research is needed to clarify our understanding of how the family contributes to or can help mitigate the development of obesity. Research into how environmental factors (e.g., television, video games, cars, and readily available snack foods) affect behavior and body weight must also continue.

Strategies for promoting maintenance of weight loss and preventing relapse have been largely ignored in the pediatric population. Future cstudies must address both maintenance and relapse prevention in children and adolescents.

Almost no research has been done in the area of prevention, although prevention of pediatric obesity may be the only effective treatment of adult obesity. By adapting existing treatment protocols, programs directed at primary prevention of obesity can be developed. Issues to be resolved include who should be targeted (all children or just those at risk) and where these programs would be administered (e.g., in schools, in communities, through physicians' offices). Schools clearly represent a cost-effective setting, but intervention programs must be developed and tested in other locations as well.

At least two or three critical periods have been identified during childhood for the development of obesity and its putative health consequences (diabetes, hypertension, hypercholesterolemia, and cardiovascular disease). These periods represent potential treatment targets for the prevention of adult obesity, and additional research is needed to identify the most effective time to target efforts to prevent and treat childhood obesity.