Efficacy of a child-centred and family-based program in promoting healthy weight and healthy behaviors in Chinese American children: a randomized controlled study

A Scoping Review of Tailoring in Pediatric Obesity Interventions

Background: Families with children who have or are at risk for obesity have differing needs and a one-size-fits-all approach can negatively impact program retention, engagement, and outcomes. Individually tailored interventions could engage families and children through identifying and prioritizing desired areas of focus. Despite literature defining tailoring as individualized treatment informed by assessment of behaviors, intervention application varies. This review aims to exhibit the use of the term "tailor" in pediatric obesity interventions and propose a uniform definition. Methods: We conducted a scoping review following PRISMA-ScR guidelines among peer-reviewed pediatric obesity prevention and management interventions published between 1995 and 2021. We categorized 69 studies into 6 groups: (1) individually tailored interventions, (2) computer-tailored interventions/tailored health messaging, (3) a protocolized group intervention with a tailored component, (4) only using the term tailor in the title, abstract, introduction, or discussion, e) using the term tailor to describe another term, and (5) interventions described as culturally tailored. Results: The scoping review exhibited a range of uses and lack of explicit definitions of tailoring in pediatric obesity interventions including some that deviate from individualized designs. Effective tailored interventions incorporated validated assessments for behaviors and multilevel determinants, and recipient-informed choice of target behavior(s) and programming. Conclusions: We urge interventionists to use tailoring to describe individualized, assessment-driven interventions and to clearly define how an intervention is tailored. This can elucidate the role of tailoring and its potential for addressing the heterogeneity of behavioral and social determinants for the prevention and management of pediatric obesity.

A systematic review and meta-analysis of the child-level effects of family-based interventions for the prevention of type 2 diabetes mellitus

AIMS

The purpose of this systematic review and meta-analysis was to investigate the effects of family-based health promotion interventions on child-level risk factors for type 2 diabetes in vulnerable families.

METHODS

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist for systematic reviews formed the methodological framework. CINAHL, Embase, MEDLINE, PsycINFO, and Web of Science were searched on January 12, 2024. The NTP-OHAT Risk of Bias Assessment Tool was used to assess the risk of bias in the individual studies, and meta-analyses were performed.

RESULTS

The 4723 studies were identified, and 55 studies met the inclusion criteria. Results showed significant effects on children's body mass index (mean difference [MD], -0.18, 95% CI [-0.33 to -0.03], p = 0.02), body fat percentage (MD, -2.00, 95% CI [-3.31 to -0.69], p = 0.003), daily activity (standardized mean difference [SMD], 0.23, 95% CI [0.01; 0.44], p = 0.04), physical activity self-efficacy (SMD, 0.73, 95% CI [0.36 to 1.10], p < 0.01), intake of snacks (MD, -0.10, 95% CI [-0.17 to -0.04], p = 0.002), and sugar-sweetened beverages (SMD, -0.21, 95% CI [-0.42 to -0.01], p = 0.04). Subgroup analyses suggested that interventions aiming to change child and parent behavior simultaneously have larger effect on fasting glucose and nutrition consumption, and that interventions longer than 26 weeks have larger effects on body composition and physical activity behavior than shorter interventions.

A systematic review of culturally adapted physical activity interventions for culturally and linguistically diverse children and adolescents

OBJECTIVE

Limited evidence shows culturally and linguistically diverse (CALD) children and adolescents are less active, compared to the general population. It is unclear, how physical activity interventions have been adapted for CALD children and adolescents to enhance engagement. This study aimed to review culturally adapted physical activity interventions targeting CALD children and adolescents.

METHODS

All studies recruited children and adolescents (i.e., aged ≥5 to <18 years old) from CALD backgrounds, targeted physical activity, and included cultural adaptations. Cultural adaptations were defined as surface structures (i.e., observable characteristics of a targeted population) or deep structures (i.e., rooted in core ethnic values derived from individual cultures.

RESULTS

Twenty studies were included. Ten studies used a combination of surface and deep structure adaptations. Of these 10 studies, 3 found a significant between-group difference in physical activity favouring the intervention group. Among studies (n = 6) that used surface structure adaptations (e.g., language adjustments to information sheets, consent forms, and resources), 1 found a significant intervention effect on physical activity. With studies (n = 4) that used deep structure adaptations (e.g., incorporating traditional songs and dances relevant to cultural groups), 1 study found a significant intervention effect on physical activity.

CONCLUSION

A small number of studies found significant changes to increase physical activity levels. We found there is a lack of consistent evidence indicating that incorporating surface and/or deep structure adaptations result in significant changes in physical activity. Future research should focus on establishing higher quality methodology when developing culturally adapted interventions for CALD populations.

Interventions to prevent obesity in children aged 5 to 11 years old

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.

Family-based pediatric weight management interventions in US primary care settings targeting children ages 6-12 years old: A systematic review guided by the RE-AIM framework

Obesity is a pandemic that disproportionately affects children from vulnerable populations in the USA. Current treatment approaches in primary care settings in the USA have been reported to be insufficient at managing pediatric obesity, primarily due to implementation challenges for healthcare systems and barriers for families. While the literature has examined the efficacy of pediatric obesity interventions focused on internal validity, it lacks sufficient reporting and analysis of external validity necessary for successful translation to primary care settings. We conducted a systematic review of the primary-care-setting literature from January 2007 to March 2020 on family-based pediatric weight management interventions in both English and/or Spanish for children ages 6-12 years in the USA using the Reach, Efficacy/Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework. A literature search, using PRISMA guidelines, was conducted in January 2022 using the following electronic databases: Medline Ovid, Embase, and Cochrane Library. 22 270 records were screened, and 376 articles were reviewed in full. 184 studies were included. The most commonly reported dimensions of the RE-AIM framework were Reach (65%), Efficacy/Effectiveness (64%), and Adoption (64%), while Implementation (47%) and Maintenance (42%) were less often reported. The prevalence of reporting RE-AIM construct indicators ranged greatly, from 1% to 100%. This systematic review underscores the need for more focus on external validity to guide the development, implementation, and dissemination of future pediatric obesity interventions based in primary care settings. It also suggests conducting additional research on sustainable financing for pediatric obesity interventions.

The effect of experiential learning interventions on physical activity outcomes in children: A systematic review

BACKGROUND

This systematic review examined the effectiveness of experiential learning interventions for improving children's physical activity knowledge, attitudes, and behaviours. It also aimed to identify intervention characteristics that resulted in the greatest impact.

METHODS

Four databases: Education Research Complete, Scopus, Web of Science and PsychINFO were searched from database inception to January 2023. Eligible studies: (1) included children 0-12 years; (2) assessed the effect of physical activity outcomes on children's physical activity knowledge, attitudes or behaviour and (3) were randomised controlled trials conducted in any setting. Study risk of bias was assessed by two independent reviewers using the Cochrane risk of bias tool. Intervention approaches were categorised, and effect sizes were compared across studies for each outcome.

RESULTS

Twelve studies were included in the review: ten in school age and two in below five years. For behavioural outcomes, six of eight studies showed medium to large effects (effects size (ES) range: 0.3-0.9), two of the three studies that assessed attitudinal outcomes displayed medium effects (ES range: 0.4-0.5) and both studies that assessed knowledge outcomes displayed medium to large effects (ES range: 0.4-1.3). The two experiential learning interventions among children < 5 years demonstrated small to medium effects on behaviour change (ES range: 0.2-0.5). Effective interventions combined enjoyable practical activities (fitness activities, games and challenges), with behaviour change techniques (goal setting, and self-monitoring), were underpinned by a behaviour change theory, and were often of short duration (< 4 months) but intense (several sessions/week). Moderate to high statistical heterogeneity was observed for behaviour outcomes and risk of bias across studies was generally high.

CONCLUSIONS

This review provides some evidence supporting the effectiveness of experiential learning interventions in improving physical activity outcomes in school-aged children. Additional evidence is needed in children <5 years old. Future experiential learning interventions need to strengthen the evidence with rigorous methodological quality and clear reporting of the experiential learning components.

Effectiveness of Lifestyle Nutrition and Physical Activity Interventions for Childhood Obesity and Associated Comorbidities among Children from Minority Ethnic Groups: A Systematic Review and Meta-Analysis

Lifestyle physical activity (PA) and nutrition are known to be effective interventions in preventing and managing obesity-related comorbidities among adult populations but less so among children and adolescents. We examined the effectiveness of lifestyle interventions in children from minority ethnic populations in Western high-income countries (HICs). Our systematic review included 53 studies, involving 26,045 children from minority ethnic populations who followed lifestyle intervention programmes lasting between 8 weeks and 5 years with the aim of preventing and/or managing childhood obesity and associated comorbidities, including adiposity and cardiometabolic risks. The studies were heterogenous in terms of lifestyle intervention components (nutrition, PA, behavioural counselling) and settings (community vs. schools and after-school settings). Our meta-analysis included 31 eligible studies and showed no significant effects of lifestyle interventions when they focused on body mass index (BMI) outcomes (pooled BMI mean change = -0.09 (95% CI = -0.19, 0.01); p = 0.09). This was irrespective of the intervention programme duration (<6 months vs. ≥6 months), type (PA vs. nutrition/combined intervention) and weight status (overweight or obese vs. normal weight) as all showed nonsignificant effects in the sensitivity analysis. Nonetheless, 19 of the 53 studies reported reductions in BMI, BMI z-score and body fat percentage. However, the majority of lifestyle interventions adopting a quasi-design with combined primary and secondary obesity measures (11 out of 15 studies) were effective in reducing the obesity comorbidities of cardiometabolic risks, including metabolic syndrome, insulin sensitivity and blood pressure, in overweight and obese children. Preventing childhood obesity in high-risk ethnic minority groups is best achieved using combined PA and nutrition intervention approaches, which jointly target preventing obesity and its comorbidities, especially the outcomes of diabetes, hypertension and cardiovascular disease. Therefore, public health stakeholders should integrate cultural and lifestyle factors and contextualise obesity prevention strategies among minority ethnic groups in Western HICs.

The Healthy Kids & Families study: Outcomes of a 24-month childhood obesity prevention intervention

Socioeconomically disadvantaged children experience a high burden of obesity but few interventions address obesity prevention in this population subgroup. The Healthy Kids & Families study tested the effect of a parent-focused community health worker (CHW)-delivered lifestyle intervention to prevent childhood obesity. Participants were child-parent/guardian (Kindergarten to 6th grade at baseline) dyads (n = 247) recruited through schools located in socioeconomically disadvantaged neighborhoods in Worcester, MA, USA. Using a quasi-experimental design, the study tested the impact of Healthy Kids & Families, a theory-based, low-intensity, parent-focused, CHW-delivered intervention to improve children's weight, healthy eating and physical activity. The attention-control comparison condition was a positive parenting intervention. The primary outcome was change in child body mass index (BMI) z-score at 24 months. Secondary outcomes included number of positive child and parent changes in selected diet and physical activity behaviors targeted by the intervention and change in parent BMI. Outcomes were assessed following the intent-to-treat principle and using multivariable generalized linear mixed models. Compared to the attention-control comparison condition, the Healthy Kids & Families intervention led to a greater reduction in children's BMI z-score (β = -0.17, 95 %CI: -1.92 to -0.36; p = 0.057) and a greater number of positive behavior changes among children (β = 0.57, 95 %CI: 0.08-1.06; p = 0.02) at 24 months. There was no significant change in parent outcomes. The Healthy Kids & Families intervention shows promise for obesity prevention among children in socioeconomically disadvantaged communities.

Interventions to prevent obesity in school-aged children 6-18 years: An update of a Cochrane systematic review and meta-analysis including studies from 2015-2021

BACKGROUND

Childhood obesity remains a global public health priority due to the enormous burden it generates. Recent surveillance data suggests there has been a sharp increase in the prevalence of childhood obesity during the COVID-19 pandemic. The Cochrane review of childhood obesity prevention interventions (0-18 years) updated to 2015 is the most rigorous and comprehensive review of randomised controlled trials (RCTs) on this topic. A burgeoning number of high quality studies have been published since that are yet to be synthesised.

METHODS

An update of the Cochrane systematic review was conducted to include RCT studies in school-aged children (6-18 years) published to 30 June 2021 that assessed effectiveness on child weight (PROSPERO registration: CRD42020218928). Available cost-effectiveness and adverse effect data were extracted. Intervention effects on body mass index (BMI) were synthesised in random effects meta-analyses by setting (school, after-school program, community, home), and meta-regression examined the association of study characteristics with intervention effect.

FINDINGS

Meta-analysis of 140 of 195 included studies (183,063 participants) found a very small positive effect on body mass index for school-based studies (SMD -0·03, 95%CI -0·06,-0·01; trials = 93; participants = 131,443; moderate certainty evidence) but not after-school programs, community or home-based studies. Subgroup analysis by age (6-12 years; 13-18 years) found no differential effects in any setting. Meta-regression found no associations between study characteristics (including setting, income level) and intervention effect. Ten of 53 studies assessing adverse effects reported presence of an adverse event. Insufficient data was available to draw conclusions on cost-effectiveness.

INTERPRETATION

This updated synthesis of obesity prevention interventions for children aged 6-18 years, found a small beneficial impact on child BMI for school-based obesity prevention interventions. A more comprehensive assessment of interventions is required to identify mechanisms of effective interventions to inform future obesity prevention public health policy, which may be particularly salient in for COVID-19 recovery planning.

FUNDING

This research was funded by the National Health and Medical Research Council (NHMRC), Australia (Application No APP1153479).

A mobile health intervention to encourage physical activity in children: a randomised controlled trial

Background

Despite immense benefits of physical activity on health and developmental outcomes, few children achieve recommended daily levels of physical activity. Given more than half of families with children own a dog, we investigated the effect of a mobile health (mHealth) intervention to encourage dog-facilitated physical activity through increased family dog walking and children’s active play with their dog.

Methods

The PLAYCE PAWS study was a three-armed randomised pilot trial conducted in Perth, Western Australia. Children aged 5-10 years with a family dog were randomised to 4 weeks of either 1) SMS-only intervention, 2) ‘SMS + pedometer’ intervention or 3) ‘usual care’ control. The mHealth intervention involved SMS messages to parents; the ‘SMS + pedometer’ group also received a dog pedometer and personalised dog steps diary. Parent-reported measures were collected at baseline, 1- and 3-months post intervention. The primary outcome was weekly frequency of family dog walking and dog play; secondary outcomes were child attachment to the dog and feasibility of the intervention.

Results

A total of 150 children were randomised in staggered blocks to SMS-only (n = 50), ‘SMS + pedometer’ (n = 50) or usual care (n = 50). No differences were observed in family dog walking and dog play at 1-month. SMS-only children (OR 2.6, 95% CI 1.17, 5.83, P = 0.019) and all intervention children (OR 1.97, 95% CI 1.01, 3.86, P = 0.048) were more likely to increase total dog-facilitated physical activity (sum of family dog walking and dog play responses) at 3-months. The positive associations with total dog-facilitated physical activity disappeared (all P > 0.05) after adjusting for socio-demographic factors.

Conclusions

The PLAYCE PAWS mHealth intervention did not significantly affect dog-facilitated physical activity in children. Given high levels of dog ownership in the community, SMS prompts could be a low-cost intervention to encourage more physical activity in children. Further research is needed to understand how increased interaction with the family dog impacts on children’s overall physical activity and other health and development outcomes.

Trial registration

ANZCTR, ACTRN12620000288921, retrospectively registered on 4/3/2020.

Empowerment Approaches in Childhood Weight Management: A Systematic Review

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.

Effectiveness of lifestyle interventions for treatment of overweight/obesity among children in China: A systematic review and meta-analysis

BACKGROUND

Pediatric obesity has become a global public health problem. China has the largest population of obese children in the world. It is important to develop effective interventions to control child obesity. This systematic review summarizes proof from randomized controlled trials to assess the efficacy of lifestyle intervention to reduce BMI and metabolic risk factors for overweight/obese Chinese children.

METHODS

We searched studies from five databases (PubMed, MEDLINE, EMBASE, Cochrane Database of Systematic Reviews, and CNKI). Research that meets the following requirements was included: randomized controlled trials, participants are overweight/obese Chinese children aged <18 years old, and the effectiveness of lifestyle interventions is evaluated.

RESULTS

Eight randomized controlled trials were included. A significant difference was found between the intervention group and the control group for the BMI changes (mean difference = -1.49; 95% CI: -2.20 to -0.77; p < 0.001). Subgroup analyses consistently demonstrated that effects of lifestyle interventions on BMI change including multiple-component interventions (mean difference = -2.03 kg/m²; 95% CI: -3.62 to -0.43; p < 0.001) were stronger than those only with physical activities or health education; effects of lifestyle interventions on BMI change were also strengthened if duration of intervention last for more than 1 year (mean difference = -3.03 kg/m²; 95% CI: -4.00 to -2.06; p = 0.01) or with age during 12-18 years old (mean difference = -1.90 kg/m²; 95% CI: -3.37 to -0.43; p < 0.001).

CONCLUSIONS

Lifestyle interventions are effective in reducing BMI in Chinese children with overweight/obesity, and the effectiveness is more profound when the lifestyle intervention includes multiple components, lasts longer than one year, and/or is conducted among teens. These findings provide an important evidence base for developing and implementing potentially effective lifestyle interventions for the treatment of overweight/obesity among Chinese children.

Autoeficácia alimentar em crianças e adolescentes com sobrepeso ou obesidade: revisão integrativa de instrumentos

RESUMO Objetivo: Descrever as características dos instrumentos para avaliação da autoeficácia alimentar no sobrepeso e na obesidade em crianças e adolescentes. Métodos: Revisão integrativa da literatura, realizada em maio de 2020, em seis bases de dados (PubMed; Web of Science; Scopus; CINAHL, ADOLEC e PsycINFO) com a seguinte estratégia de busca: self-efficacy and (Overweight OR Obesity) and (Child* OR Adolescent). Resultados: Incluíram-se 35 artigos e 21 instrumentos aplicados às crianças de 6 a 9 anos (n=2), em adolescentes de 10 a 19 anos (n=9) e em crianças e adolescentes de 7 a 18 anos (n=10). Os instrumentos têm de 4 a 30 itens e variaram de duas a cinco dimensões, sendo as mais frequentes “alimentação saudável” e “atividade física”. Conclusão: Existem diferentes instrumentos confiáveis destinados à avaliação da autoeficácia alimentar do público adolescente e infantil, o que sinaliza a importância desse construto para prevenção e controle da obesidade e sobrepeso.

Eating self- efficacy in overweight and obese children and adolescents: integrative review of instruments

ABSTRACT Objective: To describe the characteristics of instruments to assess eating self-efficacy in overweight and obesity in children and adolescents. Methods: Integrative literature review, conducted in May 2020, in six databases (PubMed; Web of Science; Scopus; CINAHL, ADOLEC, and PsycINFO) with the following search strategy: Self-efficacy and (Overweight OR Obesity) and (Child* OR Adolescent). Results: The inclusion of thirty-five articles and twenty-one instruments was applied to children 6 to 9 years old (n=2), adolescents 10 to 19 years old (n=9), and children and adolescents 7 to 18 years old (n=10). The instruments have 4 to 30 items and vary from two to five dimensions, the most frequent being “healthy eating” and “physical activity.” Conclusion: There are different reliable instruments designed to assess eating self-efficacy in adolescents and children, indicating the importance of this construct for preventing and controlling obesity and overweight.

Experiential Learning Interventions and Healthy Eating Outcomes in Children: A Systematic Literature Review

Experiential learning is the process where learners create meaning from direct experience. This systematic review aimed to examine the effects of experiential learning activities on dietary outcomes (knowledge, attitudes, behaviors) in children. Four databases: Education Research Complete, Scopus, Web of Science and PsychINFO were searched from database inception to 2020. Eligible studies included children 0-12 years, assessed effect of experiential learning on outcomes of interest compared to non-experiential learning and were open to any setting. The quality of studies was assessed using the revised Cochrane risk of bias tool by two independent reviewers and effect size was calculated on each outcome. Nineteen studies were conducted in primary school, six in pre-school and one in an outside-of-school setting and used nine types of experiential learning strategies. Cooking, taste-testing, games, role-playing, and gardening were effective in improving nutrition outcomes in primary school children. Sensory evaluation, games, creative arts, and storybooks were effective for preschool children. Multiple strategies involving parents, and short/intense strategies are useful for intervention success. Experiential learning is a useful strategy to improve children's knowledge, attitudes, and behaviors towards healthy eating. Fewer studies in pre-school and outside of school settings and high risk of bias may limit the generalizability and strength of the findings.

HPV vaccination, information sources, and acculturation among Chinese college students aged 18-26 in the United States

Human papillomavirus (HPV) vaccination behaviors among Chinese college students (CCS) in the United States are affected by social determinants of health. Using a self-report questionnaire and a snowball sampling technique, this cross-sectional study investigated (a) HPV vaccination practices; (b) primary social networking platforms and preferred means of receiving HPV information; and (c) the influence of acculturation on HPV vaccination, HPV information sources, and social networking use among 213 CCS aged 18-26 in the United States. About half (50.7%) had received one to three doses of an HPV vaccine, and 91.7% had received their first dose. The most popular social networking platforms were WeChat (69.5%), Instagram (58.7%), text messaging (55.4%), and Facebook (47.4%). Preferred means of receiving future HPV information included the internet, online social networking, and health professionals. Participants with high Asian identification (AI) were less likely to receive the HPV vaccine than those with high Western identification. Participants with high AI were more likely to use WeChat for their social networking but less likely to use US-based social media platforms. Acculturation, preferred social networking platforms, and sources and communication of HPV (i.e., health professionals, family members, schoolteachers, friends) influenced participants' HPV vaccination. To promote equity of access to health messages and increase HPV vaccination, future efforts should pay attention to CCS with high AI and incorporate their cultural beliefs and practices. Given that nonprofessionals (e.g., family, friends) were influential factors in HPV vaccination, it is critical to tailor interventions for CCS to the recipients and their social circles.

Supporting and Engaging Families: An Examination of Publicly-Funded Health Promotion Programs in the Intermountain West, USA

Public health programming efforts have traditionally focused on either an individualistic or population approach, neglecting the family as a setting for or partner in health promotion efforts. Due to the multi-faceted influence of families on individual health, family-focused, and family-friendly public health interventions are important to making lasting changes for individual and community health. The purpose of this study was to examine the degree to which health promotion programs in a state in the US Intermountain West involve and support families across four family impact principles: family engagement, family stability, family responsibility, and family diversity. A survey was completed by 67 health promotion administrators and practitioners from 12 out of 13 county health departments with additional responses from public health practitioners at the State Health Department. The results of the survey indicated that health promotion efforts were best at supporting family responsibility and a diverse group of families but were weaker in family engagement and family stability. Applying a more family-centered and family-focused approach to health promotion efforts can be achieved by employing interdisciplinary efforts and by taking advantage of tools like the Public Health Family Impact Checklist to intentionally engage and support families in programs and interventions.

Cultural adaptation of an existing children's weight management programme: the CHANGE intervention and feasibility RCT

BACKGROUND

Excess weight in children is a continuing health issue. Community-based children's weight management programmes have had some effect in promoting weight loss. Families from minority ethnic communities are less likely to complete these programmes but, to date, no programmes have been culturally adapted to address this.

OBJECTIVES

We aimed to (1) culturally adapt an existing weight management programme for children aged 4-11 years and their families to make it more suited to Pakistani and Bangladeshi communities but inclusive of all families and (2) evaluate the adapted programme to assess its feasibility and acceptability, as well as the feasibility of methods, for a future full-scale trial.

DESIGN

In phase I, a cultural adaptation of a programme that was informed by formative research and guided by two theoretical frameworks was undertaken and in phase II this adapted programme was delivered in a cluster-randomised feasibility study (for which the clusters were the standard and adapted children's weight management programmes).

SETTING

Birmingham: a large, ethnically diverse UK city.

PARTICIPANTS

In phase I, Pakistani and Bangladeshi parents of children with excess weight, and, in phase II, children aged 4-11 years who have excess weight and their families.

INTERVENTIONS

A culturally adapted children's weight management programme, comprising six sessions, which was delivered to children and parents, targeting diet and physical activity and incorporating behaviour change techniques, was developed in phase I and delivered in the intervention arm to 16 groups in phase II. The eight groups in the comparator arm received the standard (unadapted) children's weight management programme.

MAIN OUTCOME MEASURES

The primary outcome was the proportion of Pakistani and Bangladeshi families completing (attending ≥ 60% of) the adapted programme. Secondary outcomes included the proportion of all families completing the adapted programme, the feasibility of delivery of the programme, the programme's acceptability to participants, the feasibility of trial processes and the feasibility of collection of outcome and cost data.

RESULTS

The proportion of Pakistani and Bangladeshi families and all families completing the adapted programme was 78.8% [95% confidence interval (CI) 64.8% to 88.2%] and 76.3% (95% CI 67.0% to 83.6%), respectively. The programme was feasible to deliver with some refinements and was well received. Ninety-two families participated in outcome data collection. Data collection was mostly feasible, but participant burden was high. Data collection on the cost of programme delivery was feasible, but costs to families were more challenging to capture. There was high attrition over the 6-month follow-up period (35%) and differential attrition in the two study arms (29% and 52% in the intervention and comparator arms, respectively).

LIMITATIONS

The study was not designed to address the issue of low participant uptake of children's weight management programmes. The design of a future trial may include individual randomisation and a 'minimal intervention' arm, the acceptability of which has not been evaluated in this study.

CONCLUSIONS

The theoretically informed, culturally adapted children's weight management programme was highly acceptable to children and families of all ethnicities. Consideration should be given to a future trial to evaluate clinical effectiveness and cost-effectiveness of the adapted programme, but the design of a future trial would need to address the logistics of data collection, participant burden and study attrition.

TRIAL REGISTRATION

Current Controlled Trials ISRCTN81798055.

FUNDING

This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 23, No. 33. See the NIHR Journals Library website for further project information. Kate Jolly is part-funded by the Collaboration for Leadership in Applied Health Research and Care West Midlands.

Perspectives and Impact of a Parent-Child Intervention on Dietary Intake and Physical Activity Behaviours, Parental Motivation, and Parental Body Composition: A Randomized Controlled Trial

Adults and children in Canada are not meeting physical activity guidelines nor consuming sufficient nutrient-rich foods. High engagement in these unhealthy behaviours can lead to obesity and its associated diseases. Parent-child interventions aimed at obesity prevention/treatment have assisted families with making positive changes to their nutrition and physical activity behaviours. Given that the home environment shapes early health behaviours, it is important to target both parents and children when addressing diet and physical activity. One method that has been shown to improve health outcomes is co-active coaching. The current study explored the impact of a three-month co-active coaching and/or health education intervention on the dietary intake and physical activity behaviours of parents with overweight/obesity and their children (ages 2.5-10; of any weight). Body composition (i.e., body mass index [BMI] and waist circumference), changes in parental motivation with respect to physical activity and dietary behaviours, and parental perceptions of program improvements were collected. A concurrent mixed methods study comprised of a randomized controlled trial and a descriptive qualitative design was utilized. Fifty parent-child dyads were recruited and randomly assigned to the control (n = 25) or intervention (n = 25) group. Assessments were completed at baseline, mid-intervention (six weeks), post-intervention (three months), and six-month follow-up. A linear mixed effects model was utilized for quantitative analysis. Inductive content analysis was used to extract themes from parent interviews. No significant results were observed over time for the dependent measures. Parents in both control and intervention groups reported varied program experiences, including developing changes in perspective, increased awareness of habits, and heightened accountability for making positive changes in themselves, and consequently, their families. Parents also shared barriers they faced when implementing changes (e.g., time, weather, stress). Qualitatively, both groups reported benefitting from this program, with the intervention group describing salient benefits from engaging in coaching. This research expands on the utility of coaching as a method for behaviour change, when compared to education only, in parents with overweight/obesity and their children.

Effectiveness of diet and physical activity interventions among Chinese-origin populations living in high income countries: a systematic review

BACKGROUND

This review examines the effectiveness of diet and physical activity interventions to reduce cardiometabolic risk among Chinese immigrants and their descendants living in high income countries. The objective of this review is to provide information to help build future interventions aimed at improving diet and increasing physical activity levels among Chinese immigrants.

METHODS

Outcomes included BMI, weight, waist circumference (WC), waist-hip ratio (WHR), cholesterol (LDL, HDL), systolic and diastolic blood pressure (SBP, DBP), hemoglobin A1c (HgbA1c), fasting blood glucose (FBG), and HOMA-IR. Six databases were systematically searched from database inception to date of search (February 2020). Meta-analyses used random effect models to estimate pooled effects of outcomes with 95% confidence intervals. The outcomes assessed were changes in mean outcomes (post-intervention versus baseline) among the intervention group versus control groups.

RESULTS

Twenty-one articles were included for synthesis, and eight of these were included in the meta-analysis. Among children/adolescents, there were no significant effects of intervention for any of the outcomes having sufficient data for meta-analysis (BMI, WHR, SBP, and DBP). Among adults, the pooled effect including three studies showed significant changes in BMI (effect size = - 1.14 kg/m2; (95% CI: - 2.06, - 0.21), I2 = 31%). There were also significant effects of intervention among adults in terms of changes in SBP and DBP, as the pooled effect across three studies was - 6.08 mmHg (95% CI - 9.42, - 2.73), I2 = 0% and - 3.81 mmHg (95% CI: - 6.34, - 1.28), I2 = 0%, respectively. Among adults there were no other significant effects among the meta-analyses conducted (weight, WC, LDL, HgbA1c, and FBG).

CONCLUSIONS

This review is the first to summarize the effectiveness of diet and physical activity interventions specifically designed for Chinese immigrants living in high income countries. There were clinically meaningful changes in BMI and blood pressure among adults, but evidence was weak for other cardiometabolic outcomes (weight, WC, LDL, HgbA1c, and FBG), and among children, there was no evidence of effect for any cardiometabolic outcomes. Given our mixed findings, more work is needed to support the design of successful interventions, particularly those targeting children and their families.

TRIAL REGISTRATION

The systematic review protocol was registered in PROSPERO on December 17, 2018, the international prospective register of systematic reviews (registration number: CRD42018117842 ).

Sources of self-efficacy for motor learning in children: systematic literature review in clinical trials

Abstract This study aimed to verify the effects of intervention models on the motor activity of children elaborated from the self-efficacy theory. The systematic review of randomized controlled clinical trials with the PRISMA strategy was used. Sixteen studies were descriptively analyzed and revealed that knowledge based on the self-efficacy theory related to motor activity has been more frequently integrated into broad intervention programs in the school environment, collectively applied, stimulating aspects related to children's health and prevention of childhood obesity. Important results were obtained in the development of self-efficacy and motor activity stimulation; however, results are not conclusive regarding the mediation among these variables. Contributions for intervention programs are detailed in this manuscript, allowing the visualization of strategies to build a mastery context, favoring the establishment of an adequate concept of motor self-efficacy in children and the development of self-regulation skills.

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.

Interventions for preventing obesity in children

EDITORIAL NOTE

This Cochrane review is now out of date and should not be used for reference. It has been split into four age groups and updated. Please refer to the 5‐11 and 12‐18 age group Cochrane reviews which were published in May 2024: https://doi.org/10.1002/14651858.CD015328.pub2 https://doi.org/10.1002/14651858.CD015330.pub2 The 2‐4 age group Cochrane review is planned for publication in September 2024.

BACKGROUND

Prevention of childhood obesity is an international public health priority given the significant impact of obesity on acute and chronic diseases, general health, development and well-being. The international evidence base for strategies to prevent obesity is very large and is accumulating rapidly. This is an update of a previous review.

OBJECTIVES

To determine the effectiveness of a range of interventions that include diet or physical activity components, or both, designed to prevent obesity in children.

SEARCH METHODS

We searched CENTRAL, MEDLINE, Embase, PsychINFO and CINAHL in June 2015. We re-ran the search from June 2015 to January 2018 and included a search of trial registers.

SELECTION CRITERIA

Randomised controlled trials (RCTs) of diet or physical activity interventions, or combined diet and physical activity interventions, for preventing overweight or obesity in children (0-17 years) that reported outcomes at a minimum of 12 weeks from baseline.

DATA COLLECTION AND ANALYSIS

Two authors independently extracted data, assessed risk-of-bias and evaluated overall certainty of the evidence using GRADE. We extracted data on adiposity outcomes, sociodemographic characteristics, adverse events, intervention process and costs. We meta-analysed data as guided by the Cochrane Handbook for Systematic Reviews of Interventions and presented separate meta-analyses by age group for child 0 to 5 years, 6 to 12 years, and 13 to 18 years for zBMI and BMI.

MAIN RESULTS

We included 153 RCTs, mostly from the USA or Europe. Thirteen studies were based in upper-middle-income countries (UMIC: Brazil, Ecuador, Lebanon, Mexico, Thailand, Turkey, US-Mexico border), and one was based in a lower middle-income country (LMIC: Egypt). The majority (85) targeted children aged 6 to 12 years.Children aged 0-5 years: There is moderate-certainty evidence from 16 RCTs (n = 6261) that diet combined with physical activity interventions, compared with control, reduced BMI (mean difference (MD) -0.07 kg/m2, 95% confidence interval (CI) -0.14 to -0.01), and had a similar effect (11 RCTs, n = 5536) on zBMI (MD -0.11, 95% CI -0.21 to 0.01). Neither diet (moderate-certainty evidence) nor physical activity interventions alone (high-certainty evidence) compared with control reduced BMI (physical activity alone: MD -0.22 kg/m2, 95% CI -0.44 to 0.01) or zBMI (diet alone: MD -0.14, 95% CI -0.32 to 0.04; physical activity alone: MD 0.01, 95% CI -0.10 to 0.13) in children aged 0-5 years.Children aged 6 to 12 years: There is moderate-certainty evidence from 14 RCTs (n = 16,410) that physical activity interventions, compared with control, reduced BMI (MD -0.10 kg/m2, 95% CI -0.14 to -0.05). However, there is moderate-certainty evidence that they had little or no effect on zBMI (MD -0.02, 95% CI -0.06 to 0.02). There is low-certainty evidence from 20 RCTs (n = 24,043) that diet combined with physical activity interventions, compared with control, reduced zBMI (MD -0.05 kg/m2, 95% CI -0.10 to -0.01). There is high-certainty evidence that diet interventions, compared with control, had little impact on zBMI (MD -0.03, 95% CI -0.06 to 0.01) or BMI (-0.02 kg/m2, 95% CI -0.11 to 0.06).Children aged 13 to 18 years: There is very low-certainty evidence that physical activity interventions, compared with control reduced BMI (MD -1.53 kg/m2, 95% CI -2.67 to -0.39; 4 RCTs; n = 720); and low-certainty evidence for a reduction in zBMI (MD -0.2, 95% CI -0.3 to -0.1; 1 RCT; n = 100). There is low-certainty evidence from eight RCTs (n = 16,583) that diet combined with physical activity interventions, compared with control, had no effect on BMI (MD -0.02 kg/m2, 95% CI -0.10 to 0.05); or zBMI (MD 0.01, 95% CI -0.05 to 0.07; 6 RCTs; n = 16,543). Evidence from two RCTs (low-certainty evidence; n = 294) found no effect of diet interventions on BMI.Direct comparisons of interventions: Two RCTs reported data directly comparing diet with either physical activity or diet combined with physical activity interventions for children aged 6 to 12 years and reported no differences.Heterogeneity was apparent in the results from all three age groups, which could not be entirely explained by setting or duration of the interventions. Where reported, interventions did not appear to result in adverse effects (16 RCTs) or increase health inequalities (gender: 30 RCTs; socioeconomic status: 18 RCTs), although relatively few studies examined these factors.Re-running the searches in January 2018 identified 315 records with potential relevance to this review, which will be synthesised in the next update.

AUTHORS' CONCLUSIONS

Interventions that include diet combined with physical activity interventions can reduce the risk of obesity (zBMI and BMI) in young children aged 0 to 5 years. There is weaker evidence from a single study that dietary interventions may be beneficial.However, interventions that focus only on physical activity do not appear to be effective in children of this age. In contrast, interventions that only focus on physical activity can reduce the risk of obesity (BMI) in children aged 6 to 12 years, and adolescents aged 13 to 18 years. In these age groups, there is no evidence that interventions that only focus on diet are effective, and some evidence that diet combined with physical activity interventions may be effective. Importantly, this updated review also suggests that interventions to prevent childhood obesity do not appear to result in adverse effects or health inequalities.The review will not be updated in its current form. To manage the growth in RCTs of child obesity prevention interventions, in future, this review will be split into three separate reviews based on child age.

Cultural adaptation of a children's weight management programme: Child weigHt mANaGement for Ethnically diverse communities (CHANGE) study

BACKGROUND

Childhood obesity prevalence continues to be at high levels in the United Kingdom (UK). South Asian children (mainly Pakistani and Bangladeshi origin) with excess adiposity are at particular risk from the cardiovascular consequences of obesity. Many community-based children's weight management programmes have been delivered in the UK, but none have been adapted for diverse cultural communities. The aim of the Child weigHt mANaGement for Ethnically diverse communities (CHANGE) study, was to culturally adapt an existing children's weight management programme for children aged 4-11 years so that the programme was more able to meet the needs of families from South Asian communities.

METHODS

The adaptation process was applied to First Steps, an evidence informed programme being delivered in Birmingham (a large, ethnically diverse city). A qualitative study was undertaken to obtain the views of South Asian parents of children with excess weight, who had fully or partially attended, or who had initially agreed but then declined to attend the First Steps programme. The resulting data were integrated with current research evidence and local programme information as part of a cultural adaptation process that was guided by two theoretical frameworks.

RESULTS

Interviews or focus groups with 31 parents in their preferred languages were undertaken. Themes arising from the data included the need for convenient timing of a programme in a close familiar location, support for those who do not speak English, the need to focus on health rather than weight, nutritional content that focuses on traditional and Western diets, more physical activity content, and support with parenting skills. The data were mapped to the Behaviour Change Wheel framework and Typology of Cultural Adaptation to develop an intervention programme outline. The research evidence and local programme information was then used in the detailed planning of the programme sessions.

CONCLUSIONS

The process of cultural adaptation of an existing children's weight management programme resulted in a theoretically underpinned programme that is culturally adapted at both the surface and deep structural levels.

TRIAL REGISTRATION

ISRCTN81798055 , registered: 13/05/2014.

Web-based intervention to promote physical activity in Taiwanese children

PURPOSE

This study investigated the effectiveness of a theory-based, technology-integrated website in promoting the physical activity of schoolchildren.

DESIGN AND METHODS

A website designed using a self-management strategy and supplemented with a geographical information system (GIS) mapping function was used to increase children's physical activity levels. A total of 524 students from six elementary schools in Taipei City completed surveys at three times during 2010 and were assigned to one of three groups: (1) a self-management group, using a website employing a goal-setting strategy and a storytelling schema based on a classical Chinese novel; (2) a knowledge-only group that was given only access to the website; or (3) a control group that was only given lectures and not allowed to access the website.

RESULTS

After adjustment for the effects of the pretest, the self-management and knowledge-only groups were found to be more physically active and have higher self-efficacy than the control group. Moreover, the self-management group had higher scores for these two variables than the knowledge-only group. Furthermore, the intervention was more effectives for male students than female students.

CONCLUSION

Overall, the self-management website proved to be effective in promoting schoolchildren's physical activity. The positive correlation of self-efficacy with the ability to handle the difficulties inherent in physical activity continued for 3 months after the intervention was completed.

How are behavioural interventions delivered to children (5-11 years old): a systematic mapping review

CONTEXT

Behavioural interventions are used to prevent, manage and treat a wide variety of conditions including obesity, diabetes, chronic pain, asthma and emotional difficulties. There has been inadequate attention to the delivery of behavioural interventions to younger children (5-11 years old).

OBJECTIVE

Our objectives were to describe the characteristics of behavioural interventions for children aged 5-11 years.

DATA SOURCES

We searched five databases: CINAHL, EMBASE, PsycINFO, MEDLINE and Cochrane Library, from January 2005 to August 2019.

STUDY SELECTION

The inclusion criteria were (1) children aged 5-11, (2) cognitive and/or behavioural interventions, (3) randomised controlled trials and (4) 2005 onward. Two researchers independently identified studies for inclusion.

DATA EXTRACTION

Two researchers independently extracted data from eligible papers.

RESULTS

The search identified 10 541 papers. We extracted information on 117 interventions (from 152 papers). Many of the interventions were categorised as complex. This was particularly true for clinical populations; 78.7% were delivered to both the child and parent, and 33.9% took place across multiple settings, typically health and school settings. Most (70.9%) were 'First Wave' (behavioural) interventions, and few (4.3%) were 'Third Wave' (characterised by metacognition, acceptance and mindfulness). Thirty-nine per cent used interactive techniques (play, arts, story and/or games). Purely digital and paper-based interventions were rare, but around a third used these tools as supplements to face-face delivery. There were differences in interventions for younger (5-7 years) and older (8-11 years) children.

CONCLUSIONS

Interventions designed and delivered to children should be developmentally sensitive. This review highlights characteristics of interventions delivered to children 5-11 years old: the involvement of the child's parent, using behavioural (rather than cognitive) modalities, using interactive techniques and some interventions were delivered across multiple settings.

Effects of total fat intake on bodyweight in children

BACKGROUND

As part of efforts to prevent childhood overweight and obesity, we need to understand the relationship between total fat intake and body fatness in generally healthy children.

OBJECTIVES

To assess the effects and associations of total fat intake on measures of weight and body fatness in children and young people not aiming to lose weight.

SEARCH METHODS

For this update we revised the previous search strategy and ran it over all years in the Cochrane Library, MEDLINE (Ovid), MEDLINE (PubMed), and Embase (Ovid) (current to 23 May 2017). No language and publication status limits were applied. We searched the World Health Organization International Clinical Trials Registry Platform and ClinicalTrials.gov for ongoing and unpublished studies (5 June 2017).

SELECTION CRITERIA

We included randomised controlled trials (RCTs) in children aged 24 months to 18 years, with or without risk factors for cardiovascular disease, randomised to a lower fat (30% or less of total energy (TE)) versus usual or moderate-fat diet (greater than 30%TE), without the intention to reduce weight, and assessed a measure of weight or body fatness after at least six months. We included prospective cohort studies if they related baseline total fat intake to weight or body fatness at least 12 months later.

DATA COLLECTION AND ANALYSIS

We extracted data on participants, interventions or exposures, controls and outcomes, and trial or cohort quality characteristics, as well as data on potential effect modifiers, and assessed risk of bias for all included studies. We extracted body weight and blood lipid levels outcomes at six months, six to 12 months, one to two years, two to five years and more than five years for RCTs; and for cohort studies, at baseline to one year, one to two years, two to five years, five to 10 years and more than 10 years. We planned to perform random-effects meta-analyses with relevant subgrouping, and sensitivity and funnel plot analyses where data allowed.

MAIN RESULTS

We included 24 studies comprising three parallel-group RCTs (n = 1054 randomised) and 21 prospective analytical cohort studies (about 25,059 children completed). Twenty-three studies were conducted in high-income countries. No meta-analyses were possible, since only one RCT reported the same outcome at each time point range for all outcomes, and cohort studies were too heterogeneous to combine.Effects of dietary counselling to reduce total fat intake from RCTsTwo studies recruited children aged between 4 and 11 years and a third recruited children aged 12 to 13 years. Interventions were combinations of individual and group counselling, and education sessions in clinics, schools and homes, delivered by dieticians, nutritionists, behaviourists or trained, supervised teachers. Concerns about imprecision and poor reporting limited our confidence in our findings. In addition, the inclusion of hypercholesteraemic children in two trials raised concerns about applicability.One study of dietary counselling to lower total fat intake found that the intervention may make little or no difference to weight compared with usual diet at 12 months (mean difference (MD) -0.50 kg, 95% confidence interval (CI) -1.78 to 0.78; n = 620; low-quality evidence) and at three years (MD -0.60 kg, 95% CI -2.39 to 1.19; n = 612; low-quality evidence). Education delivered as a classroom curriculum probably decreased BMI in children at 17 months (MD -1.5 kg/m2, 95% CI -2.45 to -0.55; 1 RCT; n = 191; moderate-quality evidence). The effects were smaller at longer term follow-up (five years: MD 0 kg/m2, 95% CI -0.63 to 0.63; n = 541; seven years; MD -0.10 kg/m2, 95% CI -0.75 to 0.55; n = 576; low-quality evidence).Dietary counselling probably slightly reduced total cholesterol at 12 months compared to controls (MD -0.15 mmol/L, 95% CI -0.24 to -0.06; 1 RCT; n = 618; moderate-quality evidence), but may make little or no difference over longer time periods. Dietary counselling probably slightly decreased low-density lipoprotein (LDL) cholesterol at 12 months (MD -0.12 mmol/L, 95% CI -0.20 to -0.04; 1 RCT; n = 618, moderate-quality evidence) and at five years (MD -0.09, 95% CI -0.17 to -0.01; 1 RCT; n = 623; moderate-quality evidence), compared to controls. Dietary counselling probably made little or no difference to HDL-C at 12 months (MD -0.03 mmol/L, 95% CI -0.08 to 0.02; 1 RCT; n = 618; moderate-quality evidence), and at five years (MD -0.01 mmol/L, 95% CI -0.06 to 0.04; 1 RCT; n = 522; moderate-quality evidence). Likewise, counselling probably made little or no difference to triglycerides in children at 12 months (MD -0.01 mmol/L, 95% CI -0.08 to 0.06; 1 RCT; n = 618; moderate-quality evidence). Lower versus usual or modified fat intake may make little or no difference to height at seven years (MD -0.60 cm, 95% CI -2.06 to 0.86; 1 RCT; n = 577; low-quality evidence).Associations between total fat intake, weight and body fatness from cohort studiesOver half the cohort analyses that reported on primary outcomes suggested that as total fat intake increases, body fatness measures may move in the same direction. However, heterogeneous methods and reporting across cohort studies, and predominantly very low-quality evidence, made it difficult to draw firm conclusions and true relationships may be substantially different.

AUTHORS' CONCLUSIONS

We were unable to reach firm conclusions. Limited evidence from three trials that randomised children to dietary counselling or education to lower total fat intake (30% or less TE) versus usual or modified fat intake, but with no intention to reduce weight, showed small reductions in body mass index, total- and LDL-cholesterol at some time points with lower fat intake compared to controls. There were no consistent effects on weight, high-density lipoprotein (HDL) cholesterol or height. Associations in cohort studies that related total fat intake to later measures of body fatness in children were inconsistent and the quality of this evidence was mostly very low. Most studies were conducted in high-income countries, and may not be applicable in low- and middle-income settings. High-quality, longer-term studies are needed, that include low- and middle-income settings to look at both possible benefits and harms.

Effects of total fat intake on bodyweight in children

BACKGROUND

As part of efforts to prevent childhood overweight and obesity, we need to understand the relationship between total fat intake and body fatness in generally healthy children.

OBJECTIVES

To assess the effects of total fat intake on measures of weight and body fatness in children and young people not aiming to lose weight.

SEARCH METHODS

For this update we revised the previous search strategy and ran it over all years in the Cochrane Library, MEDLINE (Ovid), MEDLINE (PubMed), and Embase (Ovid) (current to 23 May 2017). No language and publication status limits were applied. We searched the World Health Organization International Clinical Trials Registry Platform and ClinicalTrials.gov for ongoing and unpublished studies (5 June 2017).

SELECTION CRITERIA

We included randomised controlled trials (RCTs) in children aged 24 months to 18 years, with or without risk factors for cardiovascular disease, randomised to a lower fat (30% or less of total energy (TE)) versus usual or moderate-fat diet (greater than 30%TE), without the intention to reduce weight, and assessed a measure of weight or body fatness after at least six months. We included prospective analytical cohort studies in these children if they related baseline total fat intake to weight or body fatness at least 12 months later. We duplicated inclusion decisions and resolved disagreement by discussion with other authors.

DATA COLLECTION AND ANALYSIS

We extracted data on participants, interventions or exposures, controls and outcomes, and trial or cohort quality characteristics, as well as data on potential effect modifiers, and assessed risk of bias for all included studies. We extracted outcome data using the following time point ranges, when available: RCTs: baseline to six months, six to 12 months, one to two years, two to five years and more than five years; cohort studies: baseline to one year, one to two years, two to five years, five to 10 years and more than 10 years. We planned to perform random-effects meta-analyses with relevant subgrouping, and sensitivity and funnel plot analyses where data allowed.

MAIN RESULTS

We included 24 studies comprising three parallel-group RCTs (n = 1054 randomised) and 21 prospective analytical cohort studies (about 25,059 children completed). Twenty-three were conducted in high-income countries. No meta-analyses were possible, since only one RCT reported the same outcome at each time point range for all outcomes, and cohort studies were too heterogeneous.For the RCTs, concerns about imprecision and poor reporting limited our confidence in our findings. In addition, the inclusion of hypercholesteraemic children in two trials raised concerns about applicability. Lower versus usual or modified total fat intake may have made little or no difference to weight over a six- to twelve month period (mean difference (MD) -0.50 kg, 95% confidence interval (CI) -1.78 to 0.78; 1 RCT; n = 620; low-quality evidence), nor a two- to five-year period (MD -0.60 kg, 95% CI -2.39 to 1.19; 1 RCT; n = 612; low-quality evidence). Compared to controls, lower total fat intake (30% or less TE) probably decreased BMI in children over a one- to two-year period (MD -1.5 kg/m2, 95% CI -2.45 to -0.55; 1 RCT; n = 191; moderate-quality evidence), with no other differences evident across the other time points (two to five years: MD 0.00 kg/m2, 95% CI -0.63 to 0.63; 1 RCT; n = 541; greater than five years; MD -0.10 kg/m2, 95% CI -0.75 to 0.55; 1 RCT; n = 576; low-quality evidence). Lower fat intake probably slightly reduced total cholesterol over six to 12 months compared to controls (MD -0.15 mmol/L, 95% CI -0.24 to -0.06; 1 RCT; n = 618; moderate-quality evidence), but may make little or no difference over longer time periods. Lower fat intake probably slightly decreased low-density lipoprotein (LDL) cholesterol over six to 12 months (MD -0.12 mmol/L, 95% CI -0.20 to -0.04; 1 RCT; n = 618, moderate-quality evidence) and over two to five years (MD -0.09, 95% CI -0.17 to -0.01; 1 RCT; n = 623; moderate-quality evidence), compared to controls. However, lower total fat intake probably made little or no difference to HDL-C over a six- to 12-month period (MD -0.03 mmol/L, 95% CI -0.08 to 0.02; 1 RCT; n = 618; moderate-quality evidence), nor a two- to five-year period (MD -0.01 mmol/L, 95% CI -0.06 to 0.04; 1 RCT; n = 522; moderate-quality evidence). Likewise, lower total fat intake probably made little or no difference to triglycerides in children over a six- to 12-month period (MD -0.01 mmol/L, 95% CI -0.08 to 0.06; 1 RCT; n = 618; moderate-quality evidence). Lower versus usual or modified fat intake may make little or no difference to height over more than five years (MD -0.60 cm, 95% CI -2.06 to 0.86; 1 RCT; n = 577; low-quality evidence).Over half the cohort analyses that reported on primary outcomes suggested that as total fat intake increases, body fatness measures may move in the same direction. However, heterogeneous methods and reporting across cohort studies, and predominantly very low-quality evidence, made it difficult to draw firm conclusions and true relationships may be substantially different.

AUTHORS' CONCLUSIONS

We were unable to reach firm conclusions. Limited evidence from three trials that randomised children to a lower total fat intake (30% or less TE) versus usual or modified fat intake, but with no intention to reduce weight, showed small reductions in body mass index, total- and LDL-cholesterol at some time points with lower fat intake compared to controls, and no consistent differences in effects on weight, high-density lipoprotein (HDL) cholesterol or height. Associations in cohort studies that related total fat intake to later measures of body fatness in children were inconsistent and the quality of this evidence was mostly very low. Twenty-three out of 24 included studies were conducted in high-income countries, and may not be applicable in low- and middle-income settings. High-quality, longer-term studies are needed, that include low- and middle-income settings and look at both possible benefits and risks.

Physical Activity Behaviors and Influences Among Chinese-American Children Aged 9-13 Years: A Qualitative Study

Low physical activity is a major health issue among Chinese Americans. This study explored Chinese-American children's physical activity behaviors and influencing factors. Twenty-five children of Chinese or Taiwanese descent were interviewed to understand their favorite sports or physical activities, physical activity environments, and influences on their physical activity. All were between the ages of 9 and 13. Interviews were transcribed and coded using thematic data analysis procedures. Major themes included: (1) team sports, particularly basketball, were commonly listed as favorite sports or activities; (2) physical activity occurred mostly at school or an after-school setting; and (3) family played a major role in physical activity. Some trends/differences were detected based on age, sex, and socioeconomic status. Interventions to promote physical activity among Chinese-American children should emphasize team sports and encourage physical activity in schools, but also explore ways to involves families outside of school.

Acculturation and weight change in Asian-American children: Evidence from the ECLS-K:2011

Despite relatively low rates of overweight and obesity among Asian-American children, disparities exist based on acculturation, socioeconomic status, and Asian ethnicity. The purpose of this study was to examine the association between acculturation and weight change in Asian-American children. Secondary aims were to compare changes by Asian ethnic group and acculturation x socioeconomic status. Participants included 1200 Asian-American children from the Early Childhood Longitudinal Study, Kindergarten Class of 2010-11, a longitudinal study of U.S. children attending kindergarten in 2010-2011. Multinomial logistic regressions were conducted to predict weight change based on body mass indices in kindergarten (spring 2011) and second grade (spring 2013): consistently healthy weight, consistently overweight/obese, healthy weight change, and unhealthy weight change. Models included demographic, household, socioeconomic status, and acculturation measures, specifically mother's English proficiency and percentage of life spent in the U.S. Overall, 72.3% of children were at healthy weights in kindergarten and second grade. Of all Asian ethnic groups, Filipino children had the highest rate of being consistently overweight/obese (24.8%) and the lowest rate of being consistently healthy weight (62.9%). In addition, mother's English proficiency predicted unhealthy weight change (OR: 0.83; 95% CI: 0.75-0.92) and healthy weight change (OR: 0.75; 95% CI: 0.65-0.86), relative to "consistently healthy weight." English proficiency also predicted being consistently overweight/obese for children with less educated mothers. Findings enhance our understanding of obesity disparities within Asian Americans and highlight the need to disaggregate the population. Obesity interventions are needed for Filipino children and families with low socioeconomic status but high English proficiency.

Culture and Diet Among Chinese American Children Aged 9-13 Years: A Qualitative Study

OBJECTIVE

To examine Chinese American children's behaviors, food preferences, and cultural influences on their diet.

DESIGN

Qualitative individual interviews using constructs from the proposed model of dietary acculturation.

SETTING

Community centers and Chinese schools in Houston, TX.

PARTICIPANTS

Twenty-five Chinese American children aged 9-13 years.

PHENOMENON OF INTEREST

Diet, favorite restaurants, and parents' cooking and grocery shopping habits.

ANALYSIS

Content analysis and thematic data analysis to identify code categories and themes. Coders also identified patterns based on demographic and acculturation factors.

RESULTS

Overall, participants described their diets and associated behaviors as Asian and non-Asian. Key themes included preference for Asian and non-Asian foods; consumption of non-Asian foods for breakfast and lunch, but Asian foods for dinner; infrequent dining at restaurants; grocery shopping at Asian and non-Asian stores; and familial influences on diet. Acculturated children and children of higher socioeconomic status appeared to prefer and consume a more Westernized/non-Asian diet.

CONCLUSIONS AND IMPLICATIONS

Results illustrate that Chinese American children in this study practiced both Asian and non-Asian dietary behaviors. Findings corroborated existing acculturation research with parents and caregivers; supported constructs in the model of dietary acculturation; and provide guidance for research and programs related to dietary behaviors, determinants, and culture among this population.

What are Asian-American youth consuming? A systematic literature review

Numerous studies have explored dietary practices among children, but there are limited studies on children of Asian background in the US. This review had three aims: (a) review literature regarding Asian-American youth's dietary behaviors, (b) critically evaluate the methodological quality of such research, and (c) provide recommendations for future nutrition-related research on Asian-American youth. The authors conducted a systematic literature review through MEDLINE (EBSCO), CINAHL Plus with Full Text (EBSCO), and Embase (Ovid); extracted descriptive data; and evaluated methodological quality. Thirteen articles were included. Major findings included: (a) frequent consumption of milk, fruit, meat, unenriched white rice, vegetables, and high-fat and high-sugar items among Asian-American children and (b) acculturation's influences on diet, resulting in Asian-American youth consuming diets characterized by both Asian and American foods. Findings from this review may inform education and promotion programs and services for Asian Americans in the US.

Cultural adaptation of a children's weight management programme for Bangladeshi and Pakistani families in the UK: a cluster-randomised feasibility study protocol

BACKGROUND

Group-based children's weight management programmes are widely available in the UK and evidence shows that these are effective in the short-term. No programmes have been specifically developed to meet the cultural requirements of UK minority ethnic communities. South Asian children are a high-risk group for obesity and its consequences; therefore, the study aim is to adapt an existing weight management programme for children aged 4-11 years and their families to ensure cultural relevance to Pakistani and Bangladeshi communities, and undertake a feasibility study of the adapted programme.

METHODS/DESIGN

Pakistani and Bangladeshi families of overweight children who have been offered the existing children's weight management programme in Birmingham, UK, will be invited to interviews and focus groups to explore their experiences and views of the programme. These data, together with existing literature and service provider information, will inform adaptation of the programme to be more culturally relevant to these families. The feasibility study will employ a cluster-randomised design, and will assess success of programme adaptation and feasibility of programme delivery. Planned programmes will be randomised to be delivered as the adapted programme (intervention) or the standard programme (comparator) with a 2:1 ratio. The primary outcome will be the proportion of Pakistani and Bangladeshi families completing the adapted programme. To assess recruitment, retention and data collection methods to inform a future trial, we aim to recruit 80 participants. A range of assessments will be undertaken with participants pre-, post- and 6-months post-intervention.

DISCUSSION

This study addresses the identified need to provide children's weight management programmes that are suitable for minority ethnic communities. Whilst the focus of the intervention adaptation is on Pakistani and Bangladeshi communities, the programme will be developed to be flexibly delivered to meet the cultural needs of communities of all ethnic compositions. The feasibility study will directly compare the adapted and existing weight management programmes, and will enable a comprehensive evaluation of the success of the adaptation. Essential information will also be gathered to inform the design and sample size calculation of a future trial to evaluate intervention effectiveness.

TRIAL REGISTRATION

ISRCTN81798055, registered: 13/05/2014.

Short-Term Efficacy and Correlates of Change in Health Weight Management Program for Chinese American Children

A pretest and posttest study design was used to test a healthy weight management intervention with overweight and/or obese Chinese American children. Children attended 8-weekly small group sessions while parents attended a single 2-hour parent workshop. Children had their weight, height, blood pressure, waist and hip circumference, and fast lipids data assessed and completed several questions questionnaires regarding food choices, self-efficacy, and knowledge at baseline, 2 months, and 6 months. Parents completed questionnaires regarding demographic, acculturation level and family environment. We found significant reduction of body mass index, waist/hip ratio, systolic blood pressure and improvement of child's eating style, physical activity knowledge, self-efficacy, and children's quality of life at 6-month follow-up. In addition, significant improvement of high-density lipoprotein cholesterol and decrease in triglyceride were found at 6-month follow-up. Improvement of nutrition self-efficacy and decreased stimulus environment were associated with decreased body mass index in overweight and obese Chinese American children.

Neurobiologically informed treatment for adults with anorexia nervosa: a novel approach to a chronic disorder

Anorexia nervosa (AN) is a severe and debilitating disorder with significant medical and psychological sequelae. To date, there are no effective treatments for adults, resulting in high rates of chronicity, morbidity, and mortality. Recent advances in brain imaging research have led to an improved understanding of etiology and specific neurobiological mechanisms underlying symptoms. Despite this, there are no treatments focused on targeting symptoms using this empirically supported mechanistic understanding of the illness. Updated treatment approaches focused on targeting neurobiological mechanisms underlying core AN symptomatology are necessary to improve treatment out-comes for this population. Neurobiologically Enhanced With Family Eating Disorder Trait Response Treatment (NEW FED TR) is a neurobiologically informed treatment targeting key temperament constructs associated with the illness through the delivery of psychoeducation and skills training to patients and nominated carers.

Family-based interventions to increase physical activity in children: a systematic review, meta-analysis and realist synthesis

OBJECTIVE

Family-based interventions represent a potentially valuable route to increasing child physical activity (PA) in children. A dual meta-analysis and realist synthesis approach examined existing interventions to assist those developing programmes to encourage uptake and maintenance of PA in children.

DESIGN

Studies were screened for inclusion based on including participants aged 5-12 years, having a substantive aim of increasing PA by engaging the family and reporting on PA outcome. Duplicate data extraction and quality assessment were conducted. Meta-analysis was conducted in STATA. Realist synthesis included theory development and evidence mapping.

RESULTS

Forty-seven studies were included, of which three received a 'strong' quality rating, 21 'moderate' and 23 'weak'. The meta-analysis (19 studies) demonstrated a significant small effect in favour of the experimental group (standardized mean difference: 0.41; 95%CI 0.15-0.67). Sensitivity analysis, removing one outlier, reduced this to 0.29 (95%CI 0.14-0.45). Realist synthesis (28 studies) provided insight into intervention context (particularly, family constraints, ethnicity and parental motivation), and strategies to change PA (notably, goal-setting and reinforcement combined).

CONCLUSION

This review provides key recommendations to inform policy makers and other practitioners in developing evidence-based interventions aimed at engaging the family to increase PA in children, and identifies avenues for future research.

Evaluation of physical activity interventions in children via the reach, efficacy/effectiveness, adoption, implementation, and maintenance (RE-AIM) framework: A systematic review of randomized and non-randomized trials

CONTEXT

Existing reviews of physical activity (PA) interventions designed to increase PA behavior exclusively in children (ages 5 to 11years) focus primarily on the efficacy (e.g., internal validity) of the interventions without addressing the applicability of the results in terms of generalizability and translatability (e.g., external validity).

OBJECTIVE

This review used the RE-AIM (Reach, Efficacy/Effectiveness, Adoption, Implementation, Maintenance) framework to measure the degree to which randomized and non-randomized PA interventions in children report on internal and external validity factors.

METHODS AND RESULTS

A systematic search for controlled interventions conducted within the past 12years identified 78 studies that met the inclusion criteria. Based on the RE-AIM criteria, most of the studies focused on elements of internal validity (e.g., sample size, intervention location and efficacy/effectiveness) with minimal reporting of external validity indicators (e.g., representativeness of participants, start-up costs, protocol fidelity and sustainability).

CONCLUSIONS

Results of this RE-AIM review emphasize the need for future PA interventions in children to report on real-world challenges and limitations, and to highlight considerations for translating evidence-based results into health promotion practice.

Effectiveness of universal parental support interventions addressing children's dietary habits, physical activity and bodyweight: A systematic review

OBJECTIVES

The evidence regarding effectiveness of parental support interventions targeting children's health behaviours is weak. We aimed to review: 1) effectiveness of universal parental support interventions to promote dietary habits, physical activity (PA) or prevent overweight and obesity among children 2-18years and 2) effectiveness in relation to family socio-economic position.

METHODS

Thirty five studies from 1990 to 2013 were identified from major databases. Quality was assessed by four criteria accounting for selection and attrition bias, fidelity to intervention, and outcome measurement methodology, categorizing studies as strong, moderate or weak.

RESULTS

Four intervention types were identified: face-to-face counselling, group education, information sent home, and telephone counselling. Face-to-face or telephone counselling was effective in changing children's diet, while there was only weak evidence for improvement in PA. Sending home information was not effective. Concerning body weight, group education seemed more promising than counselling. Intervention effectiveness was generally higher in younger compared to older children. In groups with low socio-economic position, group-based approaches appeared promising.

CONCLUSION

In the future efforts should be made to improve reporting of intervention content, include a power calculation for the main outcome, the use of high quality outcome assessment methodology, and a follow-up period of at least 6months.

The Effectiveness of Interventions on Sustained Childhood Physical Activity: A Systematic Review and Meta-Analysis of Controlled Studies

BACKGROUND

Increased physical activity (PA) has been associated with a reduction in non-communicable disease risk factors and outcomes. However, interventions to increase childhood PA typically produce small to negligible effects. Recent reviews are limited due to lack of post-intervention follow-up measurement. This review aimed to examine measured effects at least six months post-intervention.

METHODS AND FINDINGS

We searched PubMed, MEDLINE, EMBASE, PsychINFO, ScienceDirect, SportDiscus and Google Scholar between 1st January 1991 and 1st November 2014 for controlled studies reporting six-month post-intervention measurement for children aged 5 to 18 years. 14 studies met inclusion criteria; 12 reported moderate-to-vigorous PA (MVPA) (n = 5790) and 10 reported total PA (TPA) (n = 4855). We calculated overall effect estimates and 95% CI's using random effects modelling with inverse variance weighting. Mean difference was calculated for MVPA, with standardised mean difference calculated to TPA due to measurement variation. Meta-regression assessed heterogeneity by continuous level variables. Negligible mean difference in MVPA existed in favour of the intervention group, amounting to 1.47 (95% CI -1.88, 4.82) mins/day compared to controls, while no difference was recorded on TPA. Sub-group analyses revealed males (2.65 mins/day: 95% CI 2.03, 3.27) reported higher levels of MVPA than females (-0.42 mins/day: 95% CI -7.77, 6.94), community settings (2.67 mins/day: 95% CI 2.05, 3.28) were more effective than school settings (1.70 mins/day: 95% CI -4.84, 8.25), and that treatment (4.47 mins/day: 95% CI -0.81, 9.76) demonstrated greater effects than population approaches (1.03 mins/day: 95% CI -2.54, 4.60). Meta-regression revealed no significant differences by factor on pooled effects. Significant heterogeneity existed between studies and potential for small study effects was present.

CONCLUSIONS

Improved PA levels subsequent to intervention were not maintained six month post-intervention. A potentially useful avenue of future research is to specifically explore community treatment of high risk individuals.

REVIEW REGISTRATION

PROSPERO CRD42014007545.

The Efficacy of a Family-Based Intervention Program on Childhood Obesity: A Quasi-Experimental Design

The purpose of this quasi-experimental study was to assess the efficacy of a family-based (FB) weight-loss and behavior-modification intervention among overweight/obese children (age 9-11 years) and their parents in Taiwan. The intervention group (52 child-parent dyads) participated in an FB program for 7 weeks. The control group (55 child-parent dyads) received an educational pamphlet about obesity prevention. The children's body mass index (BMI) z-scores were the primary outcome variable. The parents' BMI, high-calorie (HC) food-intake behaviors, screen-related behaviors, and restrictions on children's consumption of HC foods and screen-related behaviors and the availability of HC foods at home were the secondary outcome variables. Outcome variables were measured at baseline (T0), at the end of the intervention (T1), and 4 weeks after the end of the intervention (T2). A linear mixed model was used to assess the efficacy of the FB program. Results indicated that the children's BMI z-scores decreased significantly more from T0 to T2 in the experimental group than in the control group. The decreases in parents' HC food-intake behaviors and availability of HC foods at home and the increase in parental restrictions on children's consumption of HC foods were significantly greater in the experimental than in the control group from T0 to T1 and T0 to T2. The FB program was effective in modifying parental behaviors and the weight of overweight/obese children in a Taiwanese population.

What are successful recruitment and retention strategies for underserved populations? Examining physical activity interventions in primary care and community settings

The purposes of this review are to (1) describe recruitment and retention strategies for physical activity interventions focusing on underserved populations and (2) identify successful strategies which show the most promise for "best practices" recommendations to guide future research. The method used was systematic review. Data on recruitment and retention strategies were abstracted and analyzed according to participant characteristics, types of strategies used, and effectiveness using an ecological framework. Thirty-eight studies were identified. Populations included African American (n = 25), Hispanic (n = 8), or Asian (n = 3) groups. Successful recruitment strategies consisted of partnering with respected community stakeholders and organizations, well-trained study staff ethnically, linguistically, and culturally matched to the population of interest, and use of multiple advertising channels. Successful retention strategies included efficient administrative tracking of participants, persistence, skillful teamwork, and demonstrating a positive, caring attitude towards participants. Promising recruitment and retention strategies correspond to all levels of ecological influence: individual, interpersonal, organizational, and societal.

Children, parents and pets exercising together (CPET): exploratory randomised controlled trial

BACKGROUND

Levels of physical activity (PA) in UK children are much lower than recommended and novel approaches to its promotion are needed. The Children, Parents and Pets Exercising Together (CPET) study is the first exploratory randomised controlled trial (RCT) to develop and evaluate an intervention aimed at dog-based PA promotion in families. CPET aimed to assess the feasibility, acceptability and potential efficacy of a theory-driven, family-based, dog walking intervention for 9-11 year olds.

METHODS

Twenty-eight families were allocated randomly to either receive a 10-week dog based PA intervention or to a control group. Families in the intervention group were motivated and supported to increase the frequency, intensity and duration of dog walking using a number of behaviour change techniques. Parents in the intervention group were asked to complete a short study exit questionnaire. In addition, focus groups with parents and children in the intervention group, and with key stakeholders were undertaken. The primary outcome measure was 10 week change in total volume of PA using the mean accelerometer count per minute (cpm). Intervention and control groups were compared using analysis of covariance. Analysis was performed on an intention to treat basis.

RESULTS

Twenty five families were retained at follow up (89%) and 97% of all outcome data were collected at baseline and follow up. Thirteen of 14 (93%) intervention group parents available at follow up completed the study exit questionnaire and noted that study outcome measures were acceptable. There was a mean difference in child total volume of PA of 27 cpm (95% CI -70, 123) and -3 cpm (95% CI -60, 54) for intervention and control group children, respectively. This was not statistically significant. Approximately 21% of dog walking time for parents and 39% of dog walking time for children was moderate-vigorous PA.

CONCLUSIONS

The acceptability of the CPET intervention and outcome measures was high. Using pet dogs as the agent of lifestyle change in PA interventions in children and their parents is both feasible and acceptable, but did not result in a significant increase in child PA in this exploratory trial.

TRIAL REGISTRATION

ISRCTN85939423.

Effective behaviour change techniques in the prevention and management of childhood obesity

Rates of childhood obesity are increasing, and it is essential to identify the active components of interventions aiming to prevent and manage obesity in children. A systematic review of behaviour change interventions was conducted to find evidence of behaviour change techniques (BCTs) that are most effective in changing physical activity and/or eating behaviour for the prevention or management of childhood obesity. An electronic search was conducted for randomised controlled trials published between January 1990 and December 2009. Of 4309 titles and abstracts screened, full texts of 135 articles were assessed, of which 17 published articles were included in this review. Intervention descriptions were coded according to the behaviour-specific CALO-RE taxonomy of BCTs. BCTs were identified and compared across obesity management (n=9) vs prevention (n=8) trials. To assess the effectiveness of individual BCTs, trials were further divided into those that were effective (defined as either a group reduction of at least 0.13 body mass index (BMI) units or a significant difference in BMI between intervention and control groups at follow-up) vs non-effective (reported no significant differences between groups). We reliably identified BCTs utilised in effective and non-effective prevention and management trials. To illustrate the relative effectiveness of each BCT, effectiveness ratios were calculated as the ratio of the number of times each BCT was a component of an intervention in an effective trial divided by the number of times they were a component of all trials. Results indicated six BCTs that may be effective components of future management interventions (provide information on the consequences of behaviour to the individual, environmental restructuring, prompt practice, prompt identification as role model/position advocate, stress management/emotional control training and general communication skills training), and one that may be effective in prevention interventions (prompting generalisation of a target behaviour). We identified that for management trials, providing information on the consequences of behaviour in general was a feature of non-effective interventions and for prevention trials, providing information on the consequences of behaviour in general, providing rewards contingent on successful behaviour and facilitating social comparison were non-effective. To design effective behaviour change programmes for the prevention and management of childhood obesity, we would recommend utilising the BCTs identified as effective in this review. The impact on intervention effectiveness of combining BCTs should be the topic of further research.

A systematic review of intervention effects on potential mediators of children's physical activity

Background

Many interventions aiming to increase children’s physical activity have been developed and implemented in a variety of settings, and these interventions have previously been reviewed; however the focus of these reviews tends to be on the intervention effects on physical activity outcomes without consideration of the reasons and pathways leading to intervention success or otherwise.

To systematically review the efficacy of physical activity interventions targeting 5-12 year old children on potential mediators and, where possible, to calculate the size of the intervention effect on the potential mediator.

Methods

A systematic search identified intervention studies that reported outcomes on potential mediators of physical activity among 5-12 year old children. Original research articles published between 1985 and April 2012 were reviewed.

Results

Eighteen potential mediators were identified from 31 studies. Positive effects on cognitive/psychological potential mediators were reported in 15 out of 31 studies. Positive effects on social environmental potential mediators were reported in three out of seven studies, and no effects on the physical environment were reported. Although no studies were identified that performed a mediating analysis, 33 positive intervention effects were found on targeted potential mediators (with effect sizes ranging from small to large) and 73% of the time a positive effect on the physical activity outcome was reported.

Conclusions

Many studies have reported null intervention effects on potential mediators of children’s physical activity; however, it is important that intervention studies statistically examine the mediating effects of interventions so the most effective strategies can be implemented in future programs.

Children in hospital in Ireland--what do they eat and what do they weigh: a cross-sectional study

Background

Overweight and obesity is a growing problem in Ireland. Many parents are unaware when their child is overweight or obese. Our objectives were to examine parents’ perceptions of a healthy diet and their children’s BMI; and to evaluate the food offered to children in our paediatric in-patient unit.

Findings

A retrospective questionnaire was distributed to 95 patients and their families admitted over one month. Seventy-eight had BMI values calculated (42 males, 36 females). Twenty-one children (26.9%) were overweight/obese: 14/21 parents (66.7%) thought their child had a normal weight. Sixty percent of children served dinner in the hospital were given fried potatoes. Four had fruit/vegetables. Forty-six parents brought food into hospital, of these 14 brought purchased food.

Conclusions

This study highlights the problem of child obesity in Ireland and parental underestimation of this problem. The nutritional value of food served to children in hospital needs to be improved and hospital admissions used as opportunities to promote healthy eating habits.

Culturally tailored, family-centered, behavioral obesity intervention for Latino-American preschool-aged children

OBJECTIVE

To test the effect of a culturally tailored, family-centered, short-term behavioral intervention on BMI in Latino-American preschool-aged children.

METHODS

In a randomized controlled trial, 54 parent-child dyads were allocated to the intervention and 52 dyads were allocated to an alternative school-readiness program as the control condition. Parent-child dyads were eligible if the parent self-defined Latino, was at least 18 years old, had a 2- to 6-year-old child not currently enrolled in another healthy lifestyle program, had a valid telephone number, and planned on remaining in the city for the next 6 months. The Salud Con La Familia (Health with the Family) program consisted of 12 weekly 90-minute skills-building sessions designed to improve family nutritional habits and increase physical activity. Both programs were conducted in a community recreation center serving an urban neighborhood of mostly Spanish-speaking residents.

RESULTS

Forty-two percent of participating preschool-aged children were overweight or obese. Controlling for child age, gender, and baseline BMI, the effect of the treatment condition on postintervention absolute BMI was B = -0.59 (P < .001). The intervention effect seemed to be strongest for obese children.

CONCLUSIONS

A skills-building, culturally tailored intervention involving parent-child dyads changed short-term early growth patterns in these Latino-American preschool-aged children. Examining long-term effects would be a prudent next step.

Community-based interventions for enhancing access to or consumption of fruit and vegetables among five to 18-year olds: a scoping review

BACKGROUND

Low fruit and vegetable ( FV) consumption is a key risk factor for morbidity and mortality. Consumption of FV is limited by a lack of access to FV. Enhanced understanding of interventions and their impact on both access to and consumption of FV can provide guidance to public health decision-makers. The purpose of this scoping review is to identify and map literature that has evaluated effects of community-based interventions designed to increase FV access or consumption among five to 18-year olds.

METHODS

The search included 21 electronic bibliographic databases, grey literature, targeted organization websites, and 15 key journals for relevant studies published up to May 2011. Retrieved citations were screened in duplicate for relevance. Data extracted from included studies covered: year, country, study design, target audience, intervention setting, intervention strategies, interventionists, and reported outcomes.

RESULTS

The search located 19,607 unique citations. Full text relevance screening was conducted on 1,908 studies. The final 289 unique studies included 30 knowledge syntheses, 27 randomized controlled trials, 55 quasi-experimental studies, 113 cluster controlled studies, 60 before-after studies, one mixed method study, and three controlled time series studies. Of these studies, 46 included access outcomes and 278 included consumption outcomes. In terms of target population, 110 studies focused on five to seven year olds, 175 targeted eight to 10 year olds, 192 targeted 11 to 14 year olds, 73 targeted 15 to 18 year olds, 55 targeted parents, and 30 targeted teachers, other service providers, or the general public. The most common intervention locations included schools, communities or community centres, and homes. Most studies implemented multi-faceted intervention strategies to increase FV access or consumption.

CONCLUSIONS

While consumption measures were commonly reported, this review identified a small yet important subset of literature examining access to FV. This is a critically important issue since consumption is contingent upon access. Future research should examine the impact of interventions on direct outcome measures of FV access and a focused systematic review that examines these interventions is also needed. In addition, research on interventions in low- and middle-income countries is warranted based on a limited existing knowledge base.