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Background Prevention of obesity in children is an international public health priority given the prevalence of the condition (and its significant impact on health, development and well‐being). Interventions that aim to prevent obesity involve behavioural change strategies that promote healthy eating or 'activity' levels (physical activity, sedentary behaviour and/or sleep) or both, and work by reducing energy intake and/or increasing energy expenditure, respectively. There is uncertainty over which approaches are more effective and numerous new studies have been published over the last five years, since the previous version of this Cochrane review. Objectives To assess the effects of interventions that aim to prevent obesity in children by modifying dietary intake or ‘activity’ levels, or a combination of both, on changes in BMI, zBMI score and serious adverse events. Search methods We used standard, extensive Cochrane search methods. The latest search date was February 2023. Selection criteria Randomised controlled trials in children (mean age 5 years and above but less than 12 years), comparing diet or 'activity' interventions (or both) to prevent obesity with no intervention, usual care, or with another eligible intervention, in any setting. Studies had to measure outcomes at a minimum of 12 weeks post baseline. We excluded interventions designed primarily to improve sporting performance. Data collection and analysis We used standard Cochrane methods. Our outcomes were body mass index (BMI), zBMI score and serious adverse events, assessed at short‐ (12 weeks to < 9 months from baseline), medium‐ (9 months to < 15 months) and long‐term (≥ 15 months) follow‐up. We used GRADE to assess the certainty of the evidence for each outcome. Main results This review includes 172 studies (189,707 participants); 149 studies (160,267 participants) were included in meta‐analyses. One hundred forty‐six studies were based in high‐income countries. The main setting for intervention delivery was schools (111 studies), followed by the community (15 studies), the home (eight studies) and a clinical setting (seven studies); one intervention was conducted by telehealth and 31 studies were conducted in more than one setting. Eighty‐six interventions were implemented for less than nine months; the shortest was conducted over one visit and the longest over four years. Non‐industry funding was declared by 132 studies; 24 studies were funded in part or wholly by industry. Dietary interventions versus control Dietary interventions, compared with control, may have little to no effect on BMI at short‐term follow‐up (mean difference (MD) 0, 95% confidence interval (CI) ‐0.10 to 0.10; 5 studies, 2107 participants; low‐certainty evidence) and at medium‐term follow‐up (MD ‐0.01, 95% CI ‐0.15 to 0.12; 9 studies, 6815 participants; low‐cer...
Background Prevention of obesity in children is an international public health priority given the prevalence of the condition (and its significant impact on health, development and well‐being). Interventions that aim to prevent obesity involve behavioural change strategies that promote healthy eating or 'activity' levels (physical activity, sedentary behaviour and/or sleep) or both, and work by reducing energy intake and/or increasing energy expenditure, respectively. There is uncertainty over which approaches are more effective and numerous new studies have been published over the last five years, since the previous version of this Cochrane review. Objectives To assess the effects of interventions that aim to prevent obesity in children by modifying dietary intake or ‘activity’ levels, or a combination of both, on changes in BMI, zBMI score and serious adverse events. Search methods We used standard, extensive Cochrane search methods. The latest search date was February 2023. Selection criteria Randomised controlled trials in children (mean age 5 years and above but less than 12 years), comparing diet or 'activity' interventions (or both) to prevent obesity with no intervention, usual care, or with another eligible intervention, in any setting. Studies had to measure outcomes at a minimum of 12 weeks post baseline. We excluded interventions designed primarily to improve sporting performance. Data collection and analysis We used standard Cochrane methods. Our outcomes were body mass index (BMI), zBMI score and serious adverse events, assessed at short‐ (12 weeks to < 9 months from baseline), medium‐ (9 months to < 15 months) and long‐term (≥ 15 months) follow‐up. We used GRADE to assess the certainty of the evidence for each outcome. Main results This review includes 172 studies (189,707 participants); 149 studies (160,267 participants) were included in meta‐analyses. One hundred forty‐six studies were based in high‐income countries. The main setting for intervention delivery was schools (111 studies), followed by the community (15 studies), the home (eight studies) and a clinical setting (seven studies); one intervention was conducted by telehealth and 31 studies were conducted in more than one setting. Eighty‐six interventions were implemented for less than nine months; the shortest was conducted over one visit and the longest over four years. Non‐industry funding was declared by 132 studies; 24 studies were funded in part or wholly by industry. Dietary interventions versus control Dietary interventions, compared with control, may have little to no effect on BMI at short‐term follow‐up (mean difference (MD) 0, 95% confidence interval (CI) ‐0.10 to 0.10; 5 studies, 2107 participants; low‐certainty evidence) and at medium‐term follow‐up (MD ‐0.01, 95% CI ‐0.15 to 0.12; 9 studies, 6815 participants; low‐cer...
Network meta‐analysis (NMA) combines evidence from multiple trials to compare the effectiveness of a set of interventions. In many areas of research, interventions are often complex, made up of multiple components or features. This makes it difficult to define a common set of interventions on which to perform the analysis. One approach to this problem is component network meta‐analysis (CNMA) which uses a meta‐regression framework to define each intervention as a subset of components whose individual effects combine additively. In this article, we are motivated by a systematic review of complex interventions to prevent obesity in children. Due to considerable heterogeneity across the trials, these interventions cannot be expressed as a subset of components but instead are coded against a framework of characteristic features. To analyse these data, we develop a bespoke CNMA‐inspired model that allows us to identify the most important features of interventions. We define a meta‐regression model with covariates on three levels: intervention, study, and follow‐up time, as well as flexible interaction terms. By specifying different regression structures for trials with and without a control arm, we relax the assumption from previous CNMA models that a control arm is the absence of intervention components. Furthermore, we derive a correlation structure that accounts for trials with multiple intervention arms and multiple follow‐up times. Although, our model was developed for the specifics of the obesity data set, it has wider applicability to any set of complex interventions that can be coded according to a set of shared features.
Background. Recent systematic reviews and meta-analyses on the effects of interventions to prevent obesity in children aged 5 to 18 years identified over 200 randomized trials. Interventions targeting diet, activity (including physical activity and sedentary behaviours) and both diet and activity appear to have small but beneficial effects, on average. However, these effects varied between studies and might be explained by variation in characteristics of the interventions, for example by the extent to which the children enjoyed the intervention or whether they aim to modify behaviour through education or physical changes to the environment. Here we develop a novel analytic framework to identify key intervention characteristics considered likely to explain differential effects. Objectives. To describe the development of the analytic framework, including the involvement of school-aged children, parents, teachers and other stakeholders, and to present the content of the finalized analytic framework and the results of the coding of the interventions. Design and methods. We first conducted a literature review to find out from the existing literature what different types of characteristics of interventions we should be thinking about, and why. This information helped us to develop a comprehensive map (called a logic model) of these characteristics. We then used this logic model to develop a list of possible intervention characteristics. We held a series of workshops with children, parents, teachers and public health professionals to refine the list into a coding scheme. We then used this to code the characteristics of each intervention in all the trials which aimed to prevent obesity in children aged 5 to 18 years. Findings. Our finalized analytic framework included 25 questions across 12 characteristics. These addressed aspects such as the setting of the intervention (e.g. at school, at home or in the community), mode of delivery (e.g. to individuals or to groups children), whether the intervention targeted diet and/or activity, complexity (e.g. focused on a single swap of juice for water or aimed to change all aspects the diet), intensity, flexibility, choice, mechanism of action (e.g. through participation, education, change in the social environment, change in the physical environment), resonance (e.g. credibility of the person delivering the intervention), commercial involvement and the fun-factor (as perceived by children). We coded 255 interventions from 210 randomized trials. Conclusions. Our evidence-based analytic framework, refined by consulting with stakeholders, allowed us to code 255 interventions aiming to prevent obesity in children aged 5 to 18 years. Our confidence in the validity of the framework and coding results is increased by our rigorous methods and, especially, the involvement of children at multiple stages.
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