Systematic Review and Meta-Analysis of Comprehensive Behavioral Family Lifestyle Interventions Addressing Pediatric Obesity

Janicke, David M.; Steele, Ric G.; Gayes, Laurie A.; Lim, Crystal S.; Clifford, Lisa M.; Schneider, Elizabeth M.; Carmody, Julia K.; Westen, Sarah C.

doi:10.1093/jpepsy/jsu023

Cited by 223 publications

(222 citation statements)

References 55 publications

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“…However, in the current study, the number of treatment contacts, number of treatment months, and number of visits with a pediatrician were particularly important, such that larger effect sizes were associated with more treatment contacts, longer duration of treatment, and greater involvement from a pediatrician. This finding is consistent with Janicke et al (2014), who reported that larger effect sizes were associated with longer treatment (duration in months) and more treatment sessions. It is left to future studies to determine whether the impact of treatment duration and number of contacts differs depending on who is delivering the intervention or on the background and level of training of the interventionist.…”

Section: Discussionsupporting

confidence: 91%

Pediatric weight management interventions in primary care settings: A meta-analysis.

2016

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Objective Although the primary care setting has been recommended as an acceptable environment for pediatric overweight/obesity treatment, a quantitative analysis has not been conducted to determine the effectiveness of pediatric weight management interventions delivered in these settings. Therefore, the purpose of the current study was to conduct a meta-analysis of weight management interventions for youth in primary care settings. Method A literature search using PsycINFO and PubMed was conducted to identify articles published through October 2015. Eighteen studies (3,358 participants) met inclusion criteria; studies included a treatment and comparison group and targeted individuals or families for treatment. Study characteristics were coded, and study rigor of articles was assessed. Results The overall effect size for change in BMI in primary care weight management interventions compared to control groups was small but statistically significant (d = 0.26, 95% CI [0.14, 0.38]). The number of treatment contacts, treatment months, and visits with a pediatrician emerged as significant moderators of outcome, such that BMI reduction was positively related to greater contact. Conclusions In comparison to control conditions, weight management programs in primary care settings can be effective for BMI reduction, suggesting that primary care is a suitable setting for treatment of pediatric overweight/obesity. Additionally, treatments that were longer in duration, included more contacts (in person or phone), and included more contacts by a pediatrician had greater impact on BMI reduction. Future studies should continue to examine other aspects of acceptability and accessibility as well as demonstrate the effectiveness of interventions on improving psychosocial outcomes.

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Section: Discussionsupporting

confidence: 91%

Pediatric weight management interventions in primary care settings: A meta-analysis.

2016

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“…4,5 Two other metaanalyses have reported larger intervention differences of 0.31 and 0.47. 4,6 However, Ho et al 4 showed that study duration was important with much larger effects in shorter studies than those lasting .6 months (0.31 vs 0.09 BMI z score units, respectively). Janicke et al 6 included studies in adolescents and showed that age was a significant moderator, with greater effects in older children.…”

Section: Discussionmentioning

confidence: 99%

“…4,6 However, Ho et al 4 showed that study duration was important with much larger effects in shorter studies than those lasting .6 months (0.31 vs 0.09 BMI z score units, respectively). Janicke et al 6 included studies in adolescents and showed that age was a significant moderator, with greater effects in older children. 6 Direct comparisons are also complicated given that each metaanalysis was examining related but subtly different types of interventions, from educational approaches 5 to comprehensive lifestyle interventions.…”

Section: Discussionmentioning

confidence: 99%

“…Janicke et al 6 included studies in adolescents and showed that age was a significant moderator, with greater effects in older children. 6 Direct comparisons are also complicated given that each metaanalysis was examining related but subtly different types of interventions, from educational approaches 5 to comprehensive lifestyle interventions. 6 Alternatively, the relatively small intervention effect we observed may have arisen because our children were recruited through screening rather than families seeking treatment.…”

Section: Discussionmentioning

confidence: 99%

“…3 Although individual studies report mixed success, 2 meta-analyses indicate that BMI is ∼1 unit lower in intervention children compared with control children. [4][5][6] However, virtually all interventions are only 6 to 12 months in duration, [4][5][6] with few exceptions. 7,8 Whether long-term changes to weight and the behavioral practices underpinning them are sustained has rarely been examined, 9,10 but this is important given that shorter studies report greater BMI differences than longer studies.…”

Section: What This Study Addsmentioning

confidence: 99%

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A Tailored Family-Based Obesity Intervention: A Randomized Trial

Taylor¹,

et al. 2015

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OBJECTIVE: To determine whether a 2-year family-based intervention using frequent contact and limited expert involvement was effective in reducing excessive weight compared with usual care.METHODS: Two hundred and six overweight and obese (BMI $85th percentile) children aged 4 to 8 years were randomized to usual care (UC) or tailored package (TP) sessions at university research rooms. UC families received personalized feedback and generalized advice regarding healthy lifestyles at baseline and 6 months. TP families attended a single multidisciplinary session to develop specific goals suitable for each family, then met with a mentor each month for 12 months, and every third month for another 12 months to discuss progress and provide support. Outcome measurements (anthropometry, questionnaires, dietary intake, accelerometry) were obtained at 0, 12, and 24 months.RESULTS: BMI at 24 months was significantly lower in TP compared with UC children (difference, 95% confidence interval: -0.34, -0.65 to -0.02), as was BMI z score (-0.12, -0.20 to -0.04) and waist circumference (-1.5, -2.5 to -0.5 cm). TP children consumed more fruit and vegetables (P = .038) and fewer noncore foods (P = .020) than UC children, and fewer noncore foods were available in the home (P = .002). TP children were also more physically active (P = .035). No differences in parental feeding practices, parenting, quality of life, child sleep, or behavior were observed.CONCLUSIONS: Frequent, low-dose support was effective for reducing excessive weight in predominantly mild to moderately overweight children over a 2-year period. Such initiatives could feasibly be incorporated into primary care.

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Screening for Obesity and Intervention for Weight Management in Children and Adolescents

O’Connor

Evans

Burda

et al. 2017

JAMA

400

234

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Systematic Review and Meta-Analysis of Comprehensive Behavioral Family Lifestyle Interventions Addressing Pediatric Obesity

Abstract: CBFLIs demonstrated efficacy for improving weight outcomes in youths who are overweight or obese.

Cited by 223 publications

References 55 publications

Pediatric weight management interventions in primary care settings: A meta-analysis.

Pediatric weight management interventions in primary care settings: A meta-analysis.

A Tailored Family-Based Obesity Intervention: A Randomized Trial

Screening for Obesity and Intervention for Weight Management in Children and Adolescents

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