Multicomponent Lifestyle Interventions for Treating Overweight and Obesity in Children and Adolescents: A Systematic Review and Meta-Analyses

Elvsaas, Ida-Kristin Ørjasæter; Giske, Liv; Fure, Brynjar; Juvet, Lene Kristine

doi:10.1155/2017/5021902

Cited by 56 publications

(68 citation statements)

References 96 publications

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“…Various reports and expert panels typically suggest BMI z-score reductions at benchmarks of 0.25, 0.20, and 0.15 as clinically signi cant and as associated with improvements in cardiometablic pro le [22,78]. While other reviews offer differing interpretations of clinically relevant BMI z-score improvements (e.g., 0.12-0.16) [79]. Notably, arresting gain in excess BMI also likely constitutes a clinically important bene t for many children [76,78,80].…”

Section: Discussionmentioning

confidence: 99%

High intensity versus low intensity family-based childhood obesity treatment programs: Effectiveness, engagement and implementation outcomes from a randomized controlled trial in medically underserved region

Zoellner¹,

You²,

Hill³

et al. 2020

Preprint

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Background Access to evidence- and family-based childhood obesity (FBCO) treatment interventions in the US is a challenge, especially in medically underserved regions where disparities in childhood obesity persist. Methods A comparative effectiveness RCT of two 6-month FBCO treatment interventions varied in structure and contact hours—iChoose (high intensity) and Family Connections (low intensity)—in a medically underserved region. Guided by a systems-based and community-based participatory research approach and the RE-AIM planning and evaluation framework, this paper reports on effectiveness (BMI z-scores) and implementation outcomes. Changes in parent outcomes, secondary outcomes (e.g. QOL, nutrition, physical activity), engagement, and implementation costs are also reported. Analyses included descriptive statistics and intention-to-treat Heckman treatment effect models with cluster robust inference adjustment. Results Enrolled children (n = 139, mean age 10.1 ± 1.7 years, 30% overweight, 70% obese, 45% black, 63% on Medicaid) were randomly assigned to iChoose (n = 70) or Family Connections (n = 69). Retention rates were 63% for iChoose and 84% for Family Connection. Among children, 6-month BMI z-score changes were not statistically significant within iChoose [BMI z-score 0.03 (95% CI = -0.13, 0.19)] or Family Connections [BMI z-score 0.00 (95% CI = -0.16, 0.16)]. Likewise, relative between condition effects were not statistically significant and similar null effects were found in parents’ BMI changes. Yet relative to iChoose, Family Connections parents had significant improvement in quality of life (p = 0.03). Both programs were delivered with high fidelity (77–100%). iChoose engagement was 30% family classes, 36% IVR calls, and 25% physical activity classes; Family Connections engagement was 52% parent classes and 61% IVR calls. Implementations costs per children with improved BMI z-score was $2,841 for iChoose and $955 for Family Connections. Conclusions Both FBCO treatment interventions were delivered with high fidelity; yet neither yielded significant improvements in child or parent BMI. Relative to iChoose, descriptive data indicated higher retention, better engagement, and lower costs for Family Connections—suggesting that a lower intensity program may better fit the intended audience’s context. Future research efforts need to address lack of program effects and further explore strategies to leverage higher engagement in lower intensity programs for populations in medically underserved areas. Trial registration: Clincialtrials.gov: NCT03245775. Registered 10 August 2017. https://clinicaltrials.gov/ct2/show/NCT03245775?term=NCT03245775&draw=2&rank=1

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Section: Discussionmentioning

confidence: 99%

High intensity versus low intensity family-based childhood obesity treatment programs: Effectiveness, engagement and implementation outcomes from a randomized controlled trial in medically underserved region

Zoellner¹,

You²,

Hill³

et al. 2020

Preprint

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“…Group‐based treatment of childhood obesity may be more effective than individual approaches. A review suggested an enhanced effect of group interventions at 6‐month follow‐up, but there was no evidence for longer‐term effects . Although health services in the primary care setting are important for detecting and managing obesity and its complications, there is little evidence of effective primary care interventions .…”

Section: Introductionmentioning

confidence: 99%

“…2 Modest improvements in weight and weight-related outcomes have been reported often in response to multicomponent lifestyle interventions for treating childhood obesity. 3,4 A review of lifestyle interventions indicated that immediate post-intervention improvements in children's weight status were not sustained over long term. 3 Additionally, changes in health outcomes other than weight status as cardiometabolic risk factors have been reported infrequently.…”

Section: Introductionmentioning

confidence: 99%

“…A review suggested an enhanced effect of group interventions at 6-month follow-up, but there was no evidence for longer-term effects. 4 Although health services in the primary care setting are important for detecting and managing obesity and its complications, 2 there is little evidence of effective primary care interventions. 5 The most effective weight management interventions include frequent interactions between multidisciplinary teams and families, which differ from how most primary care visits are conducted.…”

Section: Introductionmentioning

confidence: 99%

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No additional long‐term effect of group vs individual family intervention in the treatment of childhood obesity—A randomised trial

et al. 2019

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Aim Long‐term evaluations of childhood obesity treatments are needed. We examined changes in weight and cardiometabolic risk 1 year after children completed individual family or group‐based weight management interventions. Methods In 2009‐2010, 6‐ to 12‐year‐old children with overweight or obesity from Finnmark and Troms (Norway) were recruited after media coverage and randomised to 24 months of individual family (n = 49) or group intervention (n = 48). Individual family intervention included counselling by a paediatric hospital team and a public health nurse in the local community. Group intervention included meetings with other families and a multidisciplinary hospital team, weekly physical activity sessions and a family camp. The primary outcome body mass index (BMI) and cardiometabolic risk factors were analysed 12 months after intervention. Results From baseline to 36 months, children's BMI increased 3.0 kg/m2 in individual family and 2.1 kg/m2 in group intervention (between‐group −0.9kg/m2, P = 0.096). Data were available from 62 children (64%). Between‐group differences in C peptide (P = 0.01) were detected in favour of group intervention. Pooled data from both treatment groups showed continued decrease in BMI standard deviation score (P < 0.001). Conclusion No between‐group difference in BMI was observed 12 months after intervention. Both groups combined showed sustained decrease in BMI standard deviation score.

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“…While prevention of obesity is important, so too is the provision of effective clinical care to those who are affected. Treatment of children with obesity requires multi-disciplinary, multicomponent interventions, with early parental/carer involvement to encourage family-wide changes [2][3][4]. The optimal model of care for children with obesity, from an economic and health viewpoint, is an evidence-based staged approach to management, where primary, secondary and tertiary services are involved depending on severity and the response to treatment [5].…”

Section: Introductionmentioning

confidence: 99%

Clinician perspectives on models of care for pediatric weight management services in Australia: A mixed-methods study

Cohen¹,

Alexander²,

Signorelli³

et al. 2019

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Introduction For children with moderate to severe obesity, secondary and tertiary level services provide a platform for a more intensive approach toward weight management. Clinician and health care managers’ (HCM) views are imperative for informing the nature of future services to treat such children. Methods This concurrent mixed-methods study utilized questionnaires and semi-structured focus groups with clinicians, and one-on-one semi-structured interviews with HCMs, who worked in six secondary or tertiary pediatric weight management clinics across five public hospitals in New South Wales, Australia. The Theoretical Domains Framework was employed to underpin the development of the interview guides. The recorded interviews were transcribed verbatim and coded line-by-line, noting the key emerging themes. The results from the questionnaire were analyzed using descriptive statistics. Results Clinicians (n=27) provided multiple approaches to weight management, tailored to families and patients. Clinicians more often provided general healthy eating advice over a specific diet approach. Four-fifths used body mass index percentile change as a measure of success, as well as behavioral outcomes such as improvements in physical activity levels, screen time and sleep quality. Use of a combination of group and individual sessions were thought to improve engagement and reduce attrition rates. Clinicians and HCMs recommended integrating clinics into community centres and providing specific programs for sub-groups such as children from culturally and linguistically diverse communities or children with development delay. Many clinicians and HCMs stressed the importance of pediatric weight clinics using a holistic approach to treatment. Research into clinical outcomes for services was recommended to enable the development of a business case for further funding of pediatric weight management services. Conclusion Addressing common barriers to current pediatric weight management services, and designing future models of care based on key stakeholders’ preferences, are critical to achieving optimal care provision for this high risk population.

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Multicomponent Lifestyle Interventions for Treating Overweight and Obesity in Children and Adolescents: A Systematic Review and Meta-Analyses

Cited by 56 publications

References 96 publications

High intensity versus low intensity family-based childhood obesity treatment programs: Effectiveness, engagement and implementation outcomes from a randomized controlled trial in medically underserved region

High intensity versus low intensity family-based childhood obesity treatment programs: Effectiveness, engagement and implementation outcomes from a randomized controlled trial in medically underserved region

No additional long‐term effect of group vs individual family intervention in the treatment of childhood obesity—A randomised trial

Clinician perspectives on models of care for pediatric weight management services in Australia: A mixed-methods study

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