This review provides an update to a previous Evidence Base Update addressing behavioral treatments for overweight and obesity in children and adolescents. Articles were identified through a systematic search of the biomedical literature in PubMed/MEDLINE (1946-), Elsevier EMBASE (1947-), SCOPUS (1823-), Clarivate Web of Science Core Collection (WOS, 1900-), PsycINFO (1800-), The Cochrane Library and Clinicaltrials.gov published between June 2014 and August 2022. Family-based treatment (FBT) remains a well-established treatment for overweight and obesity in children and is now well-established in adolescents and toddlers. Parent-only behavioral treatment remains well-established in children and is now well-established among adolescents and children. Possibly effective treatments continue to include FBT-parent only for adolescents, and behavioral weight loss (BWL) with a family component for adolescents, children, and toddlers. Several variations of FBT and BWL can now be considered possibly effective including FBT+motivational interviewing, FBT+social facilitation maintenance, group-based FBT, low-dose FBT, BWL+stress management, and camp-based BWL. Cognitive behavioral treatment (CBT) for adolescents also met criteria for possibly effective treatments. Current research has also established that behavioral treatments can be effectively delivered in alternative settings (e.g. primary care) and through alternative mediums (e.g. telehealth). Research continues to support the use of multicomponent lifestyle interventions in accordance with recent recommendations from the American Academy of Pediatrics, the American Psychological Association, and the United State Preventative Services Task Force. However, more work is needed to ensure appropriate access for children with comorbid medical and psychiatric disorders and children from socially, politically, and economically marginalized groups.

Background/Objectives. Food insecurity and pediatric obesity have increased concurrently in the U.S., raising questions about the role of Federal Nutrition Assistance Programs (FNAPs) in shaping weight outcomes. This systematic review examined evidence on relationships between FNAP participation and pediatric weight outcomes. Methods. Six databases were searched for U.S.-based, peer-reviewed studies published through July 2024 that assessed FNAP participation and pediatric weight outcomes. Results. Seventy-five studies met the inclusion criteria, and no consistent pattern indicated that any single FNAP or program type (educational setting-based or direct financial support) reliably reduced or increased childhood overweight or obesity risk. Twenty studies found statistically significant beneficial relationships between FNAP participation and pediatric weight outcomes. Most studies reported mixed findings (n = 32), typically varying by subgroup (e.g., age, grade level, gender, race or ethnicity, or program characteristics). Sixteen studies found no relationship between participation and weight. Seven studies found an adverse relationship. Most studies relied on non-randomized quantitative designs and secondary data, and adverse findings were more common in lower quality studies. Among 18 studies that evaluated the effects of policy changes (e.g., the Healthy Hunger-Free Kids Act (2010), 2009 WIC package change), nearly all identified associations between the policy change and weight outcomes, with eight beneficial and nine reporting mixed results. Conclusions. The findings indicate a complex non-causal relationship between FNAP participation and weight that varies across populations, programs, and study designs. Overall, evidence does not support broad adverse weight effects of FNAPs, and policy changes that strengthen nutrition standards may contribute to healthier weight outcomes. These findings have implications for nutrition policy, program design, and future research.