The impact of child and adolescent obesity treatment interventions on physical activity: a systematic review

Efforts to treat obesity in childhood and adolescence would benefit from a greater understanding of evidence‐based strategies to modify physical activity behaviour. A systematic review was conducted to examine the impact of child and adolescent obesity treatment interventions on physical activity. Studies included were randomized controlled trials or controlled trials, with overweight and obese youth (aged < 18 years), which reported statistical analysis of free‐living physical activity at pretreatment and post‐treatment. Two independent reviewers assessed each study for methodological quality. Seventeen child and three adolescent studies were retrieved, half of which were conducted in the USA. Studies were characterized by small samples of limited cultural and economic diversity. Fifteen studies reported an increase in at least one physical activity outcome at post‐test or follow‐up. Overall, study quality was rated as low (child median score = 3/10, range = 0–9; adolescent median score = 3/10, range = 2–5) with three child studies classified as high quality (≥6/10). Research evaluating the effect of child and adolescent obesity treatment trials on physical activity is limited in both quantity and quality. Studies testing innovative, theoretically driven treatment approaches that use robust methodologies are required to better understand generalizable approaches for promoting physical activity participation among obese youth.     

Effectiveness of school‐based interventions to prevent obesity among children aged 4 to 12 years old in middle‐income countries: A systematic review and meta‐analysis

Economic and accompanying nutrition transition in middle‐income countries is resulting in rapidly increasing childhood obesity prevalence, exceeding acceleration rates in the West. Previous school‐based obesity prevention reviews have mainly included studies from high‐income countries. This review aimed to summarize the evidence from randomized controlled trials evaluating the effectiveness of school‐based interventions in preventing childhood obesity in middle‐income countries. Six electronic databases were searched: MEDLINE, EMBASE, CINAHL Plus, LILACS, IBECS and WPRIM. Eligibility criteria included middle‐income country setting, randomized/cluster‐randomized controlled trials, children aged 4–12 years and school‐based interventions targeting dietary intake and/or physical activity. Twenty‐one cluster‐randomized controlled trials, conducted in Asia (n = 10), South America (n = 4), North America (n = 4) and the Middle East (n = 3), were included. Fifteen studies reported a significant intervention effect on at least one adiposity‐related outcome. Characteristics of effective interventions included combined diet and PA interventions, school teacher‐delivery, duration of >8 months, parental involvement, education sessions and school food modifications. The risk of bias in these trials was mixed. The pooled estimate of the odds ratio for obesity in intervention versus control schools (nine studies) was 0.77; 95% CI, 0.63 to 0.94; p = 0.009. In conclusion, there is some evidence to support school‐based interventions in preventing childhood obesity in middle‐income countries.     

A systematic analysis of childhood obesity prevention interventions targeting Hispanic children: lessons learned from the previous decade

Hispanic children suffer from the highest overall rates of prevalence for overweight and obesity in the US. In the last decade some interventions for prevention of childhood obesity have been developed and tailored to target this subgroup. The purpose of this review is to systematically analyze and summarize findings for health education and promotion interventions aimed at the prevention of childhood overweight and obesity among primarily Hispanic children. A systematic review of PubMed, CINAHL, and ERIC was done for the time period 2000 to May 2010. A posteriori effect size for the primary outcome of each intervention was calculated using G*Power. A total of nine interventions were located; five randomized controlled trials and four were either quasi‐experimental or pilot studies. Among these studies, only four had significant findings, and calculated effect sizes (Cohen's f) ranged from small to medium with the highest f = 0.26. Interventions were more likely to be successful when participants were at higher risk for obesity, a parental component was included, the intervention contained theoretical underpinnings, the intervention was delivered by a dedicated staff, the intervention served older children and the intervention was longer in duration. More interventions need to be developed for Hispanic children. Future interventions should also develop and utilize culturally appropriate and sensitive materials and approaches.     

What childhood obesity prevention programmes work? A systematic review and meta‐analysis

Previous reviews of childhood obesity prevention have focused largely on schools and findings have been inconsistent. Funded by the US Agency for Healthcare Research and Quality (AHRQ) and the National Institutes of Health, we systematically evaluated the effectiveness of childhood obesity prevention programmes conducted in high‐income countries and implemented in various settings. We searched MEDLINE®, Embase, PsycINFO, CINAHL®, ClinicalTrials.gov and the Cochrane Library from inception through 22 April 2013 for relevant studies, including randomized controlled trials, quasi‐experimental studies and natural experiments, targeting diet, physical activity or both, and conducted in children aged 2–18 in high‐income countries. Two reviewers independently abstracted the data. The strength of evidence (SOE) supporting interventions was graded for each study setting (e.g. home, school). Meta‐analyses were performed on studies judged sufficiently similar and appropriate to pool using random effect models. This paper reported our findings on various adiposity‐related outcomes. We identified 147 articles (139 intervention studies) of which 115 studies were primarily school based, although other settings could have been involved. Most were conducted in the United States and within the past decade. SOE was high for physical activity‐only interventions delivered in schools with home involvement or combined diet–physical activity interventions delivered in schools with both home and community components. SOE was moderate for school‐based interventions targeting either diet or physical activity, combined interventions delivered in schools with home or community components or combined interventions delivered in the community with a school component. SOE was low for combined interventions in childcare or home settings. Evidence was insufficient for other interventions. In conclusion, at least moderately strong evidence supports the effectiveness of school‐based interventions for preventing childhood obesity. More research is needed to evaluate programmes in other settings or of other design types, especially environmental, policy and consumer health informatics‐oriented interventions.     

Environmental components of childhood obesity prevention interventions: an overview of systematic reviews

Childhood obesity has a complex multi‐factorial aetiology grounded in environmental and individual level factors that affect behaviour and outcomes. An ecological, systems‐based approach to addressing childhood obesity is increasingly being advocated. The primary aim of this review is to summarize the evidence reported in systematic reviews on the effectiveness of population‐level childhood obesity prevention interventions that have an environmental component. We conducted a systematic review of reviews published since 1995, employing a standardized search strategy in nine databases. Inclusion criteria required that reviews be systematic and evaluated at least one population‐level, environmental intervention in any setting aimed at preventing or reducing obesity in children (5–18 years). Sixty‐three reviews were included, ten of which were of high quality. Results show modest impact of a broad range of environmental strategies on anthropometric outcomes. Systematic reviews vary in methodological quality, and not all relevant primary studies may be included in each review. To ensure relevance of our findings to practice, we also report on relevant underlying primary studies, providing policy‐relevant recommendations based on the evidence reviewed. Greater standardization of review methods and reporting structures will benefit policymakers and public health professionals seeking informed decision‐making.     

Dietetic management of obesity and severe obesity in children and adolescents: A scoping review of guidelines

This scoping review describes current guidelines for the dietary management of pediatric obesity and severe obesity. Guidelines were identified via electronic searches of six databases, grey literature, and reference lists and included international clinical practice guidelines (n = 21), position papers (n = 5), and scientific/consensus statements (n = 2) produced by professional bodies and/or expert panels. All recommend multicomponent lifestyle interventions including diet, physical activity, and behavior modification as first‐line treatment. Most guidelines (n = 21) recommend weight loss as a treatment goal for children and adolescents with obesity and associated comorbidities or severe obesity; 15 recommend using dietary approaches. Fourteen of 28 guidelines refer to the management of severe obesity, 10 refer to dietary approaches, and seven recommend using intensive dietary approaches. Dietary approaches to weight loss focus on caloric restriction (n = 14) with some guidelines recommending very low‐energy diet (n = 4), protein‐sparing modified fast (n = 2), and very low‐carbohydrate/ketogenic diets (n = 2). A stronger evidence base is required for dietary management of pediatric obesity and severe obesity to improve consistency in future guidelines. Guidance on the use of dietary approaches, beyond caloric restriction, and in line with the growing evidence base on novel dietary approaches is required to facilitate personalized care and optimal patient outcomes.     

An examination of comorbid asthma and obesity: assessing differences in physical activity,sleep duration,health-related quality of life and parental distress

Objective: Compare youth with comorbid asthma and obesity to youth with obesity only to determine if differences exist in body mass index, dietary intake, levels of physical activity, sleep duration and health-related quality of life. Levels of parent distress were also compared. Methods: Participants included 248 children (n?=?175 in Obesity group; n?=?73 in Asthma?+?Obesity group) with a BMI?≥?85th percentile for age and gender, and their participating parent(s) or legal guardian(s). Measures of child height and weight were obtained by study personnel and Z-scores for child body mass index were calculated using age- and gender-specific norms. Child physical activity and sleep duration were measured via accelerometers. Dietary intake, health-related quality of life and parent distress were assessed via self-report. Results: The Asthma?+?Obesity group evidenced significantly higher body mass index scores, and had lower sleep duration. There was a non-statistically significant trend for lower levels of physical activity among children in the Asthma?+?Obesity group. Dietary intake, health-related quality of life and parent distress did not differ between groups. Conclusions: Youth with comorbid asthma and obesity are at increased risk for negative health and psychosocial difficulties compared to youth who are overweight or obese only. Professionals providing treatment for youth with asthma are encouraged to assess the implications of weight status on health behaviors and family psychosocial adjustment.     

Which type of sedentary behaviour intervention is more effective at reducing body mass index in children? A meta‐analytic review

Sedentary behaviour is emerging as an independent risk factor for paediatric obesity. Some evidence suggests that limiting sedentary behaviour alone could be effective in reducing body mass index (BMI) in children. However, whether adding physical activity and diet‐focused components to sedentary behaviour reduction interventions could lead to an additive effect is unclear. This meta‐analysis aims to assess the overall effect size of sedentary behaviour interventions on BMI reduction and to compare whether interventions that have multiple components (sedentary behaviour, physical activity and diet) have a higher mean effect size than interventions with single (sedentary behaviour) component. Included studies (n = 25) were randomized controlled trials of children (<18 years) with intervention components aimed to reduce sedentary behaviour and measured BMI at pre‐ and post‐intervention. Effect size was calculated as the mean difference in BMI change between children in an intervention group and a control group. Results indicated that sedentary behaviour interventions had a significant effect on BMI reduction. The pooled effect sizes of multi‐component interventions (g = ?0.060～?0.089) did not differ from the single‐component interventions (g = ?0.154), and neither of them had a significant effect size on its own. Future paediatric obesity interventions may consider focusing on developing strategies to decrease multiple screen‐related sedentary behaviours.     

Physical environmental correlates of childhood obesity: a systematic review

Increasing rates of childhood obesity in the USA and other Western countries are a cause for serious public health concern. Neighborhood and community environments are thought to play a contributing role in the development of obesity among youth, but it is not well understood which types of physical environmental characteristics have the most potential to influence obesity outcomes. This paper reports the results of a systematic review of quantitative research examining built and biophysical environmental variables associated with obesity in children and adolescents through physical activity. Literature searches in PubMed, PsychInfo and Geobase were conducted. Fifteen quantitative studies met the inclusion criteria for this systematic review. The majority of studies were cross-sectional and published after 2005. Overall, few consistent findings emerged. For children, associations between physical environmental variables and obesity differed by gender, age, socioeconomic status, population density and whether reports were made by the parent or child. Access to equipment and facilities, neighborhood pattern (e.g. rural, exurban, suburban) and urban sprawl were associated with obesity outcomes in adolescents. For most environmental variables considered, strong empirical evidence is not yet available. Conceptual gaps, methodological limitations and future research directions are discussed.     

A systematic review of neighbourhood economic context on child obesity and obesity‐related behaviours

Childhood obesity is of great importance given a third of children in the USA are overweight or obese. Previous research has examined neighbourhood economic context in relation to children's obesity and obesity‐rated behaviours. However, different definitions and measures of neighbourhood context make it difficult to compare findings and make definitive conclusions. This review is to synthesize studies assessing the associations between neighbourhood economic context and children's obesity or obesity‐related behaviours. The review included 39 studies investigating the relationship between residential neighbourhood economic context and children's obesity, dietary habits or physical activity after controlling for family‐level economic status. Studies reported mixed results in the relationship between neighbourhood economic indicators and child obesity outcomes. Of reviewed studies, 60% showed an inverse association between higher neighbourhood economic status and obesity, and 33% and 14% showed positive associations between higher neighbourhood economic status and healthy dietary habits or physical activity. Several studies suggested gender, age, race/ethnicity, individual‐level economic status, rurality and social connectedness as moderators in the neighbourhood‐obesity association. Findings suggest that, in order to move towards causal inferences and inform interventions, future research should examine neighbourhood impacts longitudinally and test theory‐driven mediators and moderators to clarify the mechanisms by which neighbourhoods influence child obesity.     

The impact of childhood obesity on human capital in high‐income countries: A systematic review

Current evidence of the impact of childhood obesity on human capital development does not point in a consistent direction, and its interpretation is challenging. We carried out a systematic review of studies from high‐income countries that used robust causal inference approaches to assess the impact of childhood overweight and obesity on outcomes typically linked to human capital development in economics. Global Health, Medline and EconLit were used to search for peer‐reviewed papers. Three reviewers independently assessed study quality using the Newcastle‐Ottawa Scale. Nineteen papers representing 22 studies met the inclusion criteria. Included studies were categorized based on three components of human capital: cognitive performance (n = 18), measured through test scores; educational attainment (n = 3), through grade progression and college completion; and labour market outcomes (n = 1), through wages. We find that childhood overweight and obesity hinder education outcomes, with effects mostly observed at older ages of exposure measurement (12+ years). Girls with overweight and obesity experienced larger negative effects and more often than boys. Future research should elucidate the pathways through which childhood obesity impacts human capital development, to support policies that may mitigate those impacts, thus averting social costs that are currently widespread, increasing and unaccounted for.     

A review of electronic interventions for prevention and treatment of overweight and obesity in young people

The objective of this systematic review is to provide a qualitative comparison of interactive electronic media interventions for the prevention or treatment of obesity and/or obesity‐related behaviours in children and adolescents. Literature searches of 12 databases from the earliest publication date until March 2010 were conducted. Twenty‐four studies in which children and/or adolescents interacted with electronic interventions delivered as adjunct or sole interventions for the prevention or treatment of obesity and/or obesity‐related behaviours met the inclusion criteria. Fifteen focussed on obesity prevention and nine on treatment interventions. The average study quality design score was 45%. Most studies demonstrated some form of significant outcome (e.g. reported changes in dietary and/or physical activity behaviours) in participants receiving interactive electronic interventions, with 11 out of 15 studies leading to positive changes in measured or reported adiposity outcomes. In 87% of studies, the effects of interactive electronic interventions were not separately evaluated from other intervention components. These results should be viewed with caution because of the overall poor quality of the studies. Studies were mostly conducted in the USA, largely in minority populations, and the direct transferability of interventions to other populations is unclear. Further high quality research is needed in this area to accurately inform the evidence base.     

Feasibility,acceptability, and effectiveness of a multidisciplinary intervention in childhood obesity from primary care: Nutrition,physical activity,emotional regulation,and family

Childhood obesity is a growing problem with a complex aetiology, for which multidisciplinary interventions are required. Our programme describes a novel structured psychosocial family‐based intervention targeting the emotional regulation in childhood obesity, using a train trip metaphor aimed at improving healthy lifestyles for the family. The aims were (a) to describe the feasibility and acceptability of this psychosocial family‐based intervention among children with overweight or obesity in primary care and (b) to examine the effectiveness of the “ENTREN‐F” programme (with family intervention) compared with the “ENTREN” programme (without family intervention) among Spanish children regarding anthropometric variables, physical activity, emotional well‐being, and family functioning. Children were randomly allocated to either ENTREN‐F programme (n = 30) or psychological intervention for children (ENTREN, n = 40), and assessments were carried out over time (T₀ baseline vs. T₁ post/6‐month vs. T₂ 6‐month follow‐up). Both parent groups expressed high levels of satisfaction with the interventions. ENTREN‐F resulted in higher adherence to treatment and was more effective in improving z–body mass index, reducing children's anxiety, and increasing family adaptability than the ENTREN programme. There were no significant changes in parents' emotional well‐being and expressed emotion. Both groups improved in the children's emotional well‐being and light physical activity. In summary, this multidisciplinary psychosocial family‐based intervention was succesful.     

A systematic review of physical activity levels in Native American populations in Canada and the United States in the last 50 years

Physical activity is beneficial for many chronic conditions. However, activity levels of Native Americans are not well known. This systematic review investigated if Native American populations achieve the recommended physical activity levels, compared current and past activity levels, and assessed the ability of exercise training programmes to improve health outcomes among this population. Electronic databases (e.g. MEDLINE, EMBASE) were searched and citations were cross‐referenced. Included articles reported physical activity levels or investigations among Native Americans. This search identified 89 articles: self‐report (n = 61), accelerometry and pedometry (n = 10), metabolic monitoring (n = 10) and physical activity interventions (n = 17). Few adults were found to meet the physical activity recommendations (27.2% [95% confidence interval = 26.9–27.5%] self‐report, 9% [4–14%] accelerometry). Among children/youth, 26.5% (24.6–28.4%) (self‐report) to 45.7% (42.3–49.1%) (pedometry/accelerometry) met the recommendations. Adults and children/youth were generally identified as physically inactive (via doubly labelled water). Overall, Native American adults reported lower activity levels since 2000, compared to 1990s, although similar to 1980s. Few physical activity interventions employed strong methodologies, large sample sizes and objective outcome measures. There is a clear need to increase Native American populations' physical activity. Additional research is required to evaluate exercise training programmes among this population.     

Nutrition‐related interventions targeting childhood overweight and obesity: A narrative review

Systematic reviews of nutritional interventions indicate limited efficacy in reducing childhood obesity, but their blanket conclusions could obscure promising components. This narrative review sought more detail on effective components within nutrition‐related interventions involving children aged 2 to 11 years. In May 2016, the World Health Organization (WHO) searched the Cochrane Library and PubMed for relevant reviews. From 36 reviews, we screened 182 nutrition‐related randomized trials for inclusion. We then reviewed those that reported at least 1 statistically significant (P < 0.05) treatment benefit on body weight and/or composition outcomes at their longest follow‐up assessment. Fourteen trials met inclusion criteria (median n = 554; mean intervention duration = 10.8 mo; follow‐up = 4.4 mo). “Effective” approaches included environmental changes such as school water fountain installations and cafeteria menu changes and possibly less sustainable strategies such as health education lessons. However, effect sizes even of these selected significant treatment benefits were modest—significant body mass index z‐score effects range from ?0.1 to ?0.2. Each trial was associated with very small improvements in body composition. Because this is a “best‐case” scenario (reflecting our design), trialists should rigorously test these strategies alone and possibly together; be open to novel strategies; and ensure that each strategy is culturally relevant and self‐sustainable.     

The quality of dietary intake methodology and reporting in child and adolescent obesity intervention trials: a systematic review

Assessing dietary intake is important in evaluating childhood obesity intervention effectiveness. The purpose of this review was to evaluate the dietary intake methods and reporting in intervention studies that included a dietary component to treat overweight or obese children. A systematic review of studies published in the English language, between 1985 and August 2010 in health databases. The search identified 2,295 papers, of which 335 were retrieved and 31 met the inclusion criteria. Twenty‐three studies reported energy intake as an outcome measure, 20 reported macronutrient intakes and 10 studies reported food intake outcomes. The most common dietary method employed was the food diary (n = 13), followed by 24‐h recall (n = 5), food frequency questionnaire (FFQ) (n = 4) and dietary questionnaire (n = 4). The quality of the dietary intake methods reporting was rated as ‘poor’ in 15 studies (52%) and only 3 were rated as ‘excellent’. The reporting quality of FFQs tended to be higher than food diaries/recalls. Deficiencies in the quality of dietary intake methods reporting in child obesity studies were identified. Use of a dietary intake methods reporting checklist is recommended. This will enable the quality of dietary intake results to be evaluated, and an increased ability to replicate study methodology by other researchers.     

The association between childcare arrangements and risk of overweight and obesity in childhood: a systematic review

Over 80% of preschool‐aged children experience non‐parental childcare. Childcare type has the potential to influence weight outcomes, but its impact on childhood overweight/obesity is not well established. This review aims to (i) systematically evaluate the effects of childcare type on childhood overweight/obesity risk and (ii) investigate the impact of childcare intensity and age at commencement. Five electronic databases were searched for observational studies quantifying an association between childcare type ≤5 years and weight outcomes <18 years. Twenty‐four studies were included (n = 127,529 children). Thirteen studies reported increased risk of overweight/obesity in children attending informal care (n = 9) or centre care (n = 4) vs. parental care. Seven studies reported decreased risk of overweight/obesity for children in centre vs. ‘non‐centre’ care (parental and informal). Four studies reported no association between informal or centre care and overweight/obesity. Early (<3 years) informal care, especially by a relative, was associated with increased risk of overweight/obesity. Higher intensity childcare, especially when commenced early (<1 year), increased overweight/obesity risk. Later (≥3 years) centre care was associated with decreased risk of overweight/obesity. Early informal care, earlier commencement age and higher intensity represent a risk for childhood obesity. Exploration of the obesogenic aspects of these contexts is essential to inform preventative measures.     

Social influence in childhood obesity interventions: a systematic review

The objective of this study is to understand the pathways through which social influence at the family level moderates the impact of childhood obesity interventions. We conducted a systematic review of obesity interventions in which parents' behaviours are targeted to change children's obesity outcomes, because of the potential social and environmental influence of parents on the nutrition and physical activity behaviours of children. PubMed (1966–2013) and the Web of Science (1900–2013) were searched, and 32 studies satisfied our inclusion criteria. Results for existing mechanisms that moderate parents' influence on children's behaviour are discussed, and a causal pathway diagram is developed to map out social influence mechanisms that affect childhood obesity. We provide health professionals and researchers with recommendations for leveraging family‐based social influence mechanisms to increase the efficacy of obesity intervention programmes. © 2016 World Obesity     

Population-based prevention of obesity: the need for comprehensive promotion of healthful eating, physical activity, and energy balance: a scientific statement from American Heart Association Council on Epidemiology and Prevention, Interdisciplinary Committee for Prevention (formerly the expert panel on population and prevention science)

Obesity is a major influence on the development and course of cardiovascular diseases and affects physical and social functioning and quality of life. The importance of effective interventions to reduce obesity and related health risks has increased in recent decades because the number of adults and children who are obese has reached epidemic proportions. To prevent the development of overweight and obesity throughout the life course, population-based strategies that improve social and physical environmental contexts for healthful eating and physical activity are essential. Population-based approaches to obesity prevention are complementary to clinical preventive strategies and also to treatment programs for those who are already obese. This American Heart Association scientific statement aims: 1) to raise awareness of the importance of undertaking population-based initiatives specifically geared to the prevention of excess weight gain in adults and children; 2) to describe considerations for undertaking obesity prevention overall and in key risk subgroups; 3) to differentiate environmental and policy approaches to obesity prevention from those used in clinical prevention and obesity treatment; 4) to identify potential targets of environmental and policy change using an ecological model that includes multiple layers of influences on eating and physical activity across multiple societal sectors; and 5) to highlight the spectrum of potentially relevant interventions and the nature of evidence needed to inform population-based approaches. The evidence-based experience for population-wide approaches to obesity prevention is highlighted.     

Effectiveness of interventions on physical activity in overweight or obese children: a systematic review and meta‐analysis including studies with objectively measured outcomes

There is no consensus on interventions to be recommended in order to promote physical activity among overweight or obese children. The objective of this review was to assess the effects on objectively measured physical activity, of interventions promoting physical activity among overweight or obese children or adolescents, compared to no intervention or to interventions without a physical activity component. Publications up to December 2015 were located through electronic searches for randomized controlled trials resulting in inclusion of 33 studies. Standardized mean differences from baseline to post‐intervention and to long‐term follow‐up were determined for intervention and control groups and meta‐analysed using random effects models. The meta‐analysis showed that interventions had no effect on total physical activity of overweight and obese children, neither directly post‐intervention (?0.02 [?0.15, 0.11]) nor at long‐term follow‐up (0.07 [?0.27, 0.40]). Separate analyses by typology of intervention (with or without physical fitness, behavioural or environmental components) showed similar results (no effect). In conclusion, there is no evidence that currently available interventions are able to increase physical activity among overweight or obese children. This questions the contribution of physical activity to the treatment of overweight and obesity in children in the studied interventions and calls for other treatment strategies.