Effectiveness of educational and lifestyle interventions to prevent paediatric obesity: systematic review and meta-analyses of randomized and non-randomized controlled trials

Abstract

SummaryObjectiveThis review and meta‐analysis aim at updating a previous meta‐analysis carried out by Waters et al. on the efficacy of interventions aimed at preventing childhood obesity and at identifying predictors of outcome.MethodsUsing an ad‐hoc search string, PubMed database was searched for studies assessing body mass index reduction associated with programmes lasting ≥12 weeks in overweight and obese children aged 2–18 years. Studies designed for children with eating disorders or relevant comorbidities were excluded. Studies meeting inclusion criteria were classified according to patient age (<6, 6–12 and 13–18 years), and intervention type (physical activity, diet or both), setting (educational, family or both) and duration (≤1 or >1 year). The search was also extended to other databases. Hand‐searching techniques were also applied. The Cochrane ‘risk of bias’ was applied for quality assessment.ResultsSeventy‐two studies were meta‐analysed. Overall, the best results were achieved by programmes combining diet and physical activity (n = 39). With regard to the setting, programmes involving both school and family and lasting ≤1 year were the most efficacious for 6‐ to 12‐year‐old children (n = 26); family‐based‐only interventions were also effective in children <6 years old (n = 2), although results have to be interpreted cautiously because of the small number of patients enrolled and the high study heterogeneity. In 13‐ to 18‐year‐old patients, interventions delivered at school (n = 8) were substantially unsuccessful.ConclusionsInterventions for childhood obesity prevention should include both diet and physical activity, be preferentially targeted towards school age children and involve both the school and family setting. However, because of the important methodological limitations associated with currently available literature, additional studies are needed to draw definite conclusions.

Characteristics of Effective Interventions Promoting Healthy Eating for Pre-Schoolers in Childcare Settings: An Umbrella Review

“…The systematic reviews relating to pre-schoolers and healthy eating have been predominantly about preventing or managing obesity, with a focus on the effectiveness of interventions which change weight status [ 25 ]. Other systematic reviews have focused on specific determinants of obesity such as diet, physical activity and other obesogenic behaviours including sedentary behaviour and sleep [ 26 , 27 ] or type of intervention such as educational and lifestyle interventions [ 28 ], influence of the food environment [ 29 ] or nutrition policies at child-care centres and impact on role modelling [ 30 ]. The range of research questions in these reviews has been wide, as have been the recommendations for decision-makers, practitioners and policy-makers.…”

Four-year Behavioural, Health Related Quality of Life and BMI Outcomes From a Cluster Randomized Whole of Systems Trial of Prevention Strategies for Childhood Obesity (Whostops Childhood Obesity)

“…Until now, the longest was three years with one to two years being most common. [49] The trial utilised a cluster randomized design and electronic tablets for data collection saving time compared to paperbased surveys [55] . Local, high quality data was recognised by community partners as to a key aspect of the community engagement and ongoing intervention adaptation.…”

A Healthy School Start Plus for prevention of childhood overweight and obesity in disadvantaged areas through parental support in the school setting - study protocol for a parallel group cluster randomised trial

“…Therefore, the key to obesity prevention may be the home environment where parents shape the food, meal, and physical activity environment by being responsible for availability, timing, frequency of meals and activity, and through the way they interact with their children [ 21 ]. Indeed, several systematic reviews have concluded that interventions to prevent overweight and obesity in various settings obtain higher effects when parents are involved [ 22 – 27 ]. Research has identified different parenting practices and parent-child interactions which shape children’s health-related behaviours [ 28 ].…”

“…The Healthy School Start programme builds on Social Cognitive Theory (SCT) with parental self-efficacy and observational learning as central constructs [ 34 ]. The programme is in line with the latest evidence regarding the prevention of childhood obesity namely that schools should be a focal point of obesity prevention efforts, interventions should involve multiple components and include the home environment [ 26 , 27 ]. The programme is complex and comprises several components such as health information to parents, motivational interviewing with parents and educational activities for the children followed by home assignments performed together with parents.…”