{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T02:19:29Z","timestamp":1793326769421,"version":"4.5.0"},"reference-count":49,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2025,11,13]],"date-time":"2025-11-13T00:00:00Z","timestamp":1762992000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Projeto Obelisko\u2014Funda\u00e7\u00e3o de Amparo \u00e0 Pesquisa do Estado do Rio de Janeiro\u2014FAPERJ\u2014Projetos tem\u00e1ticos","award":["258256"],"award-info":[{"award-number":["258256"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>The Planetary Health Diet (PHD), recognized as a healthy and environmentally sustainable dietary pattern, has been promoted globally; however, its role in supporting weight change among children within structured weight management interventions remains unclear. A four-month randomized multicomponent family-based trial was conducted with 120 dyads of children with obesity (7\u201312 years) and their guardians. The intervention group (IG) received counseling on the PHD, portion size reduction, and strategies to increase moderate-to-vigorous physical activity, while the control group (CG) received general guidance based on the Dietary and Physical Activity Guidelines for the Brazilian Population, emphasizing the avoidance of ultra-processed foods. Dietary intake was assessed using a food frequency questionnaire, and anthropometric measurements were taken by trained professionals at baseline and during each consultation. Mixed-effects models were used to estimate BMI change in children and guardians. Most guardians were mothers with low-to-middle income. Attrition was around 40% in both groups, but most participants were followed up for four visits. No significant difference in BMI variation was observed between allocation groups; however, both groups of children reduced BMI (IG = \u22120.2 and CG = \u22120.4; p = 0.002), with no change among guardians. PHD adherence scores changed minimally overall, but consumption of nuts and fruits increased in both groups. Although the intervention did not outperform the control in reducing BMI, the overall BMI reduction among children in both groups suggests that participation in a lifestyle-focused trial, regardless of specific content, may promote weight management in children with obesity.<\/jats:p>","DOI":"10.3390\/ijerph22111717","type":"journal-article","created":{"date-parts":[[2025,11,13]],"date-time":"2025-11-13T12:57:13Z","timestamp":1763038633000},"page":"1717","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["A Multicomponent Family Treatment of Childhood Obesity Based on the Planetary Healthy Diet: A Randomized Controlled Trial"],"prefix":"10.3390","volume":"22","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8691-6818","authenticated-orcid":false,"given":"Joana Maia","family":"Brand\u00e3o","sequence":"first","affiliation":[{"name":"Department of Epidemiology, Social Medicine Institute, State University of Rio de Janeiro, Rua S\u00e3o Francisco Xavier, 524, 7\u00b0 andar, bloco E, sala 7017B, Maracan\u00e3, Rio de Janeiro 20550-900, RJ, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0900-5628","authenticated-orcid":false,"given":"Diana Barbosa","family":"Cunha","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Social Medicine Institute, State University of Rio de Janeiro, Rua S\u00e3o Francisco Xavier, 524, 7\u00b0 andar, bloco E, sala 7017B, Maracan\u00e3, Rio de Janeiro 20550-900, RJ, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9989-1875","authenticated-orcid":false,"given":"Magno Concei\u00e7\u00e3o","family":"Garcia","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Social Medicine Institute, State University of Rio de Janeiro, Rua S\u00e3o Francisco Xavier, 524, 7\u00b0 andar, bloco E, sala 7017B, Maracan\u00e3, Rio de Janeiro 20550-900, RJ, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cinthia Guimar\u00e3es","family":"Assemany","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Social Medicine Institute, State University of Rio de Janeiro, Rua S\u00e3o Francisco Xavier, 524, 7\u00b0 andar, bloco E, sala 7017B, Maracan\u00e3, Rio de Janeiro 20550-900, RJ, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7980-6618","authenticated-orcid":false,"given":"Marina Campos","family":"Ara\u00fajo","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Quantitative Methods in Health, Sergio Arouca National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro 20911-300, RJ, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8152-8565","authenticated-orcid":false,"given":"Val\u00e9ria Troncoso","family":"Baltar","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Biostatistics, Institute of Collective Health, Fluminense Federal University, Niter\u00f3i 24030-210, RJ, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5286-5354","authenticated-orcid":false,"given":"Rosely","family":"Sichieri","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Social Medicine Institute, State University of Rio de Janeiro, Rua S\u00e3o Francisco Xavier, 524, 7\u00b0 andar, bloco E, sala 7017B, Maracan\u00e3, Rio de Janeiro 20550-900, RJ, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,11,13]]},"reference":[{"key":"ref_1","unstructured":"WHO (2025, July 23). Obesity and Overweight. Available online: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/obesity-and-overweight."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1836","DOI":"10.1016\/S0140-6736(19)32596-6","article-title":"The 2019 report of The Lancet Countdown on health and climate change: Ensuring that the health of a child born today is not defined by a changing climate","volume":"394","author":"Watts","year":"2019","journal-title":"Lancet"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"791","DOI":"10.1016\/S0140-6736(18)32822-8","article-title":"The Global Syndemic of Obesity, Undernutrition, and Climate Change: The Lancet Commission report","volume":"393","author":"Swinburn","year":"2019","journal-title":"Lancet"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"447","DOI":"10.1016\/S0140-6736(18)31788-4","article-title":"Food in the Anthropocene: The EAT\u2013Lancet Commission on healthy diets from sustainable food systems","volume":"393","author":"Willett","year":"2019","journal-title":"Lancet"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"2837","DOI":"10.1093\/jn\/nxaa257","article-title":"The Benefits of the EAT-Lancet Commission\u2019s Dietary Recommendations Are Significant and Robust","volume":"150","author":"Springmann","year":"2020","journal-title":"J. Nutr."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Tucci, M., Martini, D., Del Bo\u2019, C., Marino, M., Battezzati, A., Bertoli, S., Porrini, M., and Riso, P. (2021). An Italian-Mediterranean Dietary Pattern Developed Based on the EAT-Lancet Reference Diet (EAT-IT): A Nutritional Evaluation. Foods, 10.","DOI":"10.3390\/foods10030558"},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Lassen, A.D., Christensen, L.M., and Trolle, E. (2020). Development of a Danish Adapted Healthy Plant-Based Diet Based on the EAT-Lancet Reference Diet. Nutrients, 12.","DOI":"10.3390\/nu12030738"},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Marchioni, D.M., Cacau, L.T., De Carli, E., de Carvalho, A.M., and Rulli, M.C. (2022). Low Adherence to the EAT-Lancet Sustainable Reference Diet in the Brazilian Population: Findings from the National Dietary Survey 2017\u20132018. Nutrients, 14.","DOI":"10.3390\/nu14061187"},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Cacau, L.T., De Carli, E., de Carvalho, A.M., Lotufo, P.A., Moreno, L.A., Bensenor, I.M., and Marchioni, D.M. (2021). Development and Validation of an Index Based on EAT-Lancet Recommendations: The Planetary Health Diet Index. Nutrients, 13.","DOI":"10.3390\/nu13051698"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"522","DOI":"10.1017\/S0007114525000157","article-title":"Children\u2019s adherence to a healthy and environmentally sustainable dietary pattern based on the EAT-Lancet recommendations: The role of the family environment","volume":"133","author":"Teixeira","year":"2025","journal-title":"Br. J. Nutr."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Ojeda-Rodr\u00edguez, A., Paula-Buestan, G., Zazpe, I., Azcona-Sanjulian, M.C., and del Moral, A.M. (2024). Higher Adherence to the EAT-Lancet Diets After a Lifestyle Intervention in a Pediatric Population with Abdominal Obesity. Nutrients, 16.","DOI":"10.3390\/nu16244270"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"461","DOI":"10.1089\/chi.2014.0060","article-title":"Attrition and the Management of Pediatric Obesity: An Integrative Review","volume":"10","author":"Dhaliwal","year":"2014","journal-title":"Child. Obes."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"381","DOI":"10.1037\/0278-6133.26.4.381","article-title":"Family-Based Obesity Treatment, Then and Now: Twenty-Five Years of Pediatric Obesity Treatment","volume":"26","author":"Epstein","year":"2007","journal-title":"Health Psychol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"e273","DOI":"10.1111\/j.1467-789X.2010.00803.x","article-title":"Attrition in paediatric weight management: A review of the literature and new directions","volume":"12","author":"Skelton","year":"2011","journal-title":"Obes. Rev."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"e12648","DOI":"10.1111\/cob.12648","article-title":"Treatment of childhood obesity based on the reduction of ultra-processed foods plus energy restriction: A randomised controlled trial based on the Brazilian guidelines","volume":"14","author":"Sichieri","year":"2024","journal-title":"Clin. Obes."},{"key":"ref_16","first-page":"e71550","article-title":"Prevention Strategies in Obesity Management: A Systematic Review Comparing Canadian and American Guidelines for Adults","volume":"16","author":"Ijoma","year":"2024","journal-title":"Cureus"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1875","DOI":"10.1038\/oby.2004.233","article-title":"Energy Intake and Meal Portions: Associations with BMI Percentile in U.S. Children","volume":"12","author":"Huang","year":"2004","journal-title":"Obes. Res."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"126","DOI":"10.1017\/S0954422424000027","article-title":"Food portion sizes: Trends and drivers in an obesogenic environment","volume":"38","author":"Papagiannaki","year":"2025","journal-title":"Nutr. Res. Rev."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"386","DOI":"10.1017\/S0029665123000071","article-title":"Child food portion sizes in the home environment: How do parents decide?","volume":"82","author":"Acolatse","year":"2023","journal-title":": Proc. Nutr. Soc."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"657","DOI":"10.1038\/ijo.2013.169","article-title":"Visual illusions and plate design: The effects of plate rim widths and rim coloring on perceived food portion size","volume":"38","author":"McClain","year":"2005","journal-title":"Int. J. Obes."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1016\/j.appet.2014.07.010","article-title":"The influence of plate size on meal composition. Literature review and experiment","volume":"82","author":"Libotte","year":"2014","journal-title":"Appetite"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"215","DOI":"10.1086\/662615","article-title":"Plate Size and Color Suggestibility: The Delboeuf Illusion\u2019s Bias on Serving and Eating Behavior","volume":"39","author":"Ittersum","year":"2012","journal-title":"J. Consum. Res."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Assemany, C.G., Cunha, D.B., Brand\u00e3o, J.M., Paravidino, V.B., Garcia, M.C., R\u00eago, A.L.V., Pereira, R.A., and Sichieri, R. (2023). A multicomponent family intervention, combined with salt reduction for children with obesity: A factorial randomized study protocol. BMC Public Health, 23.","DOI":"10.1186\/s12889-023-16356-6"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"40","DOI":"10.7326\/M17-0046","article-title":"CONSORT Statement for Randomized Trials of Nonpharmacologic Treatments: A 2017 Update and a CONSORT Extension for Nonpharmacologic Trial Abstracts","volume":"167","author":"Boutron","year":"2017","journal-title":"Ann. Intern. Med."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"e1647","DOI":"10.1542\/peds.2012-1176","article-title":"Effectiveness of Lifestyle Interventions in Child Obesity: Systematic Review with Meta-analysis","volume":"130","author":"Ho","year":"2012","journal-title":"Pediatrics"},{"key":"ref_26","unstructured":"Arora, A. (2025, October 24). Fed to Fail: 2021 Child Nutrition Report. UNICEF DATA. Available online: https:\/\/data.unicef.org\/resources\/fed-to-fail-2021-child-nutrition-report\/."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1016\/j.appet.2014.12.001","article-title":"Environmental strategies for portion control in children","volume":"88","author":"Robinson","year":"2025","journal-title":"Appetite"},{"key":"ref_28","unstructured":"Minist\u00e9rio da Sa\u00fade, Secretaria de Aten\u00e7\u00e3o \u00e0 Sa\u00fade (2014). Guia Alimentar para a Popula\u00e7\u00e3o Brasileira, Departamento de Aten\u00e7\u00e3o B\u00e1sica, Minist\u00e9rio da Sa\u00fade. [2nd ed.]."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"660","DOI":"10.2471\/BLT.07.043497","article-title":"Development of a WHO growth reference for school-aged children and adolescents","volume":"85","author":"Onyango","year":"2007","journal-title":"Bull. World Health Organ."},{"key":"ref_30","unstructured":"Minist\u00e9rio da Sa\u00fade, Secretaria de Aten\u00e7\u00e3o \u00e0 Sa\u00fade, Departamento de Aten\u00e7\u00e3o B\u00e1sica (2025, November 06). Orienta\u00e7\u00f5es para a Coleta e An\u00e1lise de dados Antropom\u00e9tricos em Servi\u00e7os de Sa\u00fade: Norma T\u00e9cnica do Sistema de Vigil\u00e2ncia Alimentar e Nutricional\u2014SISVAN, Available online: https:\/\/bvsms.saude.gov.br\/bvs\/publicacoes\/orientacoes_coleta_analise_dados_antropometricos.pdf."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"457","DOI":"10.1590\/1413-81232017222.26392015","article-title":"Validade relativa de question\u00e1rio de frequ\u00eancia alimentar com suporte de imagens","volume":"22","author":"Brito","year":"2017","journal-title":"Ci\u00eanc. Sa\u00fade Coletiva"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1821","DOI":"10.1007\/s40279-017-0716-0","article-title":"Accelerometer Data Collection and Processing Criteria to Assess Physical Activity and Other Outcomes: A Systematic Review and Practical Considerations","volume":"47","author":"Migueles","year":"2017","journal-title":"Sports Med."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1323","DOI":"10.1249\/MSS.0000000000001561","article-title":"Beyond Cut Points: Accelerometer Metrics that Capture the Physical Activity Profile","volume":"50","author":"Rowlands","year":"2018","journal-title":"Med. Sci. Sports Exerc."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1816","DOI":"10.1249\/MSS.0000000000000289","article-title":"Age Group Comparability of Raw Accelerometer Output from Wrist- and Hip-Worn Monitors","volume":"46","author":"Hildebrand","year":"2014","journal-title":"Med. Sci. Sports Exerc."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"e59","DOI":"10.1016\/S2214-109X(19)30447-4","article-title":"Affordability of the EAT\u2013Lancet reference diet: A global analysis","volume":"8","author":"Hirvonen","year":"2020","journal-title":"Lancet Glob. Health"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"e695","DOI":"10.1016\/S2214-109X(16)30186-3","article-title":"Availability, affordability, and consumption of fruits and vegetables in 18 countries across income levels: Findings from the Prospective Urban Rural Epidemiology (PURE) study","volume":"4","author":"Miller","year":"2016","journal-title":"Lancet Glob. Health"},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Caldeira, T.C.M., Nassif, L., de Sousa, T.M., Maia, E.G., Fagioli, H.B., Canella, D.S., and Claro, R.M. (2025). Cost Associated with Adherence to the EAT-Lancet Score in Brazil. Nutrients, 17.","DOI":"10.3390\/nu17020289"},{"key":"ref_38","unstructured":"Universidade Federal do Rio De Janeiro (2025, July 02). Alimenta\u00e7\u00e3o Infantil II: Consumo Alimentar de Crian\u00e7as Menores de 5 Anos: Enani 2019. Available online: https:\/\/enani.nutricao.ufrj.br\/relatorios\/."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1","DOI":"10.11606\/s1518-8787.2023057004744","article-title":"Consumo de alimentos ultraprocessados no Brasil: Distribui\u00e7\u00e3o e evolu\u00e7\u00e3o temporal 2008\u20132018","volume":"57","author":"Louzada","year":"2023","journal-title":"Rev. Sa\u00fade P\u00fablica"},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Vargas-Quesada, R., Monge-Rojas, R., Rodr\u00edguez-Ram\u00edrez, S., Araneda-Flores, J., Cacau, L.T., Cediel, G., Gait\u00e1n-Charry, D., Quevedo, T.P., Fernandes, A.C.P., and Rovirosa, A. (2025). Adherence to the EAT-Lancet Diet Among Urban and Rural Latin American Adolescents: Associations with Micronutrient Intake and Ultra-Processed Food Consumption. Nutrients, 17.","DOI":"10.3390\/nu17122048"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"152","DOI":"10.1007\/s00394-025-03661-6","article-title":"Adherence to the EAT-Lancet Planetary Health Diet in Portugal and its associations with socioeconomic and lifestyle factors","volume":"64","author":"Carvalho","year":"2025","journal-title":"Eur. J. Nutr."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"527","DOI":"10.1055\/a-1159-4506","article-title":"Stabilization of BMIz is associated with a decrease in visceral fat in children with obesity","volume":"52","author":"Naik","year":"2020","journal-title":"Horm. Metab. Res."},{"key":"ref_43","first-page":"CD012651","article-title":"Diet, physical activity and behavioural interventions for the treatment of overweight or obese children from the age of 6 to 11 years","volume":"2017","author":"Mead","year":"2017","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_44","first-page":"CD015328","article-title":"Interventions to prevent obesity in children aged 5 to 11 years old","volume":"5","author":"Spiga","year":"2024","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"e087517","DOI":"10.1136\/bmjopen-2024-087517","article-title":"Barriers to and facilitators of weight reduction in young adults with obesity: A qualitative study in an urban setting in Sri Lanka","volume":"15","author":"Gamage","year":"2025","journal-title":"BMJ Open"},{"key":"ref_46","doi-asserted-by":"crossref","unstructured":"Ravikumar, D., Spyreli, E., Woodside, J., McKinley, M., and Kelly, C. (2022). Parental perceptions of the food environment and their influence on food decisions among low-income families: A rapid review of qualitative evidence. BMC Public Health, 22.","DOI":"10.1186\/s12889-021-12414-z"},{"key":"ref_47","first-page":"913965","article-title":"Effects on Metabolic Health after a 1-Year-Lifestyle Intervention in Overweight and Obese Children: A Randomized Controlled Trial","volume":"2012","author":"Waling","year":"2011","journal-title":"J. Nutr. Metab."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"202","DOI":"10.1038\/s41430-023-01379-4","article-title":"Association between adherence to the EAT-Lancet sustainable reference diet and cardiovascular health among European adolescents: The HELENA study","volume":"78","author":"Cacau","year":"2024","journal-title":"Eur. J. Clin. Nutr."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"e13928","DOI":"10.1111\/obr.13928","article-title":"A systematic review of the relationship between portion size and indexes of adiposity in children","volume":"26","author":"Dobrescu","year":"2025","journal-title":"Obes. Rev."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/22\/11\/1717\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,13]],"date-time":"2025-11-13T13:01:43Z","timestamp":1763038903000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/22\/11\/1717"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,13]]},"references-count":49,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2025,11]]}},"alternative-id":["ijerph22111717"],"URL":"https:\/\/doi.org\/10.3390\/ijerph22111717","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11,13]]}}}