Effective interventions in overweight or obese young children: systematic review and meta-analysis

Treatment of childhood obesity based on the reduction of ultra-processed foods plus energy restriction: A randomised controlled trial based on the Brazilian guidelines

Reducing ultra-processed foods (UPF) improves diet quality and may curb energy consumption. This study aimed to compare an intervention based on the reduction of UPF, according to the Dietary Guideline for the Brazilian Population (DGBP), with and without advice on energy intake. A parallel and randomised controlled trial was carried out with children with obesity from 7 to 12 years old. Both control (CG) and intervention groups (IG) participated monthly in 6 standardised educational activities based on the 10 steps of the DGBP. An individualised food plan was also provided to the IG. The rate of change for body mass index (BMI), waist circumference, body weight, and UPF consumption were investigated based on mixed-effect models. At the end of the study, the BMI declined in the IG (Δ = -0.27 kg/m2) compared to the CG (Δ = + 0.53 kg/m2) (p = .0002). Both groups showed a decline in grams of UPF until the fourth month and a gradual increase in the following months. Combining the qualitative approach of the DGBP with counselling on energy restriction through the diet plan proved to be effective in reducing childhood obesity. Clinical Trial Registration: This trial is registered at the Brazilian Registry of Clinical Trials (REBEC), under the RBR-3st5sn registry, available at http://www.ensaiosclinicos.gov.br/rg/RBR-3st5sn/. The datasets generated by the current study are not publicly available but are available from the corresponding author on reasonable request.

Development of a checklist to assess potentially effective components in combined lifestyle interventions for children with overweight or obesity

BACKGROUND

In the Netherlands, Combined Lifestyle Interventions (CLIs), offered in primary care, aim to reduce the number of children with overweight or obesity. CLIs are carried out by a multidisciplinary team and focus on dietary advice and guidance, exercise and behaviour change. These CLIs are not uniformly designed and vary in protocols to suit the local circumstances. Due to the variation in content of CLIs it is difficult to investigate their effectiveness. To enable a proper evaluation of CLIs, we first need to unravel the 'black boxes' of CLIs by identifying the various potentially effective components.

METHODS

First of all we identified potentially effective components in literature. Subsequently we organized an online consultation with experts with diverse backgrounds and asked if they could add potentially effective components. These components were then assembled into a checklist meant to determine the presence or absence of potentially effective components in CLIs for children.

RESULTS

42 experts participated. We identified 65 potentially effective components for CLIs for children with overweight or obesity that we categorized into three themes: content, organisation and implementation.

CONCLUSIONS

Based on literature and expert opinions we developed a practical 65-item checklist to determine the presence of potentially effective components in a CLI. This checklist can be used in the development of CLIs as well as evaluation of CLIs.

Family Management of Severe Obesity in Adolescents

PURPOSE

Severe obesity, defined as a body mass index (BMI) ≥120th percent of the 95th BMI percentile for age and sex, is the fastest growing subcategory of obesity among youth, yet little is known about how this group understands and incorporates weight management strategies. The aims of this study were to explore how parents and adolescents understand severe obesity and incorporate management into their daily lives and evaluate the applicability of the Family Management Styles Framework (FMSF) to better understand the impact of severe obesity for adolescents.

DESIGN AND METHODS

Directed content analysis grounded in a modified version of the FMSF was used to analyze one-time in-home face-to-face interviews with adolescents aged 12-17 years (N = 14) who received pediatric weight management care and a parent (N = 17).

RESULTS

Both adolescents and parents described the day-to-day management as challenging and impactful to parent-child and sibling relationships. They described the need for sustained support and coaching in meeting daily physical activity requirements and related stories of weight stigma experienced. Further, parents' and adolescents' views were mostly congruent, except in their view of effectiveness of daily routines and how family attitudes and actions did or did not support the adolescent.

CONCLUSIONS

The FMSF was successfully applied to understand family management of adolescents with severe obesity. These adolescents have complex physical and psychological needs impacting effective weight management and family life.

PRACTICE IMPLICATIONS

Technology interventions should be considered to improve physiological and psychological outcomes for youth with severe obesity.

Capability, opportunity, and motivation: an across contexts empirical examination of the COM-B model

BACKGROUND

There is limited evidence for successful weight gain prevention interventions targeting young adults. Developing effective interventions necessitates a theoretical model that can identify barriers and enablers for healthy eating and physical activity among young adults to support weight management. This study empirically examines the utility of the COM-B model as a framework for intervention planning across two behavioural contexts: eating and physical activity.

METHODS

A cross-sectional survey research design was employed to empirically test the COM-B model in the contexts of young adult's eating and physical activity behaviours. Informed by the Theoretical Domains Framework, pre-validated measures appropriate for capturing the latency of the COM (Capability, Opportunity, and Motivation) constructs were sourced. Both surveys (eating and physical activity) were administered online to two independent samples of young adults aged 18-35 years. Models were specified and tested using structural equation modelling.

RESULTS

A total of 582 (mean age = 22.8 years; 80.3% female) and 455 (mean age = 24.9 years; 80.8% female) participants were included in the physical activity and eating analyses, respectively. The COM-B model explained 31% of variance in physical activity behaviour and 23% of variance in eating behaviour. In the physical activity model (N = 582), capability and opportunity were found to be associated with behaviour through the mediating effect of motivation. In the eating model (N = 455), capability was found to be associated with behaviour through the mediating effect of motivation. Capability was also found to mediate the association between opportunity and motivation. Consistencies and variations were observed across both models in terms of COM indicators.

CONCLUSIONS

Findings support the COM-B model's explanatory potential in the context of young adult's physical activity and eating behaviours. Barriers and enablers underlying young adult's physical activity and eating behaviours were identified that represent potential targets for future intervention design. Further research is needed to validate present study findings across different populations and settings.

Effectiveness of dietary interventions on weight outcomes in childhood: a systematic review meta-analysis of randomized controlled trials

BACKGROUND

Rapid growth and elevated weight in childhood are significantly associated with obesity in later life, but evidence regarding dietary interventions and weight outcomes is lacking. This study aimed to determine the effectiveness of dietary interventions on body mass index (BMI) and BMI z-score in childhood.

METHODS

PubMed, EmBase, and the Cochrane library were searched from inception till June 2019. Studies that investigated the effectiveness of dietary interventions on BMI and BMI z-score in childhood were considered eligible in our study. The changes in BMI and BMI z-score between dietary interventions and control were calculated by pooled weighted mean differences (WMDs) and 95% CIs were evaluated using random-effects model.

RESULTS

Twenty-eight randomized controlled trials involving a total of 17,488 children were included. The summary WMDs indicated that children who received dietary interventions had greater reduction in BMI (WMD: -0.12; 95% CI: -0.20 to -0.05; P=0.001) and BMI z-score (WMD: -0.04; 95% CI: -0.06 to -0.02; P=0.001) when compared to the usual controls. Subgroup analyses revealed that the sample size, mean age, duration of interventions, and study quality could affect the effectiveness of dietary interventions in children.

CONCLUSIONS

The findings of this meta-analysis suggested that dietary interventions improved BMI and BMI z-score, whereas these results are limited due to substantial heterogeneity and study quality of the included studies.

A Scoping Review: Family and Child Perspectives of Clinic-Based Obesity Treatment

PROBLEM

Interventions for children with obesity lead to only modest improvements in BMI and long-term outcomes, and data are limited on the perspectives of families of children with obesity in clinic-based treatment. This scoping review seeks to answer the question: What is known about the perspectives of families and children who receive care in clinic-based child obesity treatment?

ELIGIBILITY CRITERIA

Studies were eligible for inclusion in this review that 1) reported parent, family or child perspectives of obesity treatment; 2) addressed concepts identified in the obesity literature as barriers or facilitators to success in obesity treatment from the perspective of the parent/family/child, including reasons for failure to return to clinic and satisfaction with care.

SAMPLE

Twelve studies qualified for final inclusion in this scoping review RESULTS: Families report a lack of interventions tailored to their unique needs and resources. Barriers and facilitators encompass 1) structural issues (e.g., clinic location and scheduling); 2) financial issues; 3) patient and family issues; and 4) personal behaviors, motivation, and expectations.

CONCLUSION

Data are lacking on the clinic-based treatment of children with severe obesity, and few studies report on non-maternal perspectives.

IMPLICATIONS

Clinical practice must be tailored to individual family needs. Future research should concentrate on identifying missing variables which impact successful treatment outcomes through more rigorous qualitative studies, standardized outcome measures, focus on children with severe obesity, and fathers' and siblings' perspectives.

Assessing anthropometric and laboratory outcomes of a paediatric telehealth weight management program

INTRODUCTION

Telehealth can expand quality care to patients unable to access specialty health services. The purpose of this study was to compare changes in body mass index (BMI) and laboratory values in patients visiting a weight management clinic for in-person versus telehealth counselling.

METHODS

A retrospective cohort study of active program participants from two to 22 years old was conducted. Change in BMI, BMI z-score, low-density lipoprotein (LDL), alanine aminotransferase (ALT), and glycated haemoglobin (HbA_1c) levels were measured at each patient's initial and final visit for the study period, and the difference was analysed for significance. Change in BMI z-score was analysed for non-inferiority of the telehealth group using a delta of 0.15.

RESULTS

We evaluated 1019 of 1126 (90.5%) in-person patients and 58 of 75 (77.3%) of telehealth clinic patients. The mean initial BMI was 32.2 and 32.6 for the in-person and telehealth groups, respectively. There were mean decreases in BMI z-scores of 0.044 and 0.032 in the in-person and telehealth groups, respectively, P < 0.001 with a margin of 0.15. The changes in mean HbA_1c (p = 0.59), mean LDL (p = 0.93), and a mean ALT (p = 0.09) were not significant, although only a minority of patients followed-up for lab draws, limiting interpretation of these results.

DISCUSSION

Attending a weight management clinic via telehealth was non-inferior to in-person visits for enacting a clinically significant change in BMI z-score, mitigating the effect of sample size on BMI z-score results. These findings give credibility to telehealth as a means of increasing access to paediatric weight management care.

Childhood Obesity Evidence Base Project: A Systematic Review and Meta-Analysis of a New Taxonomy of Intervention Components to Improve Weight Status in Children 2-5 Years of Age, 2005-2019

Objective: To evaluate the efficacy of childhood obesity interventions and conduct a taxonomy of intervention components that are most effective in changing obesity-related health outcomes in children 2-5 years of age. Methods: Comprehensive searches located 51 studies from 18,335 unique records. Eligible studies: (1) assessed children aged 2-5, living in the United States; (2) evaluated an intervention to improve weight status; (3) identified a same-aged comparison group; (4) measured BMI; and (5) were available between January 2005 and August 2019. Coders extracted study, sample, and intervention characteristics. Effect sizes [ESs; and 95% confidence intervals (CIs)] were calculated by using random-effects models. Meta-regression was used to determine which intervention components explain variability in ESs. Results: Included were 51 studies evaluating 58 interventions (N = 29,085; mean age = 4 years; 50% girls). Relative to controls, children receiving an intervention had a lower BMI at the end of the intervention (g = 0.10, 95% CI = 0.02-0.18; k = 55) and at the last follow-up (g = 0.17, 95% CI = 0.04-0.30; k = 14; range = 18-143 weeks). Three intervention components moderated efficacy: engage caregivers in praise/encouragement for positive health-related behavior; provide education about the importance of screen time reduction to caregivers; and engage pediatricians/health care providers. Conclusions: Early childhood obesity interventions are effective in reducing BMI in preschool children. Our findings suggest that facilitating caregiver education about the importance of screen time reduction may be an important strategy in reducing early childhood obesity.

Childhood Obesity Evidence Base Project: Building Translational Capacity through Meta-Analytic Methods

Purpose: The purpose of this article is to demonstrate the need for and utility of using a taxonomic approach for evidence aggregation and meta-analyses, with focus on prevention and reduction of childhood obesity in very young children. As evidence has been generated through heterogeneous efforts, it is important that the field makes use of all available evidence to learn what works, for who, and in what circumstances. Methods: The Childhood Obesity Evidence Base (COEB) project conducted a taxonomic meta-analysis, using Grounded Theory to code elements present in reports of existing studies and initiatives, of diverse design and evaluation approaches, which were then mapped onto the levels of the socio-ecologic model. This article is the fourth in a series that describes the COEB project overall. It discusses both generally and specifically how taxonomies contribute to traditional meta-analytic methods, what questions can and cannot be answered, the method's contribution to translational (implementation) capacity, and ability to inform future efforts. Results: The COEB project illustrates how the taxonomic meta-analytic approach broadens the evidence base, increases translational capacity for effective intervention components, and evaluates the influence of contextual elements to inform future initiatives. How the method is used to establish associations between varying intervention components, contextual elements, and outcomes is discussed. Conclusions: Taxonomies generated through this process can be used for meta-analysis, serving to generate topic-specific questions associated with intervention approaches and outcomes in context, which is adjunctive to traditional meta-analytic methods and can inform public health approaches.

Prevention and treatment of childhood and adolescent obesity: a systematic review of meta-analyses

BACKGROUND

The goal of this systematic review is to synthesize the published meta-analyses assessing the role of nutritional, behavioral and physical activity factors/interventions on the prevention or treatment of pediatric and adolescent obesity.

METHODS

An online search was conducted in PubMed (end-of-search: September 30, 2015); English-language meta-analyses pooling observational and/or interventional studies examining weight-related indices on children and adolescents were included.

RESULTS

Sixty-six meta-analyses corresponding to more than 900,000 children and adolescents were retrieved. The majority of meta-analyses included interventional studies most of which referred to mixed or combined interventions, including components such as diet, physical activity and sedentary behavior reduction. Discrepancies between meta-analyses on observational and interventional studies were noted. Combined interventions including physical activity and nutritional modifications seemed to represent the most effective means for tackling childhood obesity.

CONCLUSIONS

Synthesis of interventional or observational evidence may yield discrepant results. The combination of enhanced physical activity and improved nutrition emerged as a promising intervention in the fight against childhood/adolescent obesity. However, further research is needed about the most effective multidimensional prevention strategy.

Overview of meta-analysis on prevention and treatment of childhood obesity

OBJECTIVES

This study aimed to assess the quality of systematic reviews on prevention and non-pharmacological treatment of overweight and obesity in children and adolescents.

DATA SOURCE

A search was done in electronic databases (Medline via PubMed, Web of Science, Scopus, LILACS, the Cochrane Library, and Clinical Trials), including only systematic reviews with meta-analysis. Reviews were selected by two researchers, and a third one solved the divergences. PRISMA statement and checklist were followed.

SUMMARY OF DATA

A total of 4574 records were retrieved, including 24 after selection. Six reviews were on obesity prevention, 17 on obesity treatment, and one on mixed interventions for prevention and treatment of obesity. The interventions were very heterogeneous and showed little or no effects on weight or body mass index. Mixed interventions that included dieting, exercise, actions to reduce sedentary behavior, and programs involving the school or families showed some short-term positive effects. Reviews that analyzed cardiovascular risk factors demonstrated significant improvements in the short-term.

CONCLUSION

The systematic reviews of interventions to prevent or reduce obesity in children and adolescents generally showed little or no effects on weight or body mass index, although cardiovascular profile can be improved. Mixed interventions demonstrated better effects, but the long-term impact of obesity treatments of children and adolescents remains unclear.

Health Outcomes of Youth in Clinical Pediatric Weight Management Programs in POWER

OBJECTIVE

To describe treatment outcomes of children and adolescents enrolled in the Pediatric Obesity Weight Evaluation Registry, a consortium of multicomponent pediatric weight management programs in the US.

STUDY DESIGN

This multicenter prospective observational cohort study, established in 2013, includes youth (2-18 years of age) with obesity enrolled from 31 Pediatric Obesity Weight Evaluation Registry (POWER) sites over a 2-year period and followed up to 12 months. Weight status was evaluated by the percentage of the 95th percentile for body mass index (%BMIp95). Associations of weight status outcomes with patient characteristics and program exposure were analyzed with multivariable mixed effects modeling.

RESULTS

We included 6454 children and adolescents (median age, 11 years; IQR, 9-14 years; 53% white, 32% Hispanic; 73% with severe obesity) who were enrolled in POWER. Median changes in %BMIp95 for this cohort were -1.88 (IQR, -5.8 to 1.4), -2.50 (IQR, -7.4 to 1.8), -2.86 (IQR, -8.7 to 1.9), at 4-6, 7-9, and 10-12 of months follow-up, respectively (all P < .05). Older age (≥12 years), greater severity of obesity, and Hispanic race/ethnicity were associated with better improvement in %BMIp95. A 5-percentage point decrease in %BMIp95 was associated with improvement in cardiometabolic risk factors.

CONCLUSIONS

Overall, treatment in pediatric weight management programs is associated with a modest median decrease in BMI as measured by change in %BMIp95. Further studies are needed to confirm these findings, as well as to identify additional strategies to enhance the effectiveness of these multicomponent interventions for youth with severe obesity.

TRIAL REGISTRATION

ClinicalTrials.gov: NCT02121132.

Impact on Healthy Behaviors of Group Obesity Management Visits in Middle School Health Centers

This mixed-methods community-based participatory pilot study examined the feasibility and preliminary efficacy of group obesity management visits offered through school-based health centers. The study was implemented through an academic-community partnership in three school health centers serving primarily Latinx and African American youth. Participants (n = 71) completed pre- and post-surveys about intention to change diet and exercise habits, knowledge and self-efficacy related to healthy eating, and social support. Focus groups were conducted after the intervention and 18 months later. Group visits were feasible and highly valued by study participants. Quantitative results showed a significant decrease in soda consumption, increased support from classmates, and an increased number of exercise days. In focus groups, youth endorsed cooking, tasting, and shopping activities, noted the importance of family involvement in behavior change, and stated that stress reduction mindfulness exercises helped to change eating habits. Implications for school-based health care and school nursing are discussed.

Changes in diet quality and home food environment in preschool children following weight management

Background

Family-based obesity treatment interventions can successfully reduce energy intake in preschoolers. An implicit goal of obesity treatment interventions is to improve diet quality, but diet quality has been less examined as a treatment outcome in studies of preschoolers. The purpose of this study was to conduct a secondary analysis comparing the change in diet quality and home food environment in preschoolers assigned to a behavioral family-based obesity intervention (LAUNCH), motivational interviewing (MI) condition, or standard care (STC) condition.

Methods

Three 24-h dietary recalls were completed at baseline and 6-months and were analyzed using NDS-R software; diet quality was assessed using the Healthy Eating Index-2010 (HEI-2010). Availability of foods and beverages in the home was assessed through direct observation using the Home Health Environment tool that classifies foods and beverages as ‘red’ or ‘green’ based upon fat and sugar content. Repeated measures linear mixed effects models were used to examine changes in diet quality and home food environment between conditions (LAUNCH, MI, STC).

Results

At 6-months, preschoolers in the LAUNCH condition had a higher HEI-2010 total score (62.8 ± 13.7) compared to preschoolers in the MI (54.7 ± 13.4, P = 0.022) and STC (55.8 ± 11.6, P = 0.046) conditions. Regarding the home food environment, families in LAUNCH had significantly less ‘red’ foods in their home at 6-months (12.5 ± 3.4 ‘red’ foods) compared to families in MI (14.0 ± 3.7 ‘red’ foods, P = 0.030), and STC (14.3 ± 3.4 ‘red’ foods, P = 0.006). There were no statistically significant differences across home food environments for number of ‘green’ foods.

Conclusion

Family-based obesity treatment interventions for preschoolers can improve overall diet quality and alter the home food environment through reductions in ‘red’ foods.

Trial registration

Clinicaltrials.gov, NCT01546727. Registered March 7, 2012.

Interventions aimed at preventing and reducing overweight/obesity among children and adolescents: a meta-synthesis

The prevalence of child and adolescent obesity has been a major worldwide problem for decades. To stop the number of youth with overweight/obesity from increasing, numerous interventions focusing on improving children's weight status have been implemented. The growing body of research on weight-related interventions for youth has been summarized by several meta-analyses aiming to provide an overview of the effectiveness of interventions. Yet, the number of meta-analyses is expanding so quickly and overall results differ, making a comprehensive synopsis of the literature difficult. To tackle this problem, a meta-synthesis was conducted to draw informed conclusions about the state of the effectiveness of interventions targeting child and adolescent overweight. The results of the quantitative synthesis of 26 meta-analyses resulted in a standardized mean difference (SMD) of -0.12 (95%CI: -0.16, -0.08). Several moderator analyses showed that participant and intervention characteristics had little impact on the overall effect size. However, a moderator analysis distinguishing between obesity treatment and obesity prevention studies showed that obesity treatment interventions (SMD: -0.048, 95%CI: -0.60, -0.36) were significantly more effective in reducing body mass index than obesity prevention interventions (SMD: -0.08, 95%CI: -0.11, -0.06). Overall, the results of this meta-synthesis suggest that interventions result in statistically significant effects albeit of relatively little clinical relevance.

A scoping review protocol to map the evidence on interventions to prevent overweight and obesity in children

INTRODUCTION

Obesity has become one of the biggest public health problems of the 21st century. Prevalence of obesity in children and adolescents has increased dramatically worldwide over the last 20 years, and this trend is expected to continue. Obesity in childhood is concerning as it predicts obesity in adulthood, a common risk factor for a wide array of chronic diseases and poor health outcomes. Obesity is preventable and a vast but fragmented body of evidence on preventative interventions is now available. This article outlines the protocol for a scoping review of published literature reviews on interventions to prevent obesity in children. The scoping review addresses the broad research question 'What is the evidence on interventions to prevent childhood obesity?'. It aims to give an overview of the various interventions available, understand those which are effective and identify barriers and facilitators to their effectiveness.

METHODS AND ANALYSIS

The six-staged Arksey and O'Malley methodology framework is used to guide the scoping review process: following the definition of the research questions (stage 1); the eligibility criteria and search strategy are defined (stage 2); the study selection process based on the eligibility criteria identified will follow (stage 3); a framework developed for this review will then inform the extraction and charting of data from the included reviews (stage 4); results will be aggregated and summarised with criteria relevant for health professionals and policy-makers (stage 5); and the optional consultation (stage 6) exercise is not planned.

ETHICS AND DISSEMINATION

Since the scoping review methodology aims at synthetising information from available publications, this study does not require ethical approval. An article reporting the results of the scoping review will be submitted for publication to a scientific journal, presented at relevant conferences and disseminated as part of future workshops with professionals involved in obesity prevention.

Development of a Dutch intervention for obese young children

The objective of this article is to provide insight in the five-step development process of the best evidence, best practice intervention for obese young children 'AanTafel!'. A set of requirements for intervention development was developed to guide the data inquiry: the use of theory, influencing factors, tailoring, multi-disciplinarity, duration/frequency and evaluation and monitoring. Step I retrieved evidence from clinical guidelines, followed by a systematic review with meta-analysis (Step II) and an extended literature review (Step III). Evidence was consistent with regard to parent-focus, targeting family level, including diet, physical activity and behaviour change techniques and tailoring to age. However, no evidence or inconsistent evidence emerged from the theory-basis, group-versus-individual sessions, face-to-face contact versus Internet-mediated contact, which disciplines to involve and how to involve them, as well as intervention duration and intensity. Hence, practice-based insights from parental interviews (Step IV) and involved therapists were added and subsequently integrated to the intervention 'AanTafel!' (Step V). 'AanTafel!' is a multi-component, multi-disciplinary, family-based, parent-focused, age-specific intervention, which is tailored to individual children and families with a duration of 1 year, and using a combination of individual and group sessions as well as a Web-based learning module. Changes in scientific working principles with regard to data collection, reporting and translation to guidelines are required. Practice and science may benefit from close collaboration in designing, implementing and evaluating interventions.

Girls and Boys Have a Different Cardiometabolic Response to Obesity Treatment

Background: Childhood obesity exposes individuals to cardiometabolic disturbances. We analyzed how family-based multidisciplinary obesity treatment influenced children's cardiometabolic health. Materials and methods: In this retrospective, two-year, follow-up study of 654 2- to 18-year-old children treated for obesity in three Finnish pediatric clinics in 2005-2012, blood pressure (BP), metabolic parameters, and the influence of sex, puberty and a change in body mass index standard deviation score (BMI SDS) were analyzed. Results: At baseline, at least one cardiovascular risk factor was present in 474 (80%) cases. Boys presented with more significant changes in cardiometabolic parameters than girls during the treatment. Boys' total cholesterol (TC) improved by 12 months (P = 0.009), and their low-density lipoprotein C (LDL-C) and glycosylated hemoglobin ameliorated by 12 months (P = 0.030 and 0.022, respectively) and 24 months (P = 0.043 and 0.025, respectively). Boys' triglycerides, insulin, homeostasis model assessment for insulin resistance (HOMA-IR) and systolic BP deteriorated at 24 months (P < 0.001, 0.004, 0.002, and 0.037, respectively). In all children, the number of acceptable TC, LDL-C, insulin, and HOMA-IR values increased if BMI SDS reduced 0.25 or more by 12 months. Conclusion: Minor cardiometabolic improvements were found during the obesity treatment. These findings indicate the need to assess treatment methods and focus on prevention.

Effectiveness of a Kindergarten-Based Intervention for Preventing Childhood Obesity

BACKGROUND AND OBJECTIVES

Interventions to prevent childhood obesity targeting school age children have mostly reported limited effectiveness, suggesting such prevention programs may need to start at an earlier age, but evidence has been scarce. We reported a pilot study aiming to demonstrate the feasibility of a multifaceted intervention for preschool children and to provide a preliminary assessment of the effectiveness.

METHODS

This nonrandomized controlled trial recruited children aged 3 to 6 years from 6 kindergartens in Guangzhou, China. Based on the preference of the School and Parents Committees, 4 kindergartens (648 children) received a 3-component intervention (training of kindergarten staff, initiating healthy curriculum for children, and close collaboration between families and kindergartens) over 12 months, while the other 2 kindergartens (336 children), serving as controls, received routine health care provision. Outcome measures were the changes in BMI z score between baseline and the end of 12 months, and the prevalence of postintervention children who were overweight or obese.

RESULTS

By 12 months, children within the intervention group had a smaller BMI z score increase (0.24) compared to the control (0.41), with a difference of -0.31 (95% CI -0.47 to -0.15). The prevalence of overweight or obesity was also lower among the intervention group at the end of the study (OR: 0.43, 95% CI 0.19 to 0.96), adjusted for baseline status.

CONCLUSIONS

Our results indicated a multicomponent health behavior intervention might be effective in reducing the prevalence of obesity, but the longer term effects will need confirmation from randomized controlled trials.

Efficacy of a Community- Versus Primary Care-Centered Program for Childhood Obesity: TX CORD RCT

OBJECTIVE

This randomized controlled trial was conducted to determine comparative efficacy of a 12-month community-centered weight management program (MEND2-5 for ages 2-5 or MEND/CATCH6-12 for ages 6-12) against a primary care-centered program (Next Steps) in low-income children.

METHODS

Five hundred forty-nine Hispanic and black children (BMI ≥ 85th percentile), stratified by age groups (2-5, 6-8, and 9-12 years), were randomly assigned to MEND2-5 (27 contact hours)/MEND/CATCH6-12 (121.5 contact hours) or Next Steps (8 contact hours). Primary (BMI value at the 95th percentile [%BMI_p95 ]) and secondary outcomes were measured at baseline, 3 months (Intensive Phase), and 12 months (Transition Phase).

RESULTS

For age group 6-8, MEND/CATCH6-12 resulted in greater improvement in %BMI_p95 than Next Steps during the Intensive Phase. Effect size (95% CI) was -1.94 (-3.88, -0.01) percentage points (P = 0.05). For age group 9-12, effect size was -1.38 (-2.87, 0.16) percentage points for %BMI_p95 (P = 0.07). MEND2-5 did not differentially affect %BMI_p95 . Attendance averaged 52% and 22% during the Intensive and Transition Phases. Intervention compliance was inversely correlated to change in %BMI_p95 during the Intensive Phase (P < 0.05). In the Transition Phase, %BMI_p95 was maintained or rebounded in both programs (P < 0.05).

CONCLUSIONS

MEND/CATCH6-12 was more efficacious for BMI reduction at 3 months but not 12 months compared to Next Steps in underserved children. Intervention compliance influenced outcomes, emphasizing the need for research in sustaining family engagement in low-income populations.

Effectiveness of Nutrition Intervention in a Selected Group of Overweight and Obese African-American Preschoolers

High prevalence of childhood obesity persists as a public health concern in the USA. However, limited study has been conducted on the effectiveness of nutrition education focused on African-American (AA) preschoolers (PSLRs) in the preschool settings. The aim of this pilot study was to explore the effectiveness of nutrition education on AA PSLR's health. A convenience sample of 164 PSLRs (95% AA, 44% female) from six Head Start (HS) centers in a Midwestern metropolitan area was randomly assigned to 3 groups: intervention group A, standard curriculum plus nutrition education for PSLRs; intervention group B, standard curriculum plus nutrition education for PSLRs and their caregivers (CGs); and control group, standard curriculum. Baseline and post-intervention differences within each group and differences among the three groups in body mass index (BMI) percentiles, blood lipid profile, and food preference/knowledge were analyzed. No significant changes in BMI percentiles among the three groups were observed. When only overweight and obese PSLRs were considered, there was a significant reduction in BMI percentile in group B (PSLR + CG) and control group. More PSLRs in all three groups had blood lipid levels in the acceptable with few in the high-risk levels. There were no changes in nutrition knowledge and healthy eating behavior post-intervention. This pilot study supports including both PSLRs and CGs in future preschool-based interventions and the need for more intense intervention to optimize healthy outcomes, especially for those AA PSLRs who are overweight or obese.

Lifestyle Interventions in Preschool Children: A Meta-analysis of Effectiveness

CONTEXT

With healthy behaviors becoming established in the preschool years, intervening with preschool children to assist them in establishing a healthy lifestyle and maintaining a long-term healthy weight is critical. To optimize future intervention designs, this meta-analysis aimed to estimate the effects of lifestyle interventions on BMI among preschool children and explore potential intervention moderators.

EVIDENCE ACQUISITION

In October 2015, a search of PubMed, CINAHL, EMBASE, PsycINFO, ERIC, and Cochrane library databases yielded 52 eligible articles with 42 randomized intervention-control comparisons (31 prevention and 11 treatment). In 2016, weighted standardized mean differences for BMI were calculated using random-effects models to estimate effect sizes.

EVIDENCE SYNTHESIS

The effect sizes were -0.19 (95% CI=-0.28, -0.09) and -0.28 (95% CI=-0.48, -0.09) kg/m² for prevention and treatment interventions, with sustained effect sizes of -0.21 (95% CI=-0.35, -0.08) and -0.23 (95% CI=-0.43, -0.04) kg/m², respectively. Child mean age, percentage Hispanic, and parental intervention sessions were common significant moderators. School-based or prevention interventions with active parental involvement did not yield better outcomes. Interventions targeting parents with parenting skill training and behavioral change strategies, and children with general health and nutrition education, resulted in greater effects.

CONCLUSIONS

Although publication bias limits the validity of the study findings, the meta-analysis results highlight the promising intervention approaches of parenting skill training and behavioral change strategies to target parents. However, for children, general health and nutrition education should be employed.

Treatment of Pediatric Obesity: An Umbrella Systematic Review

OBJECTIVE

Multiple interventions are available to reduce excess body weight in children. We appraised the quality of evidence supporting each intervention and assessed the effectiveness on different obesity-related outcomes.

METHODS

We conducted a systematic search for systematic reviews of randomized controlled trials evaluating pediatric obesity interventions applied for ≥6 months. We assessed the quality of evidence for each intervention using GRADE (Grading of Recommendation, Assessment, Development, and Evaluation) approach.

RESULTS

From 16 systematic reviews, we identified 133 eligible randomized controlled trials. Physical activity interventions reduced systolic blood pressure and fasting glucose (low to moderate quality of evidence). Dietary interventions with low-carbohydrate diets had a similar effect to low-fat diets in terms of body mass index (BMI) reduction (moderate quality of evidence). Educational interventions reduced waist circumference, BMI, and diastolic blood pressure (low quality of evidence). Pharmacological interventions reduced BMI (metformin, sibutramine, orlistat) and waist circumference (sibutramine, orlistat) and increased high-density lipoprotein cholesterol (sibutramine) but also raised systolic and diastolic blood pressure (sibutramine). Surgical interventions (laparoscopic adjustable gastric banding, Roux-en-Y gastric bypass, sleeve gastrectomy) resulted in the largest BMI reduction (moderate quality of evidence). Combined interventions consisting of dietary modification, physical activity, behavioral therapy, and education significantly reduced systolic and diastolic blood pressure, BMI, and triglycerides. Combined parent-child interventions and parent-only interventions had similar effects on BMI (low quality of evidence).

CONCLUSIONS

Several childhood obesity interventions are effective in improving metabolic and anthropometric measures. A comprehensive multicomponent intervention, however, appears to have the best overall outcomes.

Brief Primary Care Obesity Interventions: A Meta-analysis

CONTEXT

Although practice guidelines suggest that primary care providers working with children and adolescents incorporate BMI surveillance and counseling into routine practice, the evidence base for this practice is unclear.

OBJECTIVE

To determine the effect of brief, primary care interventions for pediatric weight management on BMI.

DATA SOURCES

Medline, CENTRAL, Embase, PsycInfo, and CINAHL were searched for relevant publications from January 1976 to March 2016 and cross-referenced with published studies.

STUDY SELECTION

Eligible studies were randomized controlled trials and quasi-experimental studies that compared the effect of office-based primary care weight management interventions to any control intervention on percent BMI or BMI z scores in children aged 2 to 18 years.

DATA EXTRACTION

Two reviewers independently screened sources, extracted data on participant, intervention, and study characteristics, z-BMI/percent BMI, harms, and study quality using the Cochrane and Newcastle-Ottawa risk of bias tools.

RESULTS

A random effects model was used to pool the effect size across eligible 10 randomized controlled trials and 2 quasi-experimental studies. Compared with usual care or control treatment, brief interventions feasible for primary care were associated with a significant but small reduction in BMI z score (-0.04, [95% confidence interval, -0.08 to -0.01]; P = .02) and a nonsignificant effect on body satisfaction (standardized mean difference 0.00, [95% confidence interval, -0.21 to 0.22]; P = .98).

LIMITATIONS

Studies had methodological limitations, follow-up was brief, and adverse effects were not commonly measured.

CONCLUSIONS

BMI surveillance and counseling has a marginal effect on BMI, highlighting the need for revised practice guidelines and the development of novel approaches for providers to address this problem.

The Role of Active Video-Accompanied Exercises in Improvement of the Obese State in Children: A Prospective Study from Turkey

OBJECTIVE

The aim of this study was to determine the effects of active video games and music-accompanied aerobic and callisthenic exercises on body mass index (BMI), body fat ratio, physical performance tests, psychosocial status, and self-respect in overweight and obese adolescents.

METHODS

Fifty (21 males and 29 females) slightly overweight and obese participants with no chronic disorder and of an average age of 12.16±0.99 years were included in the study. The percentile values for BMI, triceps skinfold thickness, waist circumference measurements, and physical performance tests were evaluated. The effects of obesity on psychological wellness were evaluated using the depression scale for children (DSC) and the Piers-Harris Children's Self-Concept Scale for self-esteem. Following these evaluations, the participants were subjected to an exercise program in five groups of 10 people, 3 days a week for a duration of 8 weeks. Each exercise session lasted 45 minutes. Participants were re-evaluated at the end of the exercise program. The data collected both before and after the exercise program were analyzed using the SPSS 18.0 program.

RESULTS

According to BMI reference values, 28% of the 50 participants (n=14; 6 males and 8 females) were assessed to be overweight and 72% to be obese (n=36; 15 males and 21 females). Following the exercise program, 14% of the participants (n=7; 3 males and 4 females) were assessed as normal, 46% (n=23; 14 males and 9 female) as slightly overweight, and 40% (n=20; 4 male and 16 female) as obese. It was determined that the decrease in BMI values (p<0.05) was higher in male participants than in female participants and that the frequency of obesity was higher in the females. A statistically significant decrease in BMI values was found after the exercise program (p<0.01). Following the exercise program, statistically significant differences have also been observed in the self-esteem (p<0.01), psychological wellness (p=0.025), triceps skinfold thickness, as well as in waist circumference and BMI values of the participants compared to the pre-exercise phase (p<0.01).

CONCLUSION

An exercise program applied with active video games was found to have positive effects on the obese state as well as on the psychosocial status and self-esteem of obese individuals, indicating that exercise and physical activity have an important role in improvement of the obese state in childhood as well as having positive contributions to self-esteem and psychological wellness state.

A Multi-Component Day-Camp Weight-Loss Program Is Effective in Reducing BMI in Children after One Year: A Randomized Controlled Trial

The objective of the present study was to evaluate the effectiveness of a one-year multi-component immersive day-camp weight-loss intervention for children with overweight and obesity. The study design was a parallel-group randomized controlled trial. One hundred fifteen 11-13-year-old children with overweight and obesity were randomized into either: A six-week day-camp intervention arm focusing on increased physical activity, and healthy diet followed by a subsequent one-year family-based intervention, or a standard intervention arm consisting of one weekly exercise session for six weeks. Body mass index (BMI) was the primary outcome. BMI z-score, clustered cardiovascular risk z-score, and body composition were secondary outcomes. All outcomes were measured at baseline, six week-, and 52 week follow-up. After six weeks, children from the day-camp intervention arm had improved their BMI (-2.2 kg/m² (95% CI -2.6 to -1.7, P<0.001)) and all secondary outcomes when compared to the children from the standard intervention arm. After 52 weeks, the day-camp intervention arm had a lower BMI (-1.2 kg/m² (95% CI -1.8 to -0.5, P = 0.001)), and BMI z-score (-0.20 (95% CI -0.35 to -0.05, P = 0.008)), and clustered cardiovascular risk z-score (-0.23 (95% CI -0.37 to -0.08, P = 0.002)) compared to the standard intervention arm. No group differences were detected in body composition after 52 weeks. This study shows that the day-camp intervention arm is effective in reducing BMI and improving the metabolic health of children with overweight and obesity. However, the effects seem to be diminishing over time.

Differential outcome of the IDEFICS intervention in overweight versus non-overweight children: did we achieve 'primary' or 'secondary' prevention?

BACKGROUND

The aim of this study was to explore whether the IDEFICS intervention had a differential effect on 11,041 children's weight trajectories depending on their baseline body mass index status.

METHODS

Two subgroups of children are considered in the present analysis: those who were overweight or obese prior to the intervention and those who were neither overweight nor obese.

RESULTS

Among children in all eight countries who did not have prevalent overweight or obesity (OWOB) at baseline, 2 years later, there was no significant difference between intervention and control groups in risk of having developed OWOB. However, we observed a strong regional heterogeneity, which could be attributed to the presence of one distinctly outlying country, Belgium, where the intervention group had increased risk for becoming overweight. In contrast, among the sample of children with prevalent OWOB at baseline, we observed a significantly greater probability of normalized weight status after 2 years. In other words, a protective effect against persistent OWOB was observed in children in intervention regions compared with controls, which corresponded to an adjusted odds ratio of 0.76 (95% confidence interval: 0.58, 0.98).

DISCUSSION

This analysis thus provided evidence of a differential effect of the IDEFICS intervention, in which children with overweight may have benefited without having been specifically targeted. However, no overall primary preventive effect could be observed in children without initial overweight or obesity.

Exercise intervention and cardiovascular risk factors in obese children. Comparison between obese youngsters taking part in a physical activity school-based programme with and without individualised diet counselling: the ACORDA project

AIM

To determine the effects of a school-based exercise intervention programme on cardiovascular risk factors, including body fat (BF), metabolic profile and physical activity (PA) in children with and without individualised dietary counselling approach (IDC and WIDC).

SUBJECTS AND METHODS

Forty-six overweight children from 6-16 years old (25 girls, 54.3%; age = 10.3 ± 2.8) of six schools took part in an 8-month interdisciplinary, school-based intervention programme. All children were engaged in PA classes, but only one group was exposed to individualised counselling. Blood pressure (BP), lipids and lipoproteins, accelerometer-based PA, percentage of body fat (%BF) and trunk fat (%TF) measures were taken before and after intervention. General Linear Model (Repeated Measures ANOVA) adjusted for age, maturation and height change was used to analyse the longitudinal effect of individualised counselling between two evaluations in each group.

RESULTS

Favourable changes were observed for %BF, %TF, systolic BP and total cholesterol in the IDC group. Subjects WIDC only increased light and moderate-vigorous PA. In IDC, significant effects for time * group interactions were found for systolic BP, total cholesterol and LDL-cholesterol, indicating that counselling might add favourable changes in these markers, beyond those explained by PA and growth.

CONCLUSION

School-based interventions can contribute to counteracting obesity in youth, particularly when individualised dietary counselling is provided. Therefore, the link between schools and professional counselling should be strengthened to ensure consolidated changes towards healthy behaviours.