclusion in thisreview were (1) RCT (2) overweight or obese (3)adolescent (10ndash19 years World Health Organization2014) (4) a MWMI (behavioral dietary and physicalactivity components) (5) reported self-esteem andweight changes Body mass index (BMI) z-score wasthe preferential choice for ascertaining weight statusbut if not reported other weight outcomes werecollected

Search results were imported into EndNote X72Version 1702 (Thomson Reuters New York CityUSA) Duplicate articles were manually removed bythe lead author (MM) Throughout the title and ab-stract screening two authors (MM and AD) inde-pendently excluded papers if they did not report theresults of an RCT if the intervention did not includeall three behavioral dietary and physical activitycomponents or if there was no measure of self-esteemIncluded papers were cross-checked and discrepancieswere resolved by the third author (MB) Papers thatincluded healthy weight individuals or individuals out-side the adolescent age range were included at full-paper screening and the authors were contacted to re-trieve results specific to the population of interestThese papers were subsequently excluded if authorsdid not respond within 1 month of initial contact orwere unable to provide the requested data All fullpapers were independently screened by two authors(MM and AD) and were cross-checked with anydisagreements resolved by the third author (MB)

Data ExtractionData extraction was conducted using the NationalHealth and Medical Research Council of Australiadata extraction tool for RCT and cohort studies Datawere independently extracted by two researchers(MM and AD) and included outcome measuresintervention and control conditions study designpopulation characteristics and results The two sets ofextracted data were compared to ensure complete andcorrect interpretation Any disagreements were settledby the MB Data that were missing from the includedstudies such as additional results and detailed meth-odology were obtained from separate publications

380 Murray Dordevic and Bonham

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(Brennan Walkley Fraser Greenway amp Wilks2008 Brennan Walkley Wilks Fraser amp Greenway

2013 Kornman et al 2010 Nguyen McGregoret al 2012 Shrewsbury et al 2011 Shrewsbury

et al 2009) or requested from authors

Risk of BiasThe American Dietetic Association Quality CriteriaChecklist was used to assess the quality of the papers

(Academy of Nutrition and Dietetics 2012) Criteriawere independently tested by two researchers (MM

and AD) to determine study quality including ran-domization research question participant selection

and comparability blinding outcome measures stat-istical analysis and potential for bias from funding

Studies were designated a positive neutral or negativerating Publication bias was assessed through visual in-

terpretation of funnel plots created using RevMan 53(Cochrane Informatics amp Knowledge Management

Department 2014 see Figure S1)

Statistical AnalysisCohenrsquos d effect sizes were calculated for weight andself-esteem outcomes to allow for comparison of re-

sults across studies Positive effect sizes indicated theoutcome had improved that is increased self-esteem

or decreased weight (02frac14 small effect05frac14me-dium effect08frac14 large effect) Where an effect size

could not be calculated the reported significance ofresults was assessed Following tests for normality ef-

fect sizes for self-esteem and weight changes were as-sessed for correlation using the Pearson Correlation

test and the coefficient of determination (R2)Meta-analyses were performed to compare the

change in the intervention and control groups forboth self-esteem and BMI z-score using Stata

Statistical Software (Release 13 2013 Texas USA)Only studies that reported the mean (SD) change in

self-esteem or BMI z-score and compared the inter-vention with a no-treatment control group were

included in the meta-analyses If data were not origin-ally reported in this format results were requested

from the authors for inclusion in this review To ac-count for the different tools used to measure self-

esteem outcomes a standard mean difference (SMD)was calculated from the Cohenrsquos d effect size for each

study Studies that reported a weight outcome otherthan BMI z-score were excluded from the meta-

analysis Weighted mean difference was calculated forBMI z-score for the meta-analysis All meta-analyses

were carried out using random effects analysisSensitivity analyses were not performed as only a

small number of studies were included and they wereall of neutral or positive quality

Results

Database searches identified 4707 original papersFollowing title and abstract screening 115 full-textarticles were retrieved and assessed for eligibilityThirteen papers met the review criteria including 2studies that were reviewed by Lowry et al (2007) and11 studies published since Seven studies wereincluded in the meta-analyses (Figure 1)

Description of Included StudiesThe included studies involved between 32 and 208male andor female participants aged 10ndash19 yearswho were overweight or obese (BMI 85th percent-ile) Owing to the limited number of studies that ex-clusively examined the overweight adolescentpopulation studies with mixed populations wereincluded (Croker et al 2012 Danielsen NordhusJulıusson Maelighle amp Pallesen 2013 Lochrie et al2013 Lubans et al 2012 Morgan Saunders ampLubans 2012 Neumark-Sztainer et al 2010 Sacheret al 2010) However only data relating to the popu-lation of interest are reported

Interventions ranged from seven weeks up to a yearin length Only results taken immediately postinterven-tion were assessed in this review For studies thatincluded an intense treatment phase followed by a main-tenance phase the results taken immediately after the in-tense treatment phase have been used as theldquopostinterventionrdquo results (Brennan Wilks WalkleyFraser amp Greenway 2012 Daley Copeland WrightRoalfe amp Wales 2006 Neumark-Sztainer et al 2010)One exception to this was the study by NguyenShrewsbury et al (2012) that had an additional outcomemeasurement at 12 months half way through the main-tenance phase For this study the 12-month measureshave been used as the ldquopostinterventionrdquo results as thiswas the first time point that reported separate results forthe intervention and control groups

All interventions included dietary physical activityand behavioral strategies (Table I) For the purpose ofthis review all groups that received a treatment that metthe review criteria for a MWMI were considered ldquointer-vention groupsrdquo hence there are a greater number ofintervention than control groups In all studies theintervention and control groups were considered com-parable at baseline for the outcomes of interest

Risk of BiasIncluded studies were assessed against 10 criteria andstudy quality was generally high (Table I) Four criteriahad to be met for a study to receive a positive quality rat-ing The remaining six criteria contributed to the overallrating but were not compulsory for a positive rating tobe assigned All 14 studies in this review met the criteriafor a clearly stated research question clearly definedvalid and reliable outcome measures and low risk of bias

The Impact of Weight Management on Self-Esteem 381

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owing to funding or sponsorship Four studies weredowngraded to a neutral quality rating for not meetingthe criteria (1) selection of participants free from bias(Danielsen et al 2013 Morgan et al 2012) (2) studygroups comparable at baseline (Neumark-Sztainer et al2010) or (3) intervention and comparison conditionsdescribed in detail (Mellin Slinkard amp Irwin 1987Morgan et al 2012) Other criteria that were not met byall studies but did not result in the assignment of any neu-tral quality ratings included appropriate statistical

analysis handling of withdrawals described and use

blinding to prevent bias Funnel plot analysis (Figure S1)did not suggest publication bias however should be inter-

preted with caution owing to the small number of studies

The Impact of Multicomponent WeightManagement Interventions on AdolescentSelf-EsteemSelf-esteem effect sizes were able to be calculated foreight studies (Table II) A positive effect on adolescent

Figure 1 PRISMA flow diagram of included and excluded studies


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arolina at wilm


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Posi

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Main

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No

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5m

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Loch

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nit

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Posi

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29

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39

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MI

85th

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ng

Fourt

een

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Childre

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Iz-

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Lubans

etal

2012A

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34

Posi

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152

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MI

85th

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ISch

ool-

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terv

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Del

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Sel

f-es

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BM

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Mel

lin

etal1987

Unit

edSta

tes2

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(21

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52

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ght

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av-

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tex

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T

wo-p

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incl

uded

C

W

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No

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self

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posi

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Fourt

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Follow

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ght


Dow




arolina at wilm


Tab

leI

(co

nti

nu

ed

)

Stu

dy

(auth

or

yea

rlo

cati

on)

Quali

tyra

ting

Part

icip

ants

Inte

rven

tions

Focu

son

self

-est

eem

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self-esteem was observed following four MWMIsacross three studies (Croker et al 2012 Danielsenet al 2013 Nguyen Shrewsbury et al 2012) Fivestudies showed no effect on adolescent self-esteem fol-lowing MWMI (Brennan et al 2012 DeBar et al2012 Lochrie et al 2013 Lubans et al 2012Neumark-Sztainer et al 2010) No positive effects onself-esteem were observed in any of the controlgroups One wait-listed control group (Croker et al2012) showed a small negative effect on self-esteem

Mixed results were also observed in the studies forwhich an effect size could not be calculatedImprovements in adolescent self-esteem were observedfollowing MWMIs by Daley et al (2006) Mellin et al(1987) Sacher et al (2010) and Wadden et al(1990) However only Daley et al (2006) reportedthat this change was different to that observed in thecontrol group No changes in self-esteem were de-tected following intervention by Morgan et al (2012)although a significant decline in self-esteem wasobserved in the wait-listed control group who receivedthe normal school curriculum throughout the studyperiod

Multicomponent Weight ManagementInterventions Improve Weight Outcomes inAdolescentsOf the 13 included studies there were 14 groups whoreceived a MWMI and 11 no-treatment controlgroups Of these effect sizes were able to be calculatedfor nine intervention groups and seven control groups(Table III) Seven intervention groups had small to me-dium positive effects indicating successful weight loss(Brennan et al 2012 Croker et al 2012 Danielsenet al 2013 DeBar et al 2012 Lochrie et al 2013Lubans et al 2012 Nguyen Shrewsbury et al2012) and two intervention groups had no effect(Neumark-Sztainer et al 2010 Nguyen Shrewsburyet al 2012) All seven control groups showed no ef-fect on weight

Of the studies for which effect size could not be cal-culated the results were similar Mellin et al (1987)Morgan et al (2012) Sacher et al (2010) andWadden et al (1990) all observed significant weightloss following intervention Morgan et al (2012) andSacher et al (2010) also showed that these changeswere significantly different to changes observed in thecontrol groups No studies observed significant weightchange in the control groups

Correlation Between Self-Esteem Improvementand Weight Loss Effect SizesThere is a strong (rfrac14 641 R2frac140410) positive linearrelationship between effect sizes for self-esteem im-provement and weight loss across all intervention andcontrol groups (pfrac14 008)T

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Tab

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Bre

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20

215

(54

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13

26

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29

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NA

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25

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Danie

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16

28

8(0

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31

7(0

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191

(44

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199

(34

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199

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54

40

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40

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NA

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268

40

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42

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NA

01

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etal1987

37

NA

NA

08

8(1

50)a

NA

29

NA

NA

05

2(1

34)a

NA

Morg

an

etal2012

19

NA

NA

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8(0

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NA

21

NA

NA

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6(0

47)d

NA

Neu

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152

(34

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(29

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379

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(wit

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25

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27

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9(0

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Nguyen

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50

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24

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Tab

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We

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20

20

8(0

37)

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46)

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etal2012

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29

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26

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01

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28

31

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32

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NA

NA

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30)

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20

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18

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5(0

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etal2012

54

19

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61)

18

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etal1987

37

1365

aN

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(67

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29

1295

aN

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1)a

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etal2012

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91)b

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21

NA

NA

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3(0

87)b

NA

Neu

mark

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85

321

(61

)b322

(62

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279

310

(53

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(55

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(wit

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20

3(0

37)

19

7(0

42)

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8(0

19)

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5

Nguyen

etal2012

(wit

hout

AT

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50

20

2(0

29)

19

4(0

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9(0

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20

NA

23

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52)

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24

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26

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Quantitative Data AnalysisDifferences between intervention and control groupsfor change in self-esteem are presented in Figure 2aThis analysis included seven intervention groups(nfrac14 191) and seven control groups (nfrac14 132) with

interventions or intensive treatment phases rangingfrom 9 weeks to 6 months in duration A moderatelevel of the variation across studies was owing to het-erogeneity (I2frac14464 Higgins Thompson Deeksamp Altman 2003) The overall summary effect showed

Figure 2 Comparison between intervention and control groups for the change in adolescent self-esteem effect size (a) andbody mass index z-score (b) following multicomponent weight management interventions SMD frac14 standard mean differ-ence WMD frac14 weighted mean difference


Dow




arolina at wilm


no effect on self-esteem as a result of interventionSMD of 027 (95 confidence interval 004 059)zfrac14 169 and pfrac14 092 However all studies exceptone favored the intervention for improvements in self-esteem

The difference between intervention and controlgroups for change in BMI z-score is illustrated inFigure 2b This analysis included five interventiongroups (nfrac14 135) and five control groups (nfrac14 82) withinterventions ranging from 9 weeks to 6 months induration Heterogeneity in this sample was low(I2frac14177 Higgins et al 2003) and the overall sum-mary effect was 017 (022 011) BMI z-scorepoints (zfrac14613 and plt 001) indicating statisticallysignificant weight loss following MWMI

Discussion

The purpose of this review was to examine the effectof MWMIs on self-esteem in overweight and obeseadolescents Increased self-esteem is proposed as a keyfactor for maintaining long-term weight management(Elfhag amp Rossner 2005 French et al 1995Roberts 2006) A secondary outcome of this reviewwas to examine the impact of MWMIs on weight lossand whether this was associated with improvements inself-esteem

The meta-analysis showed no difference in self-esteem between the intervention and control groupsHowever six of the seven studies in the meta-analysisfavored the intervention over control for improve-ments in self-esteem and four of the six studies notincluded in the meta-analysis found significant im-provements in self-esteem following intervention Thelatter of these findings are similar to those of an earlierreview (Lowry et al 2007) that showed improve-ments in self-esteem following weight managementinterventions in a pediatric population particularlywhen certain intervention features were presentSimilarly a number of intervention features that con-tributed to an increased likelihood of improving self-esteem were identified in this review

Improvements in self-esteem regardless of weightloss have been demonstrated in children who tookpart in weight management interventions thatincluded a focus on building self-esteem and it is rec-ommended that this be a focus of all pediatric weightmanagement interventions (Lowry et al 2007) Yetthe majority of studies identified in this review did notinclude building self-esteem as a key aspect of theirintervention Nguyen Shrewsbury et al (2012)described the greatest focus on self-esteem (one75-min group session focused on building self-esteem)and also resulted in the largest treatment effect (057)and a significant improvement in self-esteem (NguyenShrewsbury et al 2012) A focus on similar topics

such as body image social support and managing bul-lying may also contribute to improvements in self-esteem (Croker et al 2012 Pierce amp Wardle 1997Tiggemann 2005) however these findings highlightthe lack of uptake of these recommendations

Among overweight and obese youth reductions inself-esteem are often observed in domains of physicalappearance and physical ability (Franklin DenyerSteinbeck Caterson amp Hill 2006 French et al1995 Latzer amp Stein 2013 Lowry et al 2007)Particularly for adolescent girls body image is a keyconcern (Cave Fildes Luckett amp Wearring 2015)and comprises a large portion of global self-esteem(Lowry et al 2007 Pesa Syre amp Jones 2000)However weight loss and associated changes in phys-ical appearance do not necessarily reflect improve-ments in self-esteem (Lowry et al 2007) Changes inbody-esteem often occur more rapidly than changes inglobal self-esteem as a result of weight management(Lowry et al 2007) This may explain the lack ofchange observed in global self-esteem in this meta-analysis and highlights the need to also include body-esteem (or physical self-esteem) as a focus and out-come of weight management interventions foradolescents

Parental involvement in adolescent weight manage-ment interventions is a critical component for success-ful weight loss and may also be important forimproving self-esteem (Lowry et al 2007) Weight-related teasing from family is shown to be negativelyassociated with self-esteem in overweight adolescentswhereas family connectedness was positively associ-ated with adolescent self-esteem (Fulkerson StraussNeumark-Sztainer Story amp Boutelle 2007) The in-clusion of parents in weight management interventionsfosters a safer and more encouraging home environ-ment for the adolescent (Lowry et al 2007) which isassociated with increased self-esteem in nonover-weight children (Marx amp Neumark-Sztainer 2005)All studies in the present review baring one includedparents in the intervention Parental involvementshould continue to be a key component of weightmanagement interventions to ensure a supportivehome environment for the adolescent to help fosterpositive self-esteem

Weight management interventions that used agroup setting to target self-esteem have shown im-provements in self-esteem without significant weightchange (Lowry et al 2007 Sherman AlexanderGomez Kim amp Marole 1992) The ability of the peergroup setting to provide opportunities for bondingsupport feelings of belonging development of peer-based skills and positive peer exchanges is key toincreasing self-esteem (Lowry et al 2007) The im-portance of this element is being acknowledged in the


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arolina at wilm


field with all the studies in this review baring twousing group sessions in their intervention

Measures of self-esteem are self-reported and there-fore subjective Responses to questionnaires are likelyto be influenced by individual (eg age gender) andenvironmental (eg cultural group socioeconomicstatus) factors (Khanlou 2004) Changes followinginterventions may represent genuine long-termchanges in self-esteem or may be due to short-termfluctuations in self-esteem in response to specificevents (eg winning a sporting event or performanceon a test at school) (Kernis 1993) While validatedtools were used to measure self-esteem in all studies itwas difficult to conclude whether outcomes were en-tirely dependent on the intervention without inclusionof a no-treatment control group

The variety of self-esteem assessment tools also addsto the difficulty of interpretation Across the 13 studies inthis review five different tools were used with differentquestions and different scales Even within tools therewere different scales used to report the results (RosenbergSelf-esteem Scale) and different versions of the same ques-tionnaire (Harterrsquos Self-perception Profile for ChildrenHarterrsquos Self-perception Profile for Adolescents) HarterrsquosSelf-Perception Profile (Harterrsquos Self-perception Profilefor Adolescents for adolescents) which measures ninesubscales of self-esteem including physical self-esteem issuggested as the most appropriate measure for adolescentself-esteem (Lowry et al 2007) It was also the mostcommonly used tool among papers included in this re-view While Cohenrsquos d effect sizes were used to stand-ardize results in this review the consistent use of one toolwould provide the ability to compare raw self-esteemscores and create a stronger analysis in the future

Results from this review support evidence thatMWMIs induce weight loss in overweight and obeseadolescents (Hoelscher Kirk Ritchie ampCunningham-Sabo 2013 Kelly amp Melnyk 2008Luttikhuis et al 2009) The change in BMI z-score inthe present meta-analysis (017 [022 011]) wassimilar to the clinically meaningful weight loss re-ported in the 2009 Cochrane Review in children 12years at 6 months follow up from a lifestyle weightmanagement intervention (014 [017 012])(Luttikhuis et al 2009) Jelalian Mehlenbeck Lloyd-Richardson Birmaher and Wing (2006) and WalkerGately Bewick and Hill (2003) have demonstratedassociations between weight loss and increased self-esteem in overweight and obese adolescents after at-tending a weight-management intervention Similarlyin the present review a strong positive relationship be-tween treatment effects for weight loss and improve-ment in self-esteem was identified However itremains unclear whether the improvement in self-esteem was as a result of successful weight loss orwhether it was a contributing factor toward successful

weight loss Nonetheless building self-esteem shouldbe a key focus of MWMIs as improved self-esteem ap-

pears to be linked to enhanced weight lossA key strength of this review was that all included

studies had strong designs and presented level II evi-dence (Coleman et al 2009) However to further elu-

cidate the role of self-esteem in adolescent weightmanagement future research should consider power-

ing studies to detect changes in psychosocial as well asphysiological outcomes Only one study in this reviewwas powered to detect a change in psychosocial out-

comes (Daley et al 2006) which may explain thelack of significant results observed for self-esteem

Additionally a large number of included studies didnot describe their method of handling withdrawals or

use blinding to prevent the introduction of bias Toimprove confidence in the effectiveness of MWMIs

and reduce the risk of bias future studies should bedesigned with concealed allocation and document andreport in detail the flow of participants

Identification of intervention components that im-

prove self-esteem is important for future weight man-agement intervention design Included interventionswere heterogeneous offering different levels of diet-

ary physical activity and behavioral interventionwhich may have collectively or individually influenced

the results Inconsistent reporting of intervention andcomparator conditions make it difficult to elucidate

the components that contributed to improvements inself-esteem Future studies should report intervention

and comparator procedures in adequate detail so thatsuccessful components can be identified and repli-cated These limitations highlight areas for improve-

ment to develop best-practice guidelines forundertaking and evaluating MWMIs in adolescents to

enhance self-esteem

Conclusion

Overweight and obese adolescents experience low

self-esteem largely owing to poor body image yetthis meta-analysis found no improvement in self-esteem even with significant weight loss Although it

was noted that interventions that had larger effects onself-esteem also had larger effects on weight loss The

incorporation of intervention components that wereidentified to contribute to improvements in self-

esteem may assist future weight management interven-tions to improve the self-esteem of overweight and

obese adolescents Furthermore a consistent measureof self-esteem would enable easier interpretation ofself-esteem scores and comparison of results across

studies to improve our understanding of the relation-ship between self-esteem and weight management in

adolescents


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arolina at wilm


Supplementary Data

Supplementary data can be found at httpwwwjpepsy

oxfordjournalsorg

Acknowledgments

The authors would like to acknowledge Dr Zoe Davidson

for her assistance in performing the meta-analyses

Funding

This work was supported by an Australian GovernmentResearch Training Program Scholarship

Conflicts of interest none declared

References

Academy of Nutrition and Dietetics (2012) Evidence ana-lysis manual Steps in the academy evidence analysis pro-cess Chicago IL ADA Research and Strategic Business

DevelopmentBrennan L Walkley J Fraser S F Greenway K amp

Wilks R (2008) Motivational interviewing and cognitivebehaviour therapy in the treatment of adolescent over-

weight and obesity Study design and methodologyContemporary Clinical Trials 29 359ndash375

Brennan L Walkley J Wilks R Fraser S F amp

Greenway K (2013) Physiological and behavioural out-comes of a randomised controlled trial of a cognitive be-havioural lifestyle intervention for overweight and obese

adolescents Obesity Research and Clinical Practice 7e23ndashe41

Brennan L Wilks R Walkley J Fraser S F amp

Greenway K (2012) Treatment acceptability and psycho-social outcomes of a randomised controlled trial of a cog-nitive behavioural lifestyle intervention for overweight and

obese adolescents Behaviour Change 29 36ndash62Cave L Fildes J Luckett G amp Wearring A (2015)

Mission Australiarsquos 2015 youth survey report MissionAustralia

Coleman K Norris S Weston A Grimmer-Somers KHillier S Merlin T Salisbury J (2009) NHMRCadditional levels of evidence and grades for recommenda-tions for developers of guidelines (Vol Stage 2Consultation) Australia National Health and Medical

Research CouncilCroker H Viner R M Nicholls D Haroun D

Chadwick P Edwards C Wardle J (2012) Family-based behavioural treatment of childhood obesity in a UK

national health service setting Randomized controlledtrial International Journal of Obesity 36 16ndash26 doi

101038ijo2011182Daley A J Copeland R J Wright N P Roalfe A amp

Wales J K H (2006) Exercise therapy as a treatment forpsychopathologic conditions in obese and morbidly obese

adolescents A randomized controlled trial Pediatrics118 2126ndash2134

Danielsen Y S Nordhus I H Julıusson P B Maelighle Mamp Pallesen S (2013) Effect of a family-based cognitive

behavioural intervention on body mass index self-esteem

and symptoms of depression in children with obesity (aged

7mdash13) A randomised waiting list controlled trial ObesityResearch amp Clinical Practice 7 e116ndashe128

DeBar L L Stevens V J Perrin N Wu P Pearson J ampJo B (2012) A primary care-based multicomponent life-

style intervention for overweight adolescent femalesPediatrics 129 e611ndashe620

Elfhag K amp Rossner S (2005) Who succeeds in maintain-ing weight loss A conceptual review of factors associated

with weight loss maintenance and weight regain ObesityReviews 6 67ndash85

Franklin J Denyer G Steinbeck K S Caterson I D ampHill A J (2006) Obesity and risk of low self-esteem Astatewide survey of Australian children Pediatrics 118

2481ndash2487French S A Story M amp Perry C L (1995) Self-esteem

and obesity in children and adolescents A literature re-view Obesity Research 3 479ndash490

Fulkerson J Strauss J Neumark-Sztainer D Story M

amp Boutelle K (2007) Correlates of psychosocial well-being among overweight adolescents The role of the fam-ily Journal of Consulting and Clinical Psychology 75

181ndash186Griffiths L J Parsons T J amp Hill A J (2010) Self-es-

teem and quality of life in obese children and adolescentsA systematic review International Journal of PediatricObesity 5 282ndash304

Harter S (1993) Causes and consequences of low self-

esteem in children and adolescents In R F Baumeister(Ed) Self-esteemmdashThe puzzle of low self-regard (pp87ndash116) USA Springer

Higgins J Thompson S Deeks J amp Altman D (2003)

Measuring inconsistency in meta-analyses BMJ 327557ndash560

Hoelscher D M Kirk S Ritchie L amp Cunningham-Sabo L (2013) Position of the Academy of Nutrition and

Dietetics Interventions for the prevention and treatmentof pediatric overweight and obesity Journal of theAcademy of Nutrition and Dietetics 113 1375ndash1394

Jelalian E Mehlenbeck R Lloyd-Richardson EBirmaher V amp Wing R (2006) lsquoAdventure therapyrsquo

combined with cognitivebehavioral treatment for over-weight adolescents International Journal of Obesity 3031ndash39

Kelly S A amp Melnyk B M (2008) Systematic review of

multicomponent interventions with overweight middleadolescents implications for clinical practice and researchWorldviews on Evidence-Based Nursing 5 113ndash135

Kernis M (1993) The roles of stability and level of self-

esteem in psychological functioning In R Baumeister(Ed) Self-esteem (pp 167ndash182) USA Springer

Khanlou N (2004) Influences on adolescent self-esteem inmulticultural Canadian secondary schools Public HealthNursing 21 404ndash411

Kohn M Rees J M Brill S Fonseca H Jacobson M

Katzman D K Schneider M (2006) Preventing andtreating adolescent obesity A position paper of the Societyfor Adolescent Medicine Journal of Adolescent Health

38 784ndash787Kornman K P Shrewsbury V A Chou A C Ngyuen

B Lee A Orsquoconnor J Baur L A (2010) Electronic


Dow




arolina at wilm


therapeutic contact for adolescent weight management

The Loozit study Telemedicine and E-Health 16

678ndash685Latzer Y amp Stein D (2013) A review of the psychological

and familial perspectives of childhood obesity Journal of

Eating Disorders 1 7Lobstein T Baur L amp Uauy R (2004) Obesity in chil-

dren and young people a crisis in public health Obesity

Reviews 5(Suppl 1) 4ndash104Lochrie A S Wysocki T Hossain J Milkes A Antal

H Buckloh L Lang J (2013) The effects of a family-

based intervention (FBI) for overweightobese children on

health and psychological functioning Clinical Practice in

Pediatric Psychology 1 159ndash170 doi httpdxdoiorg

101037cpp0000020Lowry K W Sallinen B amp Janicke D (2007) The effects

of weight management programs on self-esteem in pediat-

ric overweight populations Journal of Pediatric

Psychology 32 1179ndash1195Lubans D R Morgan P J Okely A D Dewar D

Collins C E Batterham M Plotnikoff R C (2012)

Preventing obesity among adolescent girls One-year out-

comes of the nutrition and enjoyable activity for teen girls

(NEAT Girls) cluster randomized controlled trial

Archives of Pediatrics and Adolescent Medicine 166

821ndash827Luttikhuis H Baur L Jansen H Shrewsbury V

Orsquomalley C Stolk R amp Summerbell C (2009)

Interventions for treating obesity in children (Review)

Cochrane Database of Systematic Reviews 3 1ndash57Marx R D amp Neumark-Sztainer D (2005) Questions amp

Answers Eating Disorders The Journal of Treatment amp

Prevention 13 491ndash495McClure A C Tanksi S E Kingsbury J Gerrard M amp

Sargent J D (2010) Characteristics associated with low

self-esteem among US adolescents Academic Pediatrics

10 238ndash244Mellin L M Slinkard L A amp Irwin C E (1987)

Adolescent obesity intervention Validation of the

SHAPEDOWN program Journal of the American Dietetic

Association 87 333ndash338Mission Australia (2012) Youth Survey 2012 SydneyMoher D Shamseer L Clarke M Ghersi D Liberati

A Petticrew M PRISMA-P Group (2015) Preferred

reporting items for systematic review and meta-analysis

protocols (PRISMA-P) 2015 statement Systematic

Reviews 4 1Morgan P Saunders K amp Lubans D (2012) Improving

physical self-perception in adolescent boys from disadvan-

taged schools Psychological outcomes from the Physical

Activity Leaders randomized controlled trial Pediatric

Obesity 7 e27ndashe32 doi httpdxdoiorg101111j

2047-6310201200050xNational Health and Medical Reasearch Council (2013)

Clinical practice guidelines for the management of over-

weight and obesity in adults adolescents and children in

Australia Australia NHMRC Australian Government

Department of HealthNational Institutes for Health and Care Excellence (2013)

Managing overweight and obesity among children and

young people lifestyle weight management services NICE

public health guidance United Kingdom 47 NICENeumark-Sztainer D R Friend S E Flattum C F

Hannan P J Story M T Bauer K W Petrich C A

(2010) New moves-preventing weight-related problems in

adolescent girls A group-randomized study American

Journal of Preventive Medicine 39 421ndash432Nguyen B McGregor K A Orsquoconnor J Shrewsbury V

A Lee A Steinbeck K S Baur L A (2012)

Recruitment challenges and recommendations for adoles-

cent obesity trials Journal of Paediatrics and Child

Health 48 38ndash43Nguyen B Shrewsbury V A Orsquoconnor J Steinbeck K

S Hill A J Shah S Baur L A (2013) Two-year

outcomes of an adjunctive telephone coaching and elec-

tronic contact intervention for adolescent weight-loss

maintenance the Loozit randomized controlled trial

International Journal of Obesity 37 468ndash472Nguyen B Shrewsbury V A Orsquoconnor J Steinbeck K

S Lee A Hill A J Baur L A (2012) Twelve-month

outcomes of the Loozit randomized controlled trial


170ndash177Ogden C L Carroll M D Kit B K amp Flegal K M

(2014) Prevalence of childhood and adult obesity in the

United States 2011-2012 Journal of the American

Medical Association 311 806ndash814Pesa J A Syre T R amp Jones E (2000) Psychosocial dif-

ferences associated with body weight among female ado-

lescents The importance of body image Journal of

Adolescent Health 26 330ndash337Pierce J W amp Wardle J (1997) Cause and effect beliefs

and self-esteem of overweight children Journal of Child

Psychology and Psychiatry 38 645ndash650 doi 101111

j1469-76101997tb01691xRoberts J E (2006) Self-esteem from a clinical perspective

In M H Kernis (Ed) Self-esteem issues and answers A

sourcebook of current perspectives Psychology Press

Taylor amp Francis New York and Hove (pp 298ndash305)

Psychology PressSacher P M Kolotourou M Chadwick P M Cole T J

Lawson M S Lucas A amp Singhal A (2010)

Randomized controlled trial of the MEND program A

family-based community intervention for childhood obes-

ity Obesity 18(Suppl 1) S62ndashS68 doi httpdxdoiorg

101038oby2009433Sanders R H Han A Baker J S amp Cobley S (2015)

Childhood obesity and its physical and psychological co-

morbidities a systematic review of Australian children and

adolescents Eur J Pediatr 174 715ndash746Sherman J B Alexander M A Gomez D Kim M amp

Marole P (1992) Intervention program for obese school chil-

dren Journal of Community Health Nursing 9 183ndash190Shrewsbury V A Nguyen B Orsquoconnor J Steinbeck K

S Lee A Hill A J Baur L A (2011) Short-term

outcomes of community-based adolescent weight manage-

ment The LoozitVR

Study BMC Pediatrics 11 13Shrewsbury V A Orsquoconnor J Steinbeck K S Stevenson

K Lee A Hill A J Baur L A (2009) A randomised

controlled trial of a community-based healthy lifestyle


Dow




arolina at wilm


program for overweight and obese adolescents TheLoozitV

R

study protocol BMC Public Health 9 119Strauss R S (2000) Childhood obesity and self-esteem

Pediatrics 105 5Tiggemann M (2005) Body dissatisfaction and adolescent

self-esteem Prospective findings Body Image 2 129ndash135doi httpdxdoiorg101016jbodyim200503006

Wadden T A Stunkard A J Rich L Rubin C JSweidel G amp McKinney S (1990) Obesity in black ado-lescent girls A controlled clinical trial of treatment by diet

behaviour modification and parental support Pediatrics85 345ndash352

Walker L Gately P Bewick B amp Hill A (2003)Childrenrsquos weight-loss camps psychological benefit orjeopardy International Journal of Obesity 27 748ndash754

World Health Organization (2014) Maternal newbornchild and adolescent health Adolescent developmentRetrieved from httpwwwwhointmaternal_child_adolescenttopicsadolescencedeven Retrieved 28 May2014


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arolina at wilm


jsw101-TF1

jsw101-TF2

jsw101-TF3

jsw101-TF4

jsw101-TF5

jsw101-TF6

jsw101-TF7

jsw101-TF8

jsw101-TF9

jsw101-TF10

jsw101-TF11

domains that are of importance to the individual(Harter 1993) Self-esteem can fluctuate greatly dur-

ing adolescence and there is an increased risk of self-esteem being low particularly from the age of 13 years

(French Story amp Perry 1995 Strauss 2000)During adolescence self-esteem plays an important

role in metal health and development (McClure et al2010) Low self-esteem in adolescents particularly

overweight adolescents has been linked to disturbedeating and dieting behaviors a preoccupation with

body weight and shape an inactive lifestyle andpoorer performance in education and developmental

tasks (Latzer amp Stein 2013) Low self-esteem hasbeen hypothesized both as a contributing factor and

consequence of obesity (French et al 1995) Increasedself-esteem purportedly leads to better weight out-

comes in the long term (Elfhag amp Rossner 2005French et al 1995 Roberts 2006) Therefore weight-

management interventions for adolescents should aimto improve self-esteem

Multicomponent weight management interventions(MWMI) with behavioral dietary and physical activity

components are best practice for achieving successfulweight loss in overweight and obese adolescents (Kohn

et al 2006 Luttikhuis et al 2009 National Health andMedical Research Council 2013 National Institutes for

Health and Care Excellence 2013) However their im-pact on self-esteem is still not well reported (Luttikhuis

et al 2009) despite this being a recommendation froma previous review of the effect of weight management

programs on pediatric self-esteem (Lowry Sallinen ampJanicke 2007)

This systematic review and meta-analysis ofrandomized controlled trials (RCTs) examines the ef-

fect of MWMIs on self-esteem in overweight andobese adolescents A secondary outcome is the impact

of MWMIs on weight loss and whether this is associ-ated with improvements in self-esteem This review

provides an update of the literature since the reviewby Lowry et al (2007) and focuses specifically on (1)

adolescents an at-risk group for experiencing lowself-esteem and (2) MWMIs the most effective

method for weight management in children and ado-lescents (Luttikhuis et al 2009)

Methods

This review was registered with PROSPERO

International prospective register of systematic re-views (registration number CRD42015016889) and is

reported according to the Preferred Reporting Itemsfor Systematic reviews and Meta-Analysis (PRISMA)

Statement (see Table S1 in the supplement forPRISMA Checklist Moher et al 2015)

Literature SearchA literature search was conducted in December 2014in the Scopus MEDLINE PsychInfo CochraneLibrary Cumulative Index to Nursing and AlliedHealth Literature and Embase databases Searchterms were used to describe the population (eg over-weight youth) intervention (eg lifestyle health edu-cation nutrition physical activity) control (eg usualcare) outcomes (eg esteem body mass index) andstudy design (eg RCT controlled trial) Studies werelimited to English and humans where databases pro-vided that option (see Table S2 in the supplement forfull search strategy) The criteria for inclusion in thisreview were (1) RCT (2) overweight or obese (3)adolescent (10ndash19 years World Health Organization2014) (4) a MWMI (behavioral dietary and physicalactivity components) (5) reported self-esteem andweight changes Body mass index (BMI) z-score wasthe preferential choice for ascertaining weight statusbut if not reported other weight outcomes werecollected

Search results were imported into EndNote X72Version 1702 (Thomson Reuters New York CityUSA) Duplicate articles were manually removed bythe lead author (MM) Throughout the title and ab-stract screening two authors (MM and AD) inde-pendently excluded papers if they did not report theresults of an RCT if the intervention did not includeall three behavioral dietary and physical activitycomponents or if there was no measure of self-esteemIncluded papers were cross-checked and discrepancieswere resolved by the third author (MB) Papers thatincluded healthy weight individuals or individuals out-side the adolescent age range were included at full-paper screening and the authors were contacted to re-trieve results specific to the population of interestThese papers were subsequently excluded if authorsdid not respond within 1 month of initial contact orwere unable to provide the requested data All fullpapers were independently screened by two authors(MM and AD) and were cross-checked with anydisagreements resolved by the third author (MB)

Data ExtractionData extraction was conducted using the NationalHealth and Medical Research Council of Australiadata extraction tool for RCT and cohort studies Datawere independently extracted by two researchers(MM and AD) and included outcome measuresintervention and control conditions study designpopulation characteristics and results The two sets ofextracted data were compared to ensure complete andcorrect interpretation Any disagreements were settledby the MB Data that were missing from the includedstudies such as additional results and detailed meth-odology were obtained from separate publications


Dow




arolina at wilm




























Results







Dow




arolina at wilm









Dow




arolina at wilm


Tab

leI

Stu

dy

Qu

ality

P

art

icip

an

tsIn

terv

en

tio

ns

Du

rati

on

a

nd

Ou

tco

me

Me

asu

res

Stu

dy

(auth

or

yea

rlo

cati

on)

Quali

tyra

ting

Part

icip

ants

Inte

rven

tions

Focu

son

self

-est

eem

Dura

tion

Outc

om

em

easu

res

Bre

nnan

etal

2012A

ust

ralia

25

Posi

tive

29

(46

)m

ale

sand

34

(54

)fe

-m

ale

s11ndash19

yea

rsover

wei

ght

or

obes

e

IIn

terv

enti

on

base

don

cognit

ive

be-

havio

ralpri

nci

ple

sw

ith

afo

cus

on

makin

gsm

all

sust

ain

able

changes

indie

tary

inta

ke

physi

calact

ivit

yand

beh

avio

ralst

rate

gie

sPare

nts

involv

edfo

rfirs

thalf

of

trea

tmen

tphase

C

W

ait

list

No

spec

ific

men

-ti

on

of

self

-es-

teem

but

one

sess

ion

on

de-

vel

opin

ghel

pfu

lth

oughts

and

emoti

ons

Tre

atm

ent

phase

mdashtw

elve

60-m

inse

ssio

ns

and

one

tele

phone

call

sess

ion

over

16

wee

ks

Main

tenance

phase

mdashtw

o60-m

incl

inic

sess

ions

and

seven

15-m

inte

le-

phone

sess

ions

over

6m

onth

s

Rose

nber

gSel

f-E

stee

mSca

leB

MI

z-sc

ore

Cro

ker

etal2012

Unit

edK

ingdom

26

Posi

tive

13

(32

)m

ale

sand

28

(68

)fe

-m

ale

s10ndash12

yea

rsover

wei

ght

or

obes

e

IFam

ily-b

ase

din

terv

enti

on

del

iver

edin

gro

ups

wit

ha

focu

son

makin

gw

hole

-fam

ily

life

style

changes

thro

ugh

beh

avio

r-ch

ange

stra

tegie

sand

nutr

itio

nand

physi

calact

ivit

ygoals

Pare

nt

and

child

sess

ions

de-

liver

edse

para

tely

C

W

ait

list

No

spec

ific

men

-ti

on

of

self

-es-

teem

but

one

sess

ion

on

soci

al

support

and

how

tom

anage

bullyin

g

Fif

teen

15

-hr

sess

ions

over

6m

onth

sFollow

up

12

month

sfr

om

base

line

Hart

errsquos

Sel

f-Per

cepti

on

Pro

file

(sel

f-es

teem

)B

MI

SD

S

Dale

yet

al2006

Unit

edK

ingdom

32

Posi

tive

36

(44

)m

ale

sand

45

(56

)fe

-m

ale

s11ndash16

yea

rsB

MI

gt98th

per

centi

le

IPart

icip

ants

com

ple

ted

ara

nge

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aer

obic

act

ivit

ies

and

min

igam

esand

wer

epro

vid

edw

ith

exer

cise

counse

l-in

gfo

rbeh

avio

rch

ange

ina

one-

on-

one

sett

ingH

ealt

hy

eati

ng

habit

sw

ere

enco

ura

ged

and

wri

tten

info

r-m

ati

on

was

pro

vid

edPart

icip

ants

wer

egiv

enan

indiv

idualize

dex

erci

sepro

gra

mto

conti

nue

aft

erth

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eat-

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tpro

gra

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ent

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ol

No

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ific

men

-ti

on

of

self

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1990U

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Bre

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etal2012

20

215

(54

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21

1(4

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188

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9C

roker

etal2012

13

26

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29

5(0

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6(0

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110

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2(0

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9D

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yet

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28

24

2(0

56)b

26

1(0

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NA

NA

30

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25

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NA

NA

Danie

lsen

etal2013

16

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31

7(0

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02

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516

31

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30

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5(0

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105

23

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24

0(0

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NA

00

4103

24

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23

9(0

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NA

00

8L

och

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29

183

(50

2)b

191

(44

8)b

07

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51)b

01

718

199

(34

6)b

199

(34

3)b

00

0(3

11)b

00

0L

ubans

etal2012

54

40

3(1

12)c

40

6(1

32)c

NA

00

268

40

4(0

99)c

42

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NA

01

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etal1987

37

NA

NA

08

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50)a

NA

29

NA

NA

05

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34)a

NA

Morg

an

etal2012

19

NA

NA

00

8(0

48)d

NA

21

NA

NA

02

6(0

47)d

NA

Neu

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ain

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85

152

(34

)b151

(29

)bN

A

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379

141

(34

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3

Nguyen

etal2012

(wit

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25

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27

7(0

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Nguyen

etal2012

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50

25

9(0

58)b

29

3(0

61)b

01

9(0

51)b

05

7

Sach

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20

NA

32

5(0

68)b

02

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66)b

NA

24

NA

30

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75)b

01

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Wadden

etal1990

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com

bin

ed47

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self

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[hig

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bH

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errsquos

SPPA

SPPC

(gen

erally

score

d1

[low

est

self

-est

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4[h

ighes

tse

lf-e

stee

m])

cM

ars

hrsquos

Physi

calSel

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on

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tionnair

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calSel

f-Per

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file

for

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scen

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ePie

rs-H

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pt

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ring

range

sunav

ailab

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her

valu

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uals

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her

self

-est

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Dow




arolina at wilm


Tab

leIII

We

igh

tO

utc

om

es

of

Mu

ltic

om

po

ne

nt

We

igh

tM

an

ag

em

en

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terv

en

tio

ns

Co

mp

are

dW

ith

Co

ntr

ols

in

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erw

eig

ht

an

dO

be

seA

do

lesc

en

ts

Auth

or

yea

rIn

terv

enti

on

gro

ups

Contr

olgro

ups

nPre

-mea

n(S

D)

Post

-mea

n(S

D)

Change

mea

n(S

D)

Eff

ect

size

nPre

-mea

n(S

D)

Post

-mea

n(S

D)

Change

mea

n(S

D)

Eff

ect

size

Bre

nnan

etal2012

20

20

8(0

37)

19

9(0

46)

02

0(0

18)

02

214

20

8(0

40)

20

9(0

39)

00

1(0

12)

00

3C

roker

etal2012

13

29

5(0

52)

26

6(0

63)

01

7(0

21)

05

010

31

4(0

68)

31

4(0

68)

00

6(0

13)

00

0D

ale

yet

al2006

28

31

7(0

33)

32

3(0

02

SE)

NA

NA

30

33

2(0

37)

32

3(0

02

SE)

NA

NA

Danie

lsen

etal2013

16

25

9(0

30)

24

6(0

41)

01

2(0

17)

03

616

24

9(0

27)

25

3(0

29)

00

5(0

15)

01

4D

eBar

etal2012

105

20

0(0

34)

18

8(0

41)

NA

03

2103

20

0(0

33)

19

4(0

38)

NA

01

7L

och

rie

etal2013

29

21

9(0

40)

20

6(0

52)

01

2(0

20)

02

818

20

7(0

40)

20

5(0

43)

00

2(0

11)

00

5L

ubans

etal2012

54

19

3(0

61)

18

0(0

68)

NA

02

068

18

5(0

59)

18

0(0

67)

NA

00

8M

ellin

etal1987

37

1365

aN

A

59

(67

5)a

NA

29

1295

aN

A

03

(66

1)a

NA

Morg

an

etal2012

19

NA

NA

04

2(0

91)b

NA

21

NA

NA

00

3(0

87)b

NA

Neu

mark

-Szt

ain

eret

al2010

85

321

(61

)b322

(62

)bN

A

00

279

310

(53

)b314

(55

)bN

A

00

7

Nguyen

etal2012

(wit

hA

TC

)57

20

3(0

37)

19

7(0

42)

00

8(0

19)

01

5

Nguyen

etal2012

(wit

hout

AT

C)

50

20

2(0

29)

19

4(0

32)

00

9(0

17)

02

6

Sach

eret

al2010

20

NA

23

7(0

52)

02

2(0

27)

NA

24

NA

26

0(0

54)

00

1(0

20)

NA

Wadden

etal1990

3gro

ups

com

bin

ed47

352

b339

bN

AN

A

Note

D

ata

pre

sente

das

report

edin

ori

gin

al

paper

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eight

outc

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body

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state

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standar

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iati

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pro

vid

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leto

be

calc

ula

ted

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ndard

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or

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ther

than

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ndard

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iati

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ffec

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smal

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ve

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ght

bB

MI


Dow




arolina at wilm






Dow




arolina at wilm




Discussion









Dow




arolina at wilm






















enhance self-esteem

Conclusion








adolescents


Dow




arolina at wilm


Supplementary Data


oxfordjournalsorg

Acknowledgments



Funding



References




















































Dow




arolina at wilm




























































































ment The LoozitVR





Dow




arolina at wilm



R









Dow




arolina at wilm


jsw101-TF1

jsw101-TF2

jsw101-TF3

jsw101-TF4

jsw101-TF5

jsw101-TF6

jsw101-TF7

jsw101-TF8

jsw101-TF9

jsw101-TF10

jsw101-TF11



























Results







Dow




arolina at wilm









Dow




arolina at wilm


Tab

leI

Stu

dy

Qu

ality

P

art

icip

an

tsIn

terv

en

tio

ns

Du

rati

on

a

nd

Ou

tco

me

Me

asu

res

Stu

dy

(auth

or

yea

rlo

cati

on)

Quali

tyra

ting

Part

icip

ants

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rven

tions

Focu

son

self

-est

eem

Dura

tion

Outc

om

em

easu

res

Bre

nnan

etal

2012A

ust

ralia

25

Posi

tive

29

(46

)m

ale

sand

34

(54

)fe

-m

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s11ndash19

yea

rsover

wei

ght

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e

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on

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ple

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ith

afo

cus

on

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sust

ain

able

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indie

tary

inta

ke

physi

calact

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yand

beh

avio

ralst

rate

gie

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of

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tmen

tphase

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ait

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ion

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tenance

phase

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inic

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phone

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ker

etal2012

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tive

13

(32

)m

ale

sand

28

(68

)fe

-m

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del

iver

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gro

ups

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hole

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avio

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cepti

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yea

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per

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vid

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ng

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wen

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phase

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Danie

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etal

2013N

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Follow

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f-Per

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Pro

file

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Childre

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ISD

S


Dow




arolina at wilm


Tab

leI

(co

nti

nu

ed

)

Stu

dy

(auth

or

yea

rlo

cati

on)

Quali

tyra

ting

Part

icip

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Inte

rven

tions

Focu

son

self

-est

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Dura

tion

Outc

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DeB

ar

etal2012

Unit

edSta

tes3

3Posi

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208

(100

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yea

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com

mon

psy

choso

cialis

sues

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obes

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No

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29

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Dow




arolina at wilm


Tab

leI

(co

nti

nu

ed

)

Stu

dy

(auth

or

yea

rlo

cati

on)

Quali

tyra

ting

Part

icip

ants

Inte

rven

tions

Focu

son

self

-est

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Dura

tion

Outc

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easu

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Morg

an

etal

2012A

ust

ralia

30

Neu

tral

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(100

)m

ale

s13ndash16

yea

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centi

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gen

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ions

physi

calac-

tivit

yand

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wit

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allen

ges

and

inte

r-act

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inars

on

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nand

physi

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ybeh

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rsand

leader

ship

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W

ait

list

No

spec

ific

men

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on

of

self

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3-m

onth

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Follow

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6m

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Physi

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file

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MI

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USA

(27)

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per

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yn

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ab

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(100

)fe

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table

s


Dow




arolina at wilm


Tab

leIIS

elf

-Est

ee

mO

utc

om

es

of

Mu

ltic

om

po

ne

nt

We

igh

tM

an

ag

em

en

tIn

terv

en

tio

ns

Co

mp

are

dW

ith

Co

ntr

ols

in

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erw

eig

ht

an

dO

be

seA

do

lesc

en

ts

Auth

or

yea

rIn

terv

enti

on

gro

ups

Contr

olgro

ups

nPre

-mea

n(S

D)

Post

-mea

n(S

D)

Change

mea

n(S

D)

Eff

ect

size

nPre

-mea

n(S

D)

Post

-mea

n(S

D)

Change

mea

n(S

D)

Eff

ect

size

Bre

nnan

etal2012

20

215

(54

)a206

(63

)a

21

1(4

78)a

01

514

188

(47

)a192

(47

)a06

4(3

91)a

00

9C

roker

etal2012

13

26

9(0

57)b

29

5(0

45)b

03

6(0

39)b

05

110

29

0(0

61)b

26

8(0

52)b

00

2(0

59)b

03

9D

ale

yet

al2006

28

24

2(0

56)b

26

1(0

08

SE)b

NA

NA

30

24

9(0

49)b

25

6(0

10

SE)b

NA

NA

Danie

lsen

etal2013

16

28

8(0

52)b

31

7(0

53)b

02

9(0

53)b

05

516

31

1(0

57)b

30

6(0

59)b

00

5(0

37)b

00

9D

eBar

etal2012

105

23

9(0

26)a

24

0(0

25)a

NA

00

4103

24

1(0

27)a

23

9(0

25)a

NA

00

8L

och

rie

etal2013

29

183

(50

2)b

191

(44

8)b

07

3(4

51)b

01

718

199

(34

6)b

199

(34

3)b

00

0(3

11)b

00

0L

ubans

etal2012

54

40

3(1

12)c

40

6(1

32)c

NA

00

268

40

4(0

99)c

42

3(0

98)c

NA

01

9M

ellin

etal1987

37

NA

NA

08

8(1

50)a

NA

29

NA

NA

05

2(1

34)a

NA

Morg

an

etal2012

19

NA

NA

00

8(0

48)d

NA

21

NA

NA

02

6(0

47)d

NA

Neu

mark

-Szt

ain

eret

al2010

85

152

(34

)b151

(29

)bN

A

00

379

141

(34

)b140

(34

)bN

A

00

3

Nguyen

etal2012

(wit

hA

TC

)57

25

8(0

76)b

27

7(0

63)b

01

9(0

67)b

02

7

Nguyen

etal2012

(wit

hout

AT

C)

50

25

9(0

58)b

29

3(0

61)b

01

9(0

51)b

05

7

Sach

eret

al2010

20

NA

32

5(0

68)b

02

5(0

66)b

NA

24

NA

30

4(0

75)b

01

1(0

74)b

NA

Wadden

etal1990

3gro

ups

com

bin

ed47

576

e599

eN

AN

A

Note

D

ata

pre

sente

das

report

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ori

gin

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standard

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data

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ffec

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font

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sw

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fect

size

was

small

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0)

or

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ate

raR

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ale

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erally

score

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30

[hig

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Physi

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self

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Dow




arolina at wilm


Tab

leIII

We

igh

tO

utc

om

es

of

Mu

ltic

om

po

ne

nt

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igh

tM

an

ag

em

en

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en

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ns

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mp

are

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ith

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in

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eig

ht

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be

seA

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en

ts

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or

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terv

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gro

ups

Contr

olgro

ups

nPre

-mea

n(S

D)

Post

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D)

Change

mea

n(S

D)

Eff

ect

size

nPre

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D)

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D)

Change

mea

n(S

D)

Eff

ect

size

Bre

nnan

etal2012

20

20

8(0

37)

19

9(0

46)

02

0(0

18)

02

214

20

8(0

40)

20

9(0

39)

00

1(0

12)

00

3C

roker

etal2012

13

29

5(0

52)

26

6(0

63)

01

7(0

21)

05

010

31

4(0

68)

31

4(0

68)

00

6(0

13)

00

0D

ale

yet

al2006

28

31

7(0

33)

32

3(0

02

SE)

NA

NA

30

33

2(0

37)

32

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02

SE)

NA

NA

Danie

lsen

etal2013

16

25

9(0

30)

24

6(0

41)

01

2(0

17)

03

616

24

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27)

25

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29)

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15)

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etal2012

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20

0(0

34)

18

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NA

03

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01

7L

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rie

etal2013

29

21

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40)

20

6(0

52)

01

2(0

20)

02

818

20

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40)

20

5(0

43)

00

2(0

11)

00

5L

ubans

etal2012

54

19

3(0

61)

18

0(0

68)

NA

02

068

18

5(0

59)

18

0(0

67)

NA

00

8M

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etal1987

37

1365

aN

A

59

(67

5)a

NA

29

1295

aN

A

03

(66

1)a

NA

Morg

an

etal2012

19

NA

NA

04

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91)b

NA

21

NA

NA

00

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87)b

NA

Neu

mark

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ain

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al2010

85

321

(61

)b322

(62

)bN

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279

310

(53

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(55

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00

7

Nguyen

etal2012

(wit

hA

TC

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20

3(0

37)

19

7(0

42)

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8(0

19)

01

5

Nguyen

etal2012

(wit

hout

AT

C)

50

20

2(0

29)

19

4(0

32)

00

9(0

17)

02

6

Sach

eret

al2010

20

NA

23

7(0

52)

02

2(0

27)

NA

24

NA

26

0(0

54)

00

1(0

20)

NA

Wadden

etal1990

3gro

ups

com

bin

ed47

352

b339

bN

AN

A

Note

D

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pre

sente

das

report

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ori

gin

al

paper

sA

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eight

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or

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ve

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ght

bB

MI


Dow




arolina at wilm






Dow




arolina at wilm




Discussion









Dow




arolina at wilm






















enhance self-esteem

Conclusion








adolescents


Dow




arolina at wilm


Supplementary Data


oxfordjournalsorg

Acknowledgments



Funding



References




















































Dow




arolina at wilm




























































































ment The LoozitVR





Dow




arolina at wilm



R









Dow




arolina at wilm


jsw101-TF1

jsw101-TF2

jsw101-TF3

jsw101-TF4

jsw101-TF5

jsw101-TF6

jsw101-TF7

jsw101-TF8

jsw101-TF9

jsw101-TF10

jsw101-TF11








Dow




arolina at wilm


Tab

leI

Stu

dy

Qu

ality

P

art

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an

tsIn

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en

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Du

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a

nd

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or

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etal2012

20

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9C

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13

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28

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26

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NA

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30

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Danie

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16

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NA

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8L

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29

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(50

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191

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199

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199

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ubans

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54

40

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40

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40

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37

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29

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NA

05

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NA

Morg

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etal2012

19

NA

NA

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8(0

48)d

NA

21

NA

NA

02

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Neu

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152

(34

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(29

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379

141

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Nguyen

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Nguyen

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50

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29

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32

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24

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Wadden

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arolina at wilm






Dow




arolina at wilm




Discussion









Dow




arolina at wilm






















enhance self-esteem

Conclusion








adolescents


Dow




arolina at wilm


Supplementary Data


oxfordjournalsorg

Acknowledgments



Funding



References




















































Dow




arolina at wilm




























































































ment The LoozitVR





Dow




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ab

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Wadden

etal

1990U

nit

edSta

tes3

6

Posi

tive

47

(100

)fe

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s12ndash16

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who

rece

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tionCfrac14

Com

par

ato

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rece

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inte

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all

table

s


Dow




arolina at wilm


Tab

leIIS

elf

-Est

ee

mO

utc

om

es

of

Mu

ltic

om

po

ne

nt

We

igh

tM

an

ag

em

en

tIn

terv

en

tio

ns

Co

mp

are

dW

ith

Co

ntr

ols

in

Ov

erw

eig

ht

an

dO

be

seA

do

lesc

en

ts

Auth

or

yea

rIn

terv

enti

on

gro

ups

Contr

olgro

ups

nPre

-mea

n(S

D)

Post

-mea

n(S

D)

Change

mea

n(S

D)

Eff

ect

size

nPre

-mea

n(S

D)

Post

-mea

n(S

D)

Change

mea

n(S

D)

Eff

ect

size

Bre

nnan

etal2012

20

215

(54

)a206

(63

)a

21

1(4

78)a

01

514

188

(47

)a192

(47

)a06

4(3

91)a

00

9C

roker

etal2012

13

26

9(0

57)b

29

5(0

45)b

03

6(0

39)b

05

110

29

0(0

61)b

26

8(0

52)b

00

2(0

59)b

03

9D

ale

yet

al2006

28

24

2(0

56)b

26

1(0

08

SE)b

NA

NA

30

24

9(0

49)b

25

6(0

10

SE)b

NA

NA

Danie

lsen

etal2013

16

28

8(0

52)b

31

7(0

53)b

02

9(0

53)b

05

516

31

1(0

57)b

30

6(0

59)b

00

5(0

37)b

00

9D

eBar

etal2012

105

23

9(0

26)a

24

0(0

25)a

NA

00

4103

24

1(0

27)a

23

9(0

25)a

NA

00

8L

och

rie

etal2013

29

183

(50

2)b

191

(44

8)b

07

3(4

51)b

01

718

199

(34

6)b

199

(34

3)b

00

0(3

11)b

00

0L

ubans

etal2012

54

40

3(1

12)c

40

6(1

32)c

NA

00

268

40

4(0

99)c

42

3(0

98)c

NA

01

9M

ellin

etal1987

37

NA

NA

08

8(1

50)a

NA

29

NA

NA

05

2(1

34)a

NA

Morg

an

etal2012

19

NA

NA

00

8(0

48)d

NA

21

NA

NA

02

6(0

47)d

NA

Neu

mark

-Szt

ain

eret

al2010

85

152

(34

)b151

(29

)bN

A

00

379

141

(34

)b140

(34

)bN

A

00

3

Nguyen

etal2012

(wit

hA

TC

)57

25

8(0

76)b

27

7(0

63)b

01

9(0

67)b

02

7

Nguyen

etal2012

(wit

hout

AT

C)

50

25

9(0

58)b

29

3(0

61)b

01

9(0

51)b

05

7

Sach

eret

al2010

20

NA

32

5(0

68)b

02

5(0

66)b

NA

24

NA

30

4(0

75)b

01

1(0

74)b

NA

Wadden

etal1990

3gro

ups

com

bin

ed47

576

e599

eN

AN

A

Note

D

ata

pre

sente

das

report

edin

ori

gin

alpaper

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standard

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iati

onN

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data

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pro

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leto

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calc

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ted

SEfrac14

Sta

ndard

erro

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ndard

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iati

onE

ffec

tsi

zefrac14

Cohen

rsquosdB

old

font

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sw

her

eef

fect

size

was

small

(02

0)

or

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ate

raR

ose

nber

gse

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ale

(gen

erally

score

dfr

om

0[l

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est

self

-est

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]to

30

[hig

hes

tse

lf-e

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bH

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(gen

erally

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self

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Physi

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Ques

tionnair

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file

for

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once

pt

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Sco

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range

sunav

ailab

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valu

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uals

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her

self

-est

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Dow




arolina at wilm


Tab

leIII

We

igh

tO

utc

om

es

of

Mu

ltic

om

po

ne

nt

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igh

tM

an

ag

em

en

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en

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mp

are

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ith

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in

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or

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gro

ups

Contr

olgro

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nPre

-mea

n(S

D)

Post

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D)

Change

mea

n(S

D)

Eff

ect

size

nPre

-mea

n(S

D)

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n(S

D)

Change

mea

n(S

D)

Eff

ect

size

Bre

nnan

etal2012

20

20

8(0

37)

19

9(0

46)

02

0(0

18)

02

214

20

8(0

40)

20

9(0

39)

00

1(0

12)

00

3C

roker

etal2012

13

29

5(0

52)

26

6(0

63)

01

7(0

21)

05

010

31

4(0

68)

31

4(0

68)

00

6(0

13)

00

0D

ale

yet

al2006

28

31

7(0

33)

32

3(0

02

SE)

NA

NA

30

33

2(0

37)

32

3(0

02

SE)

NA

NA

Danie

lsen

etal2013

16

25

9(0

30)

24

6(0

41)

01

2(0

17)

03

616

24

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27)

25

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29)

00

5(0

15)

01

4D

eBar

etal2012

105

20

0(0

34)

18

8(0

41)

NA

03

2103

20

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33)

19

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38)

NA

01

7L

och

rie

etal2013

29

21

9(0

40)

20

6(0

52)

01

2(0

20)

02

818

20

7(0

40)

20

5(0

43)

00

2(0

11)

00

5L

ubans

etal2012

54

19

3(0

61)

18

0(0

68)

NA

02

068

18

5(0

59)

18

0(0

67)

NA

00

8M

ellin

etal1987

37

1365

aN

A

59

(67

5)a

NA

29

1295

aN

A

03

(66

1)a

NA

Morg

an

etal2012

19

NA

NA

04

2(0

91)b

NA

21

NA

NA

00

3(0

87)b

NA

Neu

mark

-Szt

ain

eret

al2010

85

321

(61

)b322

(62

)bN

A

00

279

310

(53

)b314

(55

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A

00

7

Nguyen

etal2012

(wit

hA

TC

)57

20

3(0

37)

19

7(0

42)

00

8(0

19)

01

5

Nguyen

etal2012

(wit

hout

AT

C)

50

20

2(0

29)

19

4(0

32)

00

9(0

17)

02

6

Sach

eret

al2010

20

NA

23

7(0

52)

02

2(0

27)

NA

24

NA

26

0(0

54)

00

1(0

20)

NA

Wadden

etal1990

3gro

ups

com

bin

ed47

352

b339

bN

AN

A

Note

D

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pre

sente

das

report

edin

ori

gin

al

paper

sA

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eight

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leto

be

calc

ula

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or

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ther

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bB

MI


Dow




arolina at wilm






Dow




arolina at wilm




Discussion









Dow




arolina at wilm






















enhance self-esteem

Conclusion








adolescents


Dow




arolina at wilm


Supplementary Data


oxfordjournalsorg

Acknowledgments



Funding



References




















































Dow




arolina at wilm




























































































ment The LoozitVR





Dow




arolina at wilm



R









Dow




arolina at wilm


jsw101-TF1

jsw101-TF2

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jsw101-TF5

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jsw101-TF7

jsw101-TF8

jsw101-TF9

jsw101-TF10

jsw101-TF11

Tab

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(co

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(auth

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elf

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mea

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size

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Bre

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etal2012

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215

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21

1(4

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etal2012

13

26

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29

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110

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61)b

26

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2(0

59)b

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9D

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yet

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28

24

2(0

56)b

26

1(0

08

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NA

NA

30

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25

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NA

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Danie

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16

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31

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199

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40

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NA

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268

40

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NA

01

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etal1987

37

NA

NA

08

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NA

29

NA

NA

05

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34)a

NA

Morg

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etal2012

19

NA

NA

00

8(0

48)d

NA

21

NA

NA

02

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NA

Neu

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(34

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(29

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A

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379

141

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25

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01

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02

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50

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50

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Dow




arolina at wilm






Dow




arolina at wilm




Discussion









Dow




arolina at wilm






















enhance self-esteem

Conclusion








adolescents


Dow




arolina at wilm


Supplementary Data


oxfordjournalsorg

Acknowledgments



Funding



References




















































Dow




arolina at wilm




























































































ment The LoozitVR





Dow




arolina at wilm



R









Dow




arolina at wilm


jsw101-TF1

jsw101-TF2

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Tab

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Dow




arolina at wilm






Dow




arolina at wilm




Discussion









Dow




arolina at wilm






















enhance self-esteem

Conclusion








adolescents


Dow




arolina at wilm


Supplementary Data


oxfordjournalsorg

Acknowledgments



Funding



References




















































Dow




arolina at wilm




























































































ment The LoozitVR





Dow




arolina at wilm



R









Dow




arolina at wilm


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2(0

56)b

26

1(0

08

SE)b

NA

NA

30

24

9(0

49)b

25

6(0

10

SE)b

NA

NA

Danie

lsen

etal2013

16

28

8(0

52)b

31

7(0

53)b

02

9(0

53)b

05

516

31

1(0

57)b

30

6(0

59)b

00

5(0

37)b

00

9D

eBar

etal2012

105

23

9(0

26)a

24

0(0

25)a

NA

00

4103

24

1(0

27)a

23

9(0

25)a

NA

00

8L

och

rie

etal2013

29

183

(50

2)b

191

(44

8)b

07

3(4

51)b

01

718

199

(34

6)b

199

(34

3)b

00

0(3

11)b

00

0L

ubans

etal2012

54

40

3(1

12)c

40

6(1

32)c

NA

00

268

40

4(0

99)c

42

3(0

98)c

NA

01

9M

ellin

etal1987

37

NA

NA

08

8(1

50)a

NA

29

NA

NA

05

2(1

34)a

NA

Morg

an

etal2012

19

NA

NA

00

8(0

48)d

NA

21

NA

NA

02

6(0

47)d

NA

Neu

mark

-Szt

ain

eret

al2010

85

152

(34

)b151

(29

)bN

A

00

379

141

(34

)b140

(34

)bN

A

00

3

Nguyen

etal2012

(wit

hA

TC

)57

25

8(0

76)b

27

7(0

63)b

01

9(0

67)b

02

7

Nguyen

etal2012

(wit

hout

AT

C)

50

25

9(0

58)b

29

3(0

61)b

01

9(0

51)b

05

7

Sach

eret

al2010

20

NA

32

5(0

68)b

02

5(0

66)b

NA

24

NA

30

4(0

75)b

01

1(0

74)b

NA

Wadden

etal1990

3gro

ups

com

bin

ed47

576

e599

eN

AN

A

Note

D

ata

pre

sente

das

report

edin

ori

gin

alpaper

sSDfrac14

standard

dev

iati

onN

Afrac14

data

not

pro

vid

edu

nab

leto

be

calc

ula

ted

SEfrac14

Sta

ndard

erro

rnot

Sta

ndard

Dev

iati

onE

ffec

tsi

zefrac14

Cohen

rsquosdB

old

font

indic

ate

sw

her

eef

fect

size

was

small

(02

0)

or

gre

ate

raR

ose

nber

gse

lf-e

stee

msc

ale

(gen

erally

score

dfr

om

0[l

ow

est

self

-est

eem

]to

30

[hig

hes

tse

lf-e

stee

m])

bH

art

errsquos

SPPA

SPPC

(gen

erally

score

d1

[low

est

self

-est

eem

]to

4[h

ighes

tse

lf-e

stee

m])

cM

ars

hrsquos

Physi

calSel

f-D

escr

ipti

on

Ques

tionnair

e

dPhysi

calSel

f-Per

cepti

on

Pro

file

for

Adole

scen

ts

ePie

rs-H

arr

isSel

f-C

once

pt

Sca

le

Sco

ring

range

sunav

ailab

lehig

her

valu

eeq

uals

hig

her

self

-est

eem


Dow




arolina at wilm


Tab

leIII

We

igh

tO

utc

om

es

of

Mu

ltic

om

po

ne

nt

We

igh

tM

an

ag

em

en

tIn

terv

en

tio

ns

Co

mp

are

dW

ith

Co

ntr

ols

in

Ov

erw

eig

ht

an

dO

be

seA

do

lesc

en

ts

Auth

or

yea

rIn

terv

enti

on

gro

ups

Contr

olgro

ups

nPre

-mea

n(S

D)

Post

-mea

n(S

D)

Change

mea

n(S

D)

Eff

ect

size

nPre

-mea

n(S

D)

Post

-mea

n(S

D)

Change

mea

n(S

D)

Eff

ect

size

Bre

nnan

etal2012

20

20

8(0

37)

19

9(0

46)

02

0(0

18)

02

214

20

8(0

40)

20

9(0

39)

00

1(0

12)

00

3C

roker

etal2012

13

29

5(0

52)

26

6(0

63)

01

7(0

21)

05

010

31

4(0

68)

31

4(0

68)

00

6(0

13)

00

0D

ale

yet

al2006

28

31

7(0

33)

32

3(0

02

SE)

NA

NA

30

33

2(0

37)

32

3(0

02

SE)

NA

NA

Danie

lsen

etal2013

16

25

9(0

30)

24

6(0

41)

01

2(0

17)

03

616

24

9(0

27)

25

3(0

29)

00

5(0

15)

01

4D

eBar

etal2012

105

20

0(0

34)

18

8(0

41)

NA

03

2103

20

0(0

33)

19

4(0

38)

NA

01

7L

och

rie

etal2013

29

21

9(0

40)

20

6(0

52)

01

2(0

20)

02

818

20

7(0

40)

20

5(0

43)

00

2(0

11)

00

5L

ubans

etal2012

54

19

3(0

61)

18

0(0

68)

NA

02

068

18

5(0

59)

18

0(0

67)

NA

00

8M

ellin

etal1987

37

1365

aN

A

59

(67

5)a

NA

29

1295

aN

A

03

(66

1)a

NA

Morg

an

etal2012

19

NA

NA

04

2(0

91)b

NA

21

NA

NA

00

3(0

87)b

NA

Neu

mark

-Szt

ain

eret

al2010

85

321

(61

)b322

(62

)bN

A

00

279

310

(53

)b314

(55

)bN

A

00

7

Nguyen

etal2012

(wit

hA

TC

)57

20

3(0

37)

19

7(0

42)

00

8(0

19)

01

5

Nguyen

etal2012

(wit

hout

AT

C)

50

20

2(0

29)

19

4(0

32)

00

9(0

17)

02

6

Sach

eret

al2010

20

NA

23

7(0

52)

02

2(0

27)

NA

24

NA

26

0(0

54)

00

1(0

20)

NA

Wadden

etal1990

3gro

ups

com

bin

ed47

352

b339

bN

AN

A

Note

D

ata

pre

sente

das

report

edin

ori

gin

al

paper

sA

llw

eight

outc

om

esre

port

edas

body

mass

index

(BM

I)z-

score

unle

ssoth

erw

ise

state

d

SDfrac14

standar

ddev

iati

on

NAfrac14

data

not

pro

vid

ed

unab

leto

be

calc

ula

ted

SEfrac14

Sta

ndard

Err

or

report

edra

ther

than

Sta

ndard

Dev

iati

onE

ffec

tsi

zefrac14

Cohen

rsquosdB

old

font

indic

ate

sw

her

eef

fect

size

was

smal

l(0

20)

or

gre

ate

raR

elati

ve

wei

ght

bB

MI


Dow




arolina at wilm






Dow




arolina at wilm




Discussion









Dow




arolina at wilm






















enhance self-esteem

Conclusion








adolescents


Dow




arolina at wilm


Supplementary Data


oxfordjournalsorg

Acknowledgments



Funding



References




















































Dow




arolina at wilm




























































































ment The LoozitVR





Dow




arolina at wilm



R









Dow




arolina at wilm


jsw101-TF1

jsw101-TF2

jsw101-TF3

jsw101-TF4

jsw101-TF5

jsw101-TF6

jsw101-TF7

jsw101-TF8

jsw101-TF9

jsw101-TF10

jsw101-TF11

Tab

leIIS

elf

-Est

ee

mO

utc

om

es

of

Mu

ltic

om

po

ne

nt

We

igh

tM

an

ag

em

en

tIn

terv

en

tio

ns

Co

mp

are

dW

ith

Co

ntr

ols

in

Ov

erw

eig

ht

an

dO

be

seA

do

lesc

en

ts

Auth

or

yea

rIn

terv

enti

on

gro

ups

Contr

olgro

ups

nPre

-mea

n(S

D)

Post

-mea

n(S

D)

Change

mea

n(S

D)

Eff

ect

size

nPre

-mea

n(S

D)

Post

-mea

n(S

D)

Change

mea

n(S

D)

Eff

ect

size

Bre

nnan

etal2012

20

215

(54

)a206

(63

)a

21

1(4

78)a

01

514

188

(47

)a192

(47

)a06

4(3

91)a

00

9C

roker

etal2012

13

26

9(0

57)b

29

5(0

45)b

03

6(0

39)b

05

110

29

0(0

61)b

26

8(0

52)b

00

2(0

59)b

03

9D

ale

yet

al2006

28

24

2(0

56)b

26

1(0

08

SE)b

NA

NA

30

24

9(0

49)b

25

6(0

10

SE)b

NA

NA

Danie

lsen

etal2013

16

28

8(0

52)b

31

7(0

53)b

02

9(0

53)b

05

516

31

1(0

57)b

30

6(0

59)b

00

5(0

37)b

00

9D

eBar

etal2012

105

23

9(0

26)a

24

0(0

25)a

NA

00

4103

24

1(0

27)a

23

9(0

25)a

NA

00

8L

och

rie

etal2013

29

183

(50

2)b

191

(44

8)b

07

3(4

51)b

01

718

199

(34

6)b

199

(34

3)b

00

0(3

11)b

00

0L

ubans

etal2012

54

40

3(1

12)c

40

6(1

32)c

NA

00

268

40

4(0

99)c

42

3(0

98)c

NA

01

9M

ellin

etal1987

37

NA

NA

08

8(1

50)a

NA

29

NA

NA

05

2(1

34)a

NA

Morg

an

etal2012

19

NA

NA

00

8(0

48)d

NA

21

NA

NA

02

6(0

47)d

NA

Neu

mark

-Szt

ain

eret

al2010

85

152

(34

)b151

(29

)bN

A

00

379

141

(34

)b140

(34

)bN

A

00

3

Nguyen

etal2012

(wit

hA

TC

)57

25

8(0

76)b

27

7(0

63)b

01

9(0

67)b

02

7

Nguyen

etal2012

(wit

hout

AT

C)

50

25

9(0

58)b

29

3(0

61)b

01

9(0

51)b

05

7

Sach

eret

al2010

20

NA

32

5(0

68)b

02

5(0

66)b

NA

24

NA

30

4(0

75)b

01

1(0

74)b

NA

Wadden

etal1990

3gro

ups

com

bin

ed47

576

e599

eN

AN

A

Note

D

ata

pre

sente

das

report

edin

ori

gin

alpaper

sSDfrac14

standard

dev

iati

onN

Afrac14

data

not

pro

vid

edu

nab

leto

be

calc

ula

ted

SEfrac14

Sta

ndard

erro

rnot

Sta

ndard

Dev

iati

onE

ffec

tsi

zefrac14

Cohen

rsquosdB

old

font

indic

ate

sw

her

eef

fect

size

was

small

(02

0)

or

gre

ate

raR

ose

nber

gse

lf-e

stee

msc

ale

(gen

erally

score

dfr

om

0[l

ow

est

self

-est

eem

]to

30

[hig

hes

tse

lf-e

stee

m])

bH

art

errsquos

SPPA

SPPC

(gen

erally

score

d1

[low

est

self

-est

eem

]to

4[h

ighes

tse

lf-e

stee

m])

cM

ars

hrsquos

Physi

calSel

f-D

escr

ipti

on

Ques

tionnair

e

dPhysi

calSel

f-Per

cepti

on

Pro

file

for

Adole

scen

ts

ePie

rs-H

arr

isSel

f-C

once

pt

Sca

le

Sco

ring

range

sunav

ailab

lehig

her

valu

eeq

uals

hig

her

self

-est

eem


Dow




arolina at wilm


Tab

leIII

We

igh

tO

utc

om

es

of

Mu

ltic

om

po

ne

nt

We

igh

tM

an

ag

em

en

tIn

terv

en

tio

ns

Co

mp

are

dW

ith

Co

ntr

ols

in

Ov

erw

eig

ht

an

dO

be

seA

do

lesc

en

ts

Auth

or

yea

rIn

terv

enti

on

gro

ups

Contr

olgro

ups

nPre

-mea

n(S

D)

Post

-mea

n(S

D)

Change

mea

n(S

D)

Eff

ect

size

nPre

-mea

n(S

D)

Post

-mea

n(S

D)

Change

mea

n(S

D)

Eff

ect

size

Bre

nnan

etal2012

20

20

8(0

37)

19

9(0

46)

02

0(0

18)

02

214

20

8(0

40)

20

9(0

39)

00

1(0

12)

00

3C

roker

etal2012

13

29

5(0

52)

26

6(0

63)

01

7(0

21)

05

010

31

4(0

68)

31

4(0

68)

00

6(0

13)

00

0D

ale

yet

al2006

28

31

7(0

33)

32

3(0

02

SE)

NA

NA

30

33

2(0

37)

32

3(0

02

SE)

NA

NA

Danie

lsen

etal2013

16

25

9(0

30)

24

6(0

41)

01

2(0

17)

03

616

24

9(0

27)

25

3(0

29)

00

5(0

15)

01

4D

eBar

etal2012

105

20

0(0

34)

18

8(0

41)

NA

03

2103

20

0(0

33)

19

4(0

38)

NA

01

7L

och

rie

etal2013

29

21

9(0

40)

20

6(0

52)

01

2(0

20)

02

818

20

7(0

40)

20

5(0

43)

00

2(0

11)

00

5L

ubans

etal2012

54

19

3(0

61)

18

0(0

68)

NA

02

068

18

5(0

59)

18

0(0

67)

NA

00

8M

ellin

etal1987

37

1365

aN

A

59

(67

5)a

NA

29

1295

aN

A

03

(66

1)a

NA

Morg

an

etal2012

19

NA

NA

04

2(0

91)b

NA

21

NA

NA

00

3(0

87)b

NA

Neu

mark

-Szt

ain

eret

al2010

85

321

(61

)b322

(62

)bN

A

00

279

310

(53

)b314

(55

)bN

A

00

7

Nguyen

etal2012

(wit

hA

TC

)57

20

3(0

37)

19

7(0

42)

00

8(0

19)

01

5

Nguyen

etal2012

(wit

hout

AT

C)

50

20

2(0

29)

19

4(0

32)

00

9(0

17)

02

6

Sach

eret

al2010

20

NA

23

7(0

52)

02

2(0

27)

NA

24

NA

26

0(0

54)

00

1(0

20)

NA

Wadden

etal1990

3gro

ups

com

bin

ed47

352

b339

bN

AN

A

Note

D

ata

pre

sente

das

report

edin

ori

gin

al

paper

sA

llw

eight

outc

om

esre

port

edas

body

mass

index

(BM

I)z-

score

unle

ssoth

erw

ise

state

d

SDfrac14

standar

ddev

iati

on

NAfrac14

data

not

pro

vid

ed

unab

leto

be

calc

ula

ted

SEfrac14

Sta

ndard

Err

or

report

edra

ther

than

Sta

ndard

Dev

iati

onE

ffec

tsi

zefrac14

Cohen

rsquosdB

old

font

indic

ate

sw

her

eef

fect

size

was

smal

l(0

20)

or

gre

ate

raR

elati

ve

wei

ght

bB

MI


Dow




arolina at wilm






Dow




arolina at wilm




Discussion









Dow




arolina at wilm






















enhance self-esteem

Conclusion








adolescents


Dow




arolina at wilm


Supplementary Data


oxfordjournalsorg

Acknowledgments



Funding



References




















































Dow




arolina at wilm




























































































ment The LoozitVR





Dow




arolina at wilm



R









Dow




arolina at wilm


jsw101-TF1

jsw101-TF2

jsw101-TF3

jsw101-TF4

jsw101-TF5

jsw101-TF6

jsw101-TF7

jsw101-TF8

jsw101-TF9

jsw101-TF10

jsw101-TF11

Tab

leIII

We

igh

tO

utc

om

es

of

Mu

ltic

om

po

ne

nt

We

igh

tM

an

ag

em

en

tIn

terv

en

tio

ns

Co

mp

are

dW

ith

Co

ntr

ols

in

Ov

erw

eig

ht

an

dO

be

seA

do

lesc

en

ts

Auth

or

yea

rIn

terv

enti

on

gro

ups

Contr

olgro

ups

nPre

-mea

n(S

D)

Post

-mea

n(S

D)

Change

mea

n(S

D)

Eff

ect

size

nPre

-mea

n(S

D)

Post

-mea

n(S

D)

Change

mea

n(S

D)

Eff

ect

size

Bre

nnan

etal2012

20

20

8(0

37)

19

9(0

46)

02

0(0

18)

02

214

20

8(0

40)

20

9(0

39)

00

1(0

12)

00

3C

roker

etal2012

13

29

5(0

52)

26

6(0

63)

01

7(0

21)

05

010

31

4(0

68)

31

4(0

68)

00

6(0

13)

00

0D

ale

yet

al2006

28

31

7(0

33)

32

3(0

02

SE)

NA

NA

30

33

2(0

37)

32

3(0

02

SE)

NA

NA

Danie

lsen

etal2013

16

25

9(0

30)

24

6(0

41)

01

2(0

17)

03

616

24

9(0

27)

25

3(0

29)

00

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15)

01

4D

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etal2012

105

20

0(0

34)

18

8(0

41)

NA

03

2103

20

0(0

33)

19

4(0

38)

NA

01

7L

och

rie

etal2013

29

21

9(0

40)

20

6(0

52)

01

2(0

20)

02

818

20

7(0

40)

20

5(0

43)

00

2(0

11)

00

5L

ubans

etal2012

54

19

3(0

61)

18

0(0

68)

NA

02

068

18

5(0

59)

18

0(0

67)

NA

00

8M

ellin

etal1987

37

1365

aN

A

59

(67

5)a

NA

29

1295

aN

A

03

(66

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NA

Morg

an

etal2012

19

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04

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21

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Neu

mark

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eret

al2010

85

321

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A

00

279

310

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(55

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A

00

7

Nguyen

etal2012

(wit

hA

TC

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20

3(0

37)

19

7(0

42)

00

8(0

19)

01

5

Nguyen

etal2012

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50

20

2(0

29)

19

4(0

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9(0

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02

6

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al2010

20

NA

23

7(0

52)

02

2(0

27)

NA

24

NA

26

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etal1990

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Dow




arolina at wilm






Dow




arolina at wilm




Discussion









Dow




arolina at wilm






















enhance self-esteem

Conclusion








adolescents


Dow




arolina at wilm


Supplementary Data


oxfordjournalsorg

Acknowledgments



Funding



References




















































Dow




arolina at wilm




























































































ment The LoozitVR





Dow




arolina at wilm



R









Dow




arolina at wilm


jsw101-TF1

jsw101-TF2

jsw101-TF3

jsw101-TF4

jsw101-TF5

jsw101-TF6

jsw101-TF7

jsw101-TF8

jsw101-TF9

jsw101-TF10

jsw101-TF11





Dow




arolina at wilm




Discussion









Dow




arolina at wilm






















enhance self-esteem

Conclusion








adolescents


Dow




arolina at wilm


Supplementary Data


oxfordjournalsorg

Acknowledgments



Funding



References




















































Dow




arolina at wilm




























































































ment The LoozitVR





Dow




arolina at wilm



R









Dow




arolina at wilm


jsw101-TF1

jsw101-TF2

jsw101-TF3

jsw101-TF4

jsw101-TF5

jsw101-TF6

jsw101-TF7

jsw101-TF8

jsw101-TF9

jsw101-TF10

jsw101-TF11



Discussion









Dow




arolina at wilm






















enhance self-esteem

Conclusion








adolescents


Dow




arolina at wilm


Supplementary Data


oxfordjournalsorg

Acknowledgments



Funding



References




















































Dow




arolina at wilm




























































































ment The LoozitVR





Dow




arolina at wilm



R









Dow




arolina at wilm


jsw101-TF1

jsw101-TF2

jsw101-TF3

jsw101-TF4

jsw101-TF5

jsw101-TF6

jsw101-TF7

jsw101-TF8

jsw101-TF9

jsw101-TF10

jsw101-TF11





















enhance self-esteem

Conclusion








adolescents


Dow




arolina at wilm


Supplementary Data


oxfordjournalsorg

Acknowledgments



Funding



References




















































Dow




arolina at wilm




























































































ment The LoozitVR





Dow




arolina at wilm



R









Dow




arolina at wilm


jsw101-TF1

jsw101-TF2

jsw101-TF3

jsw101-TF4

jsw101-TF5

jsw101-TF6

jsw101-TF7

jsw101-TF8

jsw101-TF9

jsw101-TF10

jsw101-TF11

Supplementary Data


oxfordjournalsorg

Acknowledgments



Funding



References




















































Dow




arolina at wilm




























































































ment The LoozitVR





Dow




arolina at wilm



R









Dow




arolina at wilm


jsw101-TF1

jsw101-TF2

jsw101-TF3

jsw101-TF4

jsw101-TF5

jsw101-TF6

jsw101-TF7

jsw101-TF8

jsw101-TF9

jsw101-TF10

jsw101-TF11



























































































ment The LoozitVR





Dow




arolina at wilm



R









Dow




arolina at wilm


jsw101-TF1

jsw101-TF2

jsw101-TF3

jsw101-TF4

jsw101-TF5

jsw101-TF6

jsw101-TF7

jsw101-TF8

jsw101-TF9

jsw101-TF10

jsw101-TF11


R









Dow




arolina at wilm


jsw101-TF1

jsw101-TF2

jsw101-TF3

jsw101-TF4

jsw101-TF5

jsw101-TF6

jsw101-TF7

jsw101-TF8

jsw101-TF9

jsw101-TF10

jsw101-TF11

Systematic Review and Meta-Analysis: The Impact of...

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