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Spiga F, Davies AL, Tomlinson E, Moore TH, Dawson S, Breheny K, Savović J, Gao Y, Phillips SM, Hillier-Brown F, Hodder RK, Wolfenden L, Higgins JP, Summerbell CD. Interventions to prevent obesity in children aged 5 to 11 years old. Cochrane Database Syst Rev 2024; 5:CD015328. [PMID: 38763517 PMCID: PMC11102828 DOI: 10.1002/14651858.cd015328.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/21/2024]
Abstract
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-certainty evidence) or zBMI at long-term follow-up (MD -0.05, 95% CI -0.10 to 0.01; 7 studies, 5285 participants; low-certainty evidence). Dietary interventions, compared with control, probably have little to no effect on BMI at long-term follow-up (MD -0.17, 95% CI -0.48 to 0.13; 2 studies, 945 participants; moderate-certainty evidence) and zBMI at short- or medium-term follow-up (MD -0.06, 95% CI -0.13 to 0.01; 8 studies, 3695 participants; MD -0.04, 95% CI -0.10 to 0.02; 9 studies, 7048 participants; moderate-certainty evidence). Five studies (1913 participants; very low-certainty evidence) reported data on serious adverse events: one reported serious adverse events (e.g. allergy, behavioural problems and abdominal discomfort) that may have occurred as a result of the intervention; four reported no effect. Activity interventions versus control Activity interventions, compared with control, may have little to no effect on BMI and zBMI at short-term or long-term follow-up (BMI short-term: MD -0.02, 95% CI -0.17 to 0.13; 14 studies, 4069 participants; zBMI short-term: MD -0.02, 95% CI -0.07 to 0.02; 6 studies, 3580 participants; low-certainty evidence; BMI long-term: MD -0.07, 95% CI -0.24 to 0.10; 8 studies, 8302 participants; zBMI long-term: MD -0.02, 95% CI -0.09 to 0.04; 6 studies, 6940 participants; low-certainty evidence). Activity interventions likely result in a slight reduction of BMI and zBMI at medium-term follow-up (BMI: MD -0.11, 95% CI -0.18 to -0.05; 16 studies, 21,286 participants; zBMI: MD -0.05, 95% CI -0.09 to -0.02; 13 studies, 20,600 participants; moderate-certainty evidence). Eleven studies (21,278 participants; low-certainty evidence) reported data on serious adverse events; one study reported two minor ankle sprains and one study reported the incident rate of adverse events (e.g. musculoskeletal injuries) that may have occurred as a result of the intervention; nine studies reported no effect. Dietary and activity interventions versus control Dietary and activity interventions, compared with control, may result in a slight reduction in BMI and zBMI at short-term follow-up (BMI: MD -0.11, 95% CI -0.21 to -0.01; 27 studies, 16,066 participants; zBMI: MD -0.03, 95% CI -0.06 to 0.00; 26 studies, 12,784 participants; low-certainty evidence) and likely result in a reduction of BMI and zBMI at medium-term follow-up (BMI: MD -0.11, 95% CI -0.21 to 0.00; 21 studies, 17,547 participants; zBMI: MD -0.05, 95% CI -0.07 to -0.02; 24 studies, 20,998 participants; moderate-certainty evidence). Dietary and activity interventions compared with control may result in little to no difference in BMI and zBMI at long-term follow-up (BMI: MD 0.03, 95% CI -0.11 to 0.16; 16 studies, 22,098 participants; zBMI: MD -0.02, 95% CI -0.06 to 0.01; 22 studies, 23,594 participants; low-certainty evidence). Nineteen studies (27,882 participants; low-certainty evidence) reported data on serious adverse events: four studies reported occurrence of serious adverse events (e.g. injuries, low levels of extreme dieting behaviour); 15 studies reported no effect. Heterogeneity was apparent in the results for all outcomes at the three follow-up times, which could not be explained by the main setting of the interventions (school, home, school and home, other), country income status (high-income versus non-high-income), participants' socioeconomic status (low versus mixed) and duration of the intervention. Most studies excluded children with a mental or physical disability. AUTHORS' CONCLUSIONS The body of evidence in this review demonstrates that a range of school-based 'activity' interventions, alone or in combination with dietary interventions, may have a modest beneficial effect on obesity in childhood at short- and medium-term, but not at long-term follow-up. Dietary interventions alone may result in little to no difference. Limited evidence of low quality was identified on the effect of dietary and/or activity interventions on severe adverse events and health inequalities; exploratory analyses of these data suggest no meaningful impact. We identified a dearth of evidence for home and community-based settings (e.g. delivered through local youth groups), for children living with disabilities and indicators of health inequities.
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Affiliation(s)
- Francesca Spiga
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Annabel L Davies
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Eve Tomlinson
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Theresa Hm Moore
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- NIHR Applied Research Collaboration West (ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Sarah Dawson
- NIHR Applied Research Collaboration West (ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Katie Breheny
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Jelena Savović
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- NIHR Applied Research Collaboration West (ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Yang Gao
- Department of Sport, Physical Education and Health, Hong Kong Baptist University, Kowloon, Hong Kong
| | - Sophie M Phillips
- Department of Sport and Exercise Science, Durham University, Durham, UK
- Fuse - Centre for Translational Research in Public Health, Newcastle upon Tyne, UK
- Child Health and Physical Activity Laboratory, School of Occupational Therapy, Western University, London, Ontario, Canada
| | - Frances Hillier-Brown
- Fuse - Centre for Translational Research in Public Health, Newcastle upon Tyne, UK
- Human Nutrition Research Centre and Population Health Sciences Institute, University of Newcastle, Newcastle, UK
| | - Rebecca K Hodder
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, Australia
- School of Medicine and Public Health, The University of Newcastle, Callaghan, Australia
- Population Health Research Program, Hunter Medical Research Institute, New Lambton, Australia
- National Centre of Implementation Science, The University of Newcastle, Callaghan, Australia
| | - Luke Wolfenden
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, Australia
- School of Medicine and Public Health, The University of Newcastle, Callaghan, Australia
| | - Julian Pt Higgins
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- NIHR Applied Research Collaboration West (ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
- NIHR Bristol Biomedical Research Centre at University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol, Bristol, UK
| | - Carolyn D Summerbell
- Department of Sport and Exercise Science, Durham University, Durham, UK
- Fuse - Centre for Translational Research in Public Health, Newcastle upon Tyne, UK
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Zamorano-García D, Infantes-Paniagua Á, Cuevas-Campos R, Fernández-Bustos JG. Impact of Physical Activity-Based Interventions on Children and Adolescents' Physical Self-Concept: A Meta-Analysis. RESEARCH QUARTERLY FOR EXERCISE AND SPORT 2023; 94:1-14. [PMID: 34860643 DOI: 10.1080/02701367.2021.1927945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 05/05/2021] [Indexed: 06/13/2023]
Abstract
Background: Observational studies associate physical activity (PA) with improved perceptions of children and adolescents' physical self-concept (PSC) and global self-concept (GSC). However, only a few PA-based interventions exist for improving PSC and their results have been inconclusive. Objective: To determine the effect of specific PA-based programmes on the PSC (including its sub-dimensions) and GSC of children and adolescents, and to assess possible moderators. Methods: The databases Web of Science, Scopus, SportDiscus, PubMed, CINAHL, and Cochrane Library were reviewed in February 2020. Only studies with pre-post measurements and control groups were included. The impact of PA-based interventions was explored through different meta-analyses and moderator analyses. Results: Altogether, 20 studies were included in the meta-analysis. Positive and significant effects of PA were determined on self-perceived physical appearance (g = 0.13; 95% CI = 0.03, 0.23), self-perceived sport competence (g = 0.30; 95% CI = 0.09, 0.51), self-perceived physical fitness (g = 0.19; 95% CI = 0.05, 0.32), PSC (g = 0.31; 95% CI = 0.10, 0.52), and GSC (g = 0.17; 95% CI = 0.01, 0.33). The existence of additional interventions in PA-based programmes (e.g., interventions focused on psychological factors or healthy habits) moderated the influence of PA on self-perceived sport competence and physical fitness. Moreover, environment and time were distinguished as moderators for self-perceived physical appearance and sport competence. Further, intervention type, gender, and frequency of intervention moderated the effects of PA on PSC. Conclusions: PA-based interventions, especially in school, seem to be beneficial for the development of positive physical self-perceptions.
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Marttinen R, Wilson K, Fisher K, Beitzel M, Fredrick RN. Process evaluation and challenges in collecting data from an after-school sports and literacy program in a diverse, low-income community. EVALUATION AND PROGRAM PLANNING 2022; 91:102052. [PMID: 35180551 DOI: 10.1016/j.evalprogplan.2022.102052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 12/04/2021] [Accepted: 02/11/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND To understand how programs succeed we must evaluate them. The purpose of this paper was to examine the intervention and evaluation processes and identify areas of success and challenges in delivering and evaluating the Reflective Educational Approach to Character and Health (REACH) after-school program in a low SES community. METHODS Sixty-six fifth and sixth graders from two schools participated. Data were collected at the intervention and control schools at four time points over the year. Data collected at baseline (Aug/Sep 2016), and Time 4 (May, 2017) were used for the analysis. Reach and fidelity to the intervention were assessed along with information on the process of data collection for variables of interest (e.g., accelerometer-measured physical activity level, FITNESSGRAM tests, vertical jump, and literacy). Missing data were imputed and a 2(School) by 2(Time) mixed factorial ANOVA was performed to examine the efficacy of the intervention. RESULTS There were no significant time by school interactions for any of the outcomes assessed. There were several challenges in evaluating the program such as low compliance to wearing the accelerometer, lack of effort during literacy tests, peers affecting effort on physical tests, and missing data. CONCLUSIONS We posit that research implementation be re-examined in community-based research that is conducted with students at the elementary level in low-income communities. Future research should engage with youth in the data collection process to make it a meaningful experience for them and to possibly reduce attrition from the program.
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Affiliation(s)
- Risto Marttinen
- George Mason University, Recreation and Athletic Complex, rm 2109, 4350 Bannister Creek Ct, Fairfax, VA 22030, USA.
| | - Kathleen Wilson
- Department of Kinesiology, California State University, Fullerton, 800 N. State College Blvd, Fullerton, CA 92831, USA.
| | - Koren Fisher
- Department of Kinesiology, California State University, Fullerton, 800 N. State College Blvd, Fullerton, CA 92831, USA.
| | - Maria Beitzel
- Department of Kinesiology, California State University, Fullerton, 800 N. State College Blvd, Fullerton, CA 92831, USA.
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Earle R, Littlewood R, Nalatu S, Walker J. Empowerment Approaches in Childhood Weight Management: A Systematic Review. Child Obes 2022; 18:2-30. [PMID: 34314612 DOI: 10.1089/chi.2021.0049] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Empowerment interventions facilitate individuals, organizations, and communities to gain better control over their health. They are distinctly different from traditional behavior change models and encourage participants to set their own health priorities and agenda. Current evidence suggests empowerment interventions are efficacious for smoking, sexual, and mental health outcomes. However, empowerment in childhood obesity (which remains a global public health challenge) is underresearched. This review systematically analyzed the evidence for empowerment approaches in childhood weight management. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. A search strategy was applied to six databases from inception to May 25, 2021. Evidence was appraised using The Academy of Nutrition and Dietetics Quality Criteria Checklist and National Health and Medical Research Council Levels of Evidence. Of the 9274 articles identified, 29 articles describing 14 programs met the inclusion criteria. Twenty-five studies rated positive and four rated neutral. Overall, the evidence body rated "B." Seventy-two percent of the 3318 participants were from priority populations, highlighting the unique ability of empowerment interventions to engage those most in need. Results demonstrate small to large improvements in participant body mass index with effect sizes ranging from 0.08 to 1.13. Throughout the literature, empowerment was measured inconsistently and usually with a surrogate marker. All studies were set in America or Canada. This review suggests empowerment should be further investigated in childhood weight management. Empowerment interventions represent a unique opportunity to meaningfully integrate self-determination to clinical childhood weight management practice and overcome current barriers related to priority population engagement.
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Affiliation(s)
- Renae Earle
- School of Human Movement and Nutrition Sciences, The University of Queensland, St Lucia, Queensland, Australia
| | - Robyn Littlewood
- School of Human Movement and Nutrition Sciences, The University of Queensland, St Lucia, Queensland, Australia.,Health and Wellbeing Queensland, Milton, Queensland, Australia
| | - Simone Nalatu
- Health and Wellbeing Queensland, Milton, Queensland, Australia
| | - Jacqueline Walker
- School of Human Movement and Nutrition Sciences, The University of Queensland, St Lucia, Queensland, Australia
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Characteristics of successful primary school-based experiential nutrition programmes: a systematic literature review. Public Health Nutr 2020; 24:4642-4662. [PMID: 33050980 DOI: 10.1017/s1368980020004024] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Diet and nutrition in childhood has been associated with the risk of chronic disease later in life. The aim of this review was to identify key characteristics of successful experiential nutrition interventions aimed to change nutrition-related cognitive and behavioural outcomes in primary schoolchildren. DESIGN A systematic literature review was undertaken using search terms ('food security', 'school', 'nutrition' and 'program') applied to five scientific databases (CINAHL, Scopus, Web of Science, Medline and Academic Search complete), with outcomes defined as nutrition-related knowledge, attitudes and/or dietary behaviours. PARTICIPANTS Primary school-aged children exposed to interventions conducted, at least partially, on school grounds. RESULTS A total of 3800 articles were identified from the initial search and manual searching, of which sixty-seven articles were eligible for inclusion. Forty-two articles met the criteria of being successful, defined as achieving significant differences in outcomes of interest, accompanied by a demonstrated reach. Interventions included school gardens (n 9), food provision (n 5), taste testing (n 8), cooking classes (n 10) and multicomponent programmes (n 10). Nutrition education (when combined with taste testing), cooking-related activities and gardening interventions increased children's willingness to taste unfamiliar foods including new fruits and vegetables, improved their cooking and food preparation skills and increased nutritional knowledge. CONCLUSIONS This review provides evidence that nutrition education programmes in primary schoolchildren that are experiential in nature are most likely to be successful if they include multiple strategies, have parental involvement and focus specifically on vegetable intake.
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Annesi JJ, Walsh SM, Greenwood BL, Mareno N, Unruh-Rewkowski JL. Effects of the Youth Fit 4 Life physical activity/nutrition protocol on body mass index, fitness and targeted social cognitive theory variables in 9- to 12-year-olds during after-school care. J Paediatr Child Health 2017; 53:365-373. [PMID: 28052570 DOI: 10.1111/jpc.13447] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Revised: 08/29/2016] [Accepted: 11/13/2016] [Indexed: 01/31/2023]
Abstract
AIM Childhood overweight and obesity is unacceptably high in industrialised nations. School-based interventions have largely been atheoretical and ineffective. This study aimed to test a new theory-based protocol for its effects on measures of fitness and body mass index (BMI), and its proposed psychosocial mediators, during elementary after-school (out-of-school hours) care. METHODS Nine- to 12-year-old participants of YMCA-based after-school care in the southeastern Unites States were randomised into either the experimental Youth Fit 4 Life (YF4L) treatment group (n = 86) or a typical care group (n = 55) for 45 min/day. YF4L is based on social cognitive theory, emphasising mastery over physical activities and the development of self-management/self-regulatory skills to support healthy behaviours. Physiological and psychosocial variables were assessed over a 9-month elementary school year. RESULTS Of the overall sample, 28% were overweight or obese at baseline. YF4L was associated with significantly greater improvements in BMI, and measures of self-regulation, mood, self-efficacy, cardiovascular endurance and strength over both 3 and 9 months. Changes in self-regulation, mood and self-efficacy significantly mediated the treatment type-BMI relationship over both 3 months (R 2 = 0.12, P = 0.002) and 9 months (R 2 = 0.13, P = 0.001), with change in self-regulation being a significant independent mediator. Changes in BMI and self-regulation reciprocally reinforced one another. Gender was not a significant moderator of those relationships. CONCLUSIONS The YF4L treatment mitigated rise in BMI in 9- to 12-year-old enrollees of after-school care. The treatment's basis in social cognitive theory was supported. Because of its positive effects and ability to utilise existing staff, large-scale application is warranted after sufficient replication.
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Affiliation(s)
- James J Annesi
- Wellness Department, YMCA of Metro Atlanta, Atlanta, Georgia, United States.,Wellstar School of Nursing, Kennesaw State University, Kennesaw, Georgia, United States
| | - Stephanie M Walsh
- Department of Surgery, Health Promotion and Pediatrics, Emory University School of Medicine, Atlanta, Georgia, United States.,Department of Child Wellness, Children's Healthcare of Atlanta, Atlanta, Georgia, United States
| | | | - Nicole Mareno
- Wellstar School of Nursing, Kennesaw State University, Kennesaw, Georgia, United States
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Annesi JJ, Walsh SM, Greenwood BL. Increasing Children's Voluntary Physical Activity Outside of School Hours Through Targeting Social Cognitive Theory Variables. J Prim Care Community Health 2016; 7:234-41. [PMID: 27365217 DOI: 10.1177/2150131916656177] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Volume of moderate-to-vigorous physical activity completed during the elementary school day is insufficient, and associated with health risks. Improvements in theory-based psychosocial factors might facilitate increased out-of-school physical activity. METHODS A behaviorally based after-school care protocol, Youth Fit 4 Life, was tested for its association with increased voluntary, out-of-school physical activity and improvements in its theory-based psychosocial predictors in 9- to 12-year-olds. RESULTS Increases over 12 weeks in out-of-school physical activity, and improvements in self-regulation for physical activity, exercise self-efficacy, and mood, were significantly greater in the Youth Fit 4 Life group (n = 88) when contrasted with a typical care control group (n = 57). Changes in the 3 psychosocial variables significantly mediated the group-physical activity change relationship (R(2) = .31, P < .001). Change in self-regulation was a significant independent mediator, and had a reciprocal relationship with change in out-of-school physical activity. In the Youth Fit 4 Life group, occurrence of 300 min/wk of overall physical activity increased from 41% to 71%. CONCLUSIONS Targeting theory-based psychosocial changes within a structured after-school care physical activity program was associated with increases in children's overall time being physically active. After replication, large scale application will be warranted.
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Affiliation(s)
- James J Annesi
- YMCA of Metro Atlanta, Atlanta, GA, USA Kennesaw State University, Kennesaw, GA, USA
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