School based interventions versus family based interventions in the treatment of childhood obesity- a systematic review

Improving Children's Lifestyle and Quality of Life through Synchronous Online Education: The Nutritional Adventures School-Based Program

The early introduction of effective nutritional educational programs is pivotal for instilling sustainable healthy behaviors. The present work aims to present a best practice example of a nutrition and overall lifestyle school-based training program, the Nutritional Adventures ("Diatrofoperipeteies"). Conducted during 2020-2022 in Greek primary schools, this synchronous, online educational initiative included two 1-school-hour activities with a nutrition instructor. Additionally, schools were randomly assigned to supplementary "at-home" supported-by-parents or "in-class" supported-by-educators educational activities. In total, n = 12,451 students of 84 primary schools participated. Parent-completed questionnaires were selected in the recruitment and post-intervention phase (40% participation rate); overall, the working sample was n = 1487 students. In the post-intervention phase, a significant increase in Mediterranean diet adherence was observed (KIDMED score: mean increment = 0.25 units; p < 0.001), particularly fruit and vegetable consumption. Time spent on physical activity increased, while screen time decreased. Students' total quality of life significantly improved (PedsQL; mean increment = 1.35 units; p < 0.001), including on all of its subscales (physical, emotional, social, and school function). Supplementary educational activities that were supported by educators rather than parents yielded a more favorable impact on students' lifestyle and quality of life. The Nutritional Adventures program can be regarded as a successful initiative in primary schools, yielding immediate advantages that extend beyond promoting healthy dietary habits.

Changes in fitness and fatness in Australian schoolchildren during the summer holidays: fitness lost, fatness regained? A cohort study

BACKGROUND

Emerging evidence suggests that children's fatness increases and fitness declines at a greater rate during the summer holiday period, compared with the school year. The aim of this study was to compare rates of change in fitness and fatness over the in-term and summer holiday periods among Australian schoolchildren. A secondary aim was to explore whether rates of change differed according to the child's sex, socio-economic status (SES), pubertal status and weight status.

METHODS

Children (n = 381) initially in Grade 4 (age 9) were recruited for this 2-year longitudinal study. Fatness (% body fat, BMI z-score, waist-to-height ratio) and fitness (20-m shuttle run and standing broad jump) were measured at the start and end of two consecutive years. Rates of change were calculated for the two in-school periods (Grades 4 and 5) and for the summer holiday period. Rates of change in fatness and fitness between in-school and holiday periods were compared, and differences in rates of change according to sex, socio-economic status, and weight status were explored.

RESULTS

During the holidays, percentage body fat increased at a greater rate (annualised rate of change [RoC]: +3.9 vs. Grade 4 and + 4.7 vs. Grade 5), and aerobic fitness declined at a greater rate (RoC - 4.7 vs. Grade 4 and - 4.4 vs. Grade 5), than during the in-school periods. There were no differences in rates of change for BMI z-score, waist-to-height ratio or standing broad jump. Body fatness increased faster in the holidays (relative to the in-school period) in children who are overweight and from low-SES families. Aerobic fitness declined more rapidly in the holidays in children who are overweight.

CONCLUSION

This study highlights that during the summer holiday period, children experience greater increases in fatness and declines in fitness, with children who live with low-SES families and are overweight being more affected. The findings suggest the need for targeted interventions during this period to address these negative health trends.

TRIAL REGISTRATION

Australia New Zealand Clinical Trials Registry, identifier ACTRN12618002008202. Retrospectively registered on 14 December 2018.

Cooking and Its Impact on Childhood Obesity: A Systematic Review

INTRODUCTION

This systematic review aimed to study the effect of a cooking intervention on obesity among children and adolescents aged < 18 years.

METHODS

Articles that studied the effect of cooking intervention with at least 4 sessions among children and adolescents on obesity (from January, 2000 to December, 2021) were included for analysis. Of the 500 articles identified through PubMed and ScienceDirect database, 9 studies qualified to be included in this review.

RESULTS

One-third of the studies found a positive effect of a cooking intervention on obesity among children and adolescents. School-based studies conducted among elementary school students were promising. Centers for Disease Control and Prevention body mass index percentile was the most common tool used to identify children and adolescents with overweight and obesity. The majority of the studies had a strong methodology.

DISCUSSION

All studies showed improvement in diet-related factors. Active participation of parents is crucial in making childhood interventions successful. It is difficult to delineate the effect of cooking alone on obesity as almost all studies had multicomponent interventions.

IMPLICATIONS FOR RESEARCH AND PRACTICE

These diverse results highlight the need for longitudinal studies in natural settings to comprehend the effect of long-term cooking on obesity in children and adolescents.

Ecological system theory and community participation to promote healthy food environments for obesity and non-communicable diseases prevention among school-age children

OBJECTIVES

To implement and evaluate the effectiveness of the community participatory program between school and family based on ecological system theory and participatory action research. The intervention covers three levels at the individual, family and school levels and involves educating students and parents by using technology, reducing sedentary behaviours, increasing exercise and changing to healthy food environments at school and at home.

DESIGN

A quasi-experimental design was used in this study.

SETTING

Public primary school in Thailand.

SUBJECTS

The participants in the study included 138 school-age children in grades 2-6 with their parents/guardians. The control group consisted of 134 school-age children at a school of the same size with their parents/guardians.

RESULTS

Results show that nutritional status was significantly improved within the experimental group (P value = 0·000) and between groups during follow-up (P value = 0·032). Students' knowledge about obesity and non-communicable chronic diseases (NCD) prevention, as well as physical activity and exercise behaviours, in the experimental group was significantly higher than that in the control group (P value = 0·000 and 0·044, respectively). Parents' perceptions of child obesity and family modelling behaviours in the experimental group were also significantly higher than that in the control group; P value = 0·013 and 0·000, respectively).

CONCLUSION

The community participation program was found to be successful. Not only students, families and schools improved health behaviours and healthy food environments at home and school, but the students' long-term nutritional status also improved.

Evaluation of a Childhood Obesity Program Serving a High-Need Population in Brooklyn, New York Using Survival Analysis

In this study, we used survival analysis to evaluate whether contact hours intensity was associated with a reduction in time to improvement of various BMI metrics over a 5-year follow-up period at the Live Light Live Right pediatric obesity program in Brooklyn, New York. This was a single-center retrospective longitudinal study of 406 patients during 2010-2016. Participants were categorized based on hours of exposure to Live Light Live Right's interventions; high contact hours (≥50 h) vs. low contact hours (<50 h). At baseline, 88% of patients in the high contact hour group had severe obesity and the mean age for this group was 10.0 ± 2.66. High contact hours were independently associated with a shorter time to BMI improvement in the sample. There was also a significant association between high contact hours and a longer duration in the improved state. Survival analysis was successful in evaluating the efficacy of the Live Light Live Right Program and demonstrated a positive association between greater intervention intensity and a healthier metabolic profile. Patients' active engagement in a robust treatment model exemplified by Live Light Live Right is recommended to address the childhood obesity crisis in central Brooklyn.

Fourth-Grade Cooking and Physical Activity Intervention Reveals Associations With Cooking Experience and Sex

OBJECTIVE

Examine the impact of Fuel for Fun: Cooking with Kids Plus Parents and Play (FFF) on children's culinary self-efficacy, attitude, fruit and vegetable (FV) preferences, physical activity (PA), and body mass index.

DESIGN

Randomized controlled trial.

SETTING

Eight elementary schools in 2 Northern Colorado districts.

PARTICIPANTS

Fourth-grade students; 7-month interventions: school (S.FFF)-theory-based cooking + tasting lessons, active recess, lesson-driven cafeteria promotions; or school + family (S+F.FFF) with added family nights and home activities.

MAIN OUTCOME MEASURE(S)

Cooking self-efficacy and attitudes, FV preferences, PA, and measured height/weight.

ANALYSIS

Individual outcomes nested by classroom, school, and district and assessed > 12 months with repeated measures controlled by sex and baseline cooking experience, with a significance level of P < 0.05.

RESULTS

The sample included 1,428 youth, 38 teachers, 4 cohorts, 50% boys, 75% White, and 15% Hispanic. No intervention effect was observed. Those who cooked retained higher self-efficacy, attitude, and FV preferences (P < 0.001). Girls reported higher self-efficacy and attitude than boys. Moderate-to-vigorous PA and metabolic equivalent minutes increased for all students; boys retained higher levels (P < 0.001). Body mass index percentile remained stable.

CONCLUSIONS AND IMPLICATIONS

Cooking and sex were associated with all outcome measures and should be considered for intervention tailoring. Treatment impacts were not evident nesting by classroom, school, and district. Accurate assessment of school-based interventions requires rejecting student independence from group assignment assumptions.

A Systematic Review of Healthy Nutrition Intervention Programs in Kindergarten and Primary Education

Childhood obesity and overweight rates are increasing in an exponential way. This type of diet-related health problem has consequences, not only at present but also for children's future lives. For these reasons, it is very important to find a solution, which could be nutrition intervention programs. The main objective of this article is to investigate the effectiveness of nutrition intervention programs in children aged 3-12 around the world. We used SCOPUS, Web of Science, and PubMed databases to carry out this systematic review and we followed the PRISMA statement. Two authors conducted literature searches independently, finding a total of 138 articles. Finally, after a thorough screening, a total of 19 articles were selected for detailed analysis. The results show that, in general, nutrition intervention programs are effective in improving knowledge and behaviors about healthy habits, and, consequently, that the body mass index value is reduced. However, it is true that we found differences between the incomes of families and geographical areas. In conclusion, we encourage school centers to consider including these types of programs in their educational program and bring awareness of the importance of families too.

Fuel for Fun Process Evaluation Reveals Strong Implementation and Approval with Varied Parent Engagement

OBJECTIVE

To describe the implementation and process characteristics of Fuel for Fun: Cooking with Kids Plus Parents and Play (FFF).

DESIGN

Mixed methods.

SETTING

Elementary schools in 2 Northern Colorado school districts.

PARTICIPANTS

Fourth graders (aged 9-11 years), parents, school staff, and implementation researchers; measured over 2 consecutive years in 8 schools (851 students, 45 classrooms).

INTERVENTION(S)

Social Cognitive and active learning theory-based classroom cooking with tasting lessons, active recess games, cooking with tasting food promotion during school lunch, family nights, and take-home intervention reinforcements. A 7-month program delivered by a trained intervention team.

MAIN OUTCOME MEASURE(S)

Implementation measures (observations and debriefings) assessed context, reach, dose delivered, fidelity, and dose received; process measures (surveys) assessed student and parent perceptions and intervention participation.

ANALYSIS

Descriptive statistics for quantitative and themes for qualitative data.

RESULTS

Minor adjustments in program delivery plans were required to accommodate changes in school schedules and policies. Process measures demonstrated > 90% achievement of goals for nearly all child-centered activities. One-quarter of eligible families participated in evening events, with strong parent and student approval. Fifty out of 116 parents (43%) completing an online survey reported preparing ≥ 1 of 5 recipes with their child. Fifty-nine percent of eligible students completed >1 of 10 take-home activity sheets with their parents.

CONCLUSIONS AND IMPLICATIONS

Engagement and commitment of the intervention team and school staff supported strong implementation. Participant responses were positive, but improvement in parent engagement requires investigation.

Effects of 12-Month Interdisciplinary Interventions in 8- and 9-Year-Old Children with Excess Body Weight

Childhood obesity remains one of the most serious medical challenges of the 21st century. The aim of the study was to obtain epidemiological data on the prevalence of overweight and obesity among 8- and 9-year-old children in Szczecin, and to evaluate the effectiveness of medical intervention in the form of a year of interdisciplinary work with children with excess body weight. The study consisted of two main stages: I-screening, II-intervention. The program was implemented for three consecutive years, starting in 2016-2018. The entire population of 8-9-year-olds in Szczecin is 11,494 children. In the screening part of the study, 4890 children took part, whose parent agreed to participate (42.54%). In the intervention part of the study, we analyzed a group of 515 children. Children were further divided into subgroups according to the number of visits completed. Anthropometric parameters were measured on each visit. The prevalence of overweight and obesity in the screened population was 16.9% and 6.4%, respectively. Statistically significant changes were observed in BMI (Body Mass Index) percentiles and BMI z-scores, as well as WHR (Waist-Hip Ratio) during the one year observation time. The best effects were achieved by the 3rd visit (for the first 6 months of the program). Thereafter, the effects diminished due to the longer interval between the 3rd and 4th visits (6 months). There is the need for long-term programs for the prevention of excessive body weight in children and adolescents with frequent checkpoints.

The Effects of a Physical Activity, Nutrition, and Body Image Intervention on Girls in Intermediate Schools in Saudi Arabia

This cluster-randomized study aimed to evaluate the effects of an intervention focused on physical activity, nutrition, and body image perception among girls in intermediate schools in Saudi Arabia. A seminar was delivered to the mothers of the girls in the experimental group. The experimental group then attended six interactive sessions within 3 months featuring physical activity, nutrition, and body image perception, followed by a 3-month follow-up period. A total of 138 respondents (68 in the experimental group and 70 in the control group) completed the intervention. Each participant's body mass index-for-age z-score and waist circumference were measured, and they completed a physical activity, sedentary behavior, and body image perception questionnaires before and after the intervention and at the follow-up. The intervention was evaluated using within- and between-groups generalized estimating equations. There were no significant changes in the respondents' body mass index-for-age z-score or waist circumference (p > 0.05). However, immediate significant improvements were seen in physical activity, sedentary behavior, and body image satisfaction among the experimental group, and these improvements remained at follow-up (p < 0.001). These differences were more significant among the experimental group than among the control group. We found this intervention effective. Future studies can adapt this intervention for adolescent boys and extend its duration to improve the body mass index outcome.

A randomized controlled trial on long-term effectiveness of a psychosocial aftercare program following pediatric chronic pain treatment: Who benefits the most?

BACKGROUND

For pediatric chronic pain patients, intensive interdisciplinary pain treatment (IIPT) is a well-established treatment. The treatment's short-term effectiveness can be improved by an additive psychosocial aftercare (PAC). However, neither the program's long-term effectiveness nor the patients in particular need have been investigated yet.

METHODS

This study aimed at determining the long-term effects of PAC and detecting predictors of treatment outcome within a multicenter randomized controlled trial measured at five time points up to twelve months after discharge. At inpatient admission to IIPT, patients (N=419, 14.3 years of age, 72.3% female) were randomly assigned to intervention or control group. After IIPT discharge, the intervention group received PAC, whereas the control group received treatment as usual (TAU). Patient-reported outcomes included pain and emotional characteristics. Clinicians assessed potential psychosocial risk factors and their prognosis of treatment outcome. Statistical analyses included mixed-models and univariable logistic regressions.

RESULTS

Data at the 12-month follow-up (n=288) showed a significant benefit of PAC compared with TAU; the majority (59.0%) of patients in the PAC-group reported no chronic pain compared to 29.2% of TAU-patients (p<.001). Patients with a single parent specifically benefited from PAC compared to TAU. Clinicians were able to make a reliable prognosis of treatment outcome, but did not successfully predict which patients would benefit the most from PAC.

CONCLUSIONS

Study results suggest that PAC is highly effective irrespective of patient characteristics, but particularly for patients with single parents. Its broad implementation could help to improve the long-term outcomes of youth with severely disabling chronic pain.

Psychological Interventions and Bariatric Surgery among People with Clinically Severe Obesity-A Systematic Review with Bayesian Meta-Analysis

AIM

To assess the effectiveness of perioperative psychological interventions provided to patients with clinically severe obesity undergoing bariatric surgery regarding weight loss, BMI, quality of life, and psychosocial health using the Bayesian approach.

METHODS

We considered randomised trials that assessed the beneficial and harmful effects of perioperative psychological interventions in people with clinically severe obesity undergoing bariatric surgery. We searched four data sources from inception to 3 October 2021. The authors independently selected studies for inclusion, extracted data, and assessed the risk of bias. We conducted a meta-analysis using a Bayesian approach.

PROSPERO

CRD42017077724.

RESULTS

Of 13,355 identified records, we included nine studies (published in 27 papers with 1060 participants (365 males; 693 females, 2 people with missing data)). Perioperative psychological interventions may provide little or no benefit for BMI (the last reported follow-up: MD [95% credible intervals] = -0.58 [-1.32, 0.15]; BF01 = 0.65; 7 studies; very low certainty of evidence) and weight loss (the last reported follow-up: MD = -0.50 [-2.21, 0.77]; BF01 = 1.24, 9 studies, very low certainty of evidence). Regarding psychosocial outcomes, the direction of the effect was mainly inconsistent, and the certainty of the evidence was low to very low.

CONCLUSIONS

Evidence is anecdotal according to Bayesian factors and uncertain whether perioperative psychological interventions may affect weight-related and psychosocial outcomes in people with clinically severe obesity undergoing bariatric surgery. As the results are ambiguous, we suggest conducting more high-quality studies in the field to estimate the true effect, its direction, and improve confidence in the body of evidence.

Context, importance, and process for creating a body mass index surveillance system to monitor childhood obesity within the New York City public school setting

The Office of School Health, a joint program of the Departments of Health and Education, administers New York City’s (NYC) body mass index (BMI) surveillance system to monitor childhood obesity. We describe the context, importance, and process for creating a multi-agency, school-based BMI surveillance system using BMI collected from annual FITNESSGRAM® physical fitness assessments conducted as part of a larger physical activity and wellness curriculum in NYC public schools. We also summarize our current system and methodology, highlighting the types of data and data sources that comprise the system and partnership between the Departments of Health and Education that enable data sharing. Strategies for addressing threats to data quality, including missing data, biologically implausible values, and imprecise/subjective weight or height equipment are discussed. We also review current and future surveillance data products, and provide recommendations for collecting, analyzing, interpreting, and reporting BMI data for childhood obesity surveillance. Collaboration between Departments of Health and Education as well as attention to safeguards of BMI reporting and data quality threats have enabled NYC to collect high quality BMI data to accurately monitor childhood obesity trends. These findings have implications for youth BMI surveillance systems in the United States and globally.

A Natural Experiment Comparing the Effectiveness of the "Healthy Eagles" Child Weight Management Intervention in School Versus Community Settings

Behavioural weight management interventions are recommended for the treatment of obesity in children. However, the evidence for these is limited and often generated under trial conditions with White, middle-class populations. Healthy Eagles is a behavioural weight management intervention designed to treat excess weight in children. It ran in the London Borough of Croydon from 2017 to 2020 and was delivered in both school and community settings, providing a natural experiment to compare outcomes. A total of 1560 participants started the Healthy Eagles programme; 347 were in the community setting and 703 in the school setting. Data were analysed for those who completed 70% of the programme. In the school setting, there was a small but significant reduction in BMI z-score (M = −0.04, 95% CI = −0.08, −0.01) for participants above a healthy weight, especially in those with severe obesity (M = −0.09, 95% CI = −0.15, −0.03); there was no significant change in any subgroup in the community setting. Linear regression analysis showed the school setting was associated with a 0.26 (95% CI = 0.13, 0.49) greater reduction in BMI z-score than the community setting after adjusting for ethnicity, deprivation, age and gender. Across both programmes, the effect was somewhat greater in participants from a Black (African/Caribbean/Other) ethnic background (M = −0.06, 95% CI = −0.09, −0.02) and from the two most deprived quintiles (M = −0.06, 95% CI = −0.11, −0.01). Data were limited, but minimal changes were measured in nutrition and physical activity behaviours regardless of setting. This evaluation provides indirect evidence of a small but significant benefit to running weight management interventions in a school versus community setting.

Management of Childhood Obesity-Time to Shift from Generalized to Personalized Intervention Strategies

As a major public health concern, childhood obesity is a multifaceted and multilevel metabolic disorder influenced by genetic and behavioral aspects. While genetic risk factors contribute to and interact with the onset and development of excess body weight, available evidence indicates that several modifiable obesogenic behaviors play a crucial role in the etiology of childhood obesity. Although a variety of systematic reviews and meta-analyses have reported the effectiveness of several interventions in community-based, school-based, and home-based programs regarding childhood obesity, the prevalence of children with excess body weight remains high. Additionally, researchers and pediatric clinicians are often encountering several challenges and the characteristics of an optimal weight management strategy remain controversial. Strategies involving a combination of physical activity, nutritional, and educational interventions are likely to yield better outcomes compared to single-component strategies but various prohibitory limitations have been reported in practice. This review seeks to (i) provide a brief overview of the current preventative and therapeutic approaches towards childhood obesity, (ii) discuss the complexity and limitations of research in the childhood obesity area, and (iii) suggest an Etiology-Based Personalized Intervention Strategy Targeting Childhood Obesity (EPISTCO). This purposeful approach includes prioritized nutritional, educational, behavioral, and physical activity intervention strategies directly based on the etiology of obesity and interpretation of individual characteristics.

Management of Childhood Obesity—Time to Shift from Generalized to Personalized Intervention Strategies

As a major public health concern, childhood obesity is a multifaceted and multilevel metabolic disorder influenced by genetic and behavioral aspects. While genetic risk factors contribute to and interact with the onset and development of excess body weight, available evidence indicates that several modifiable obesogenic behaviors play a crucial role in the etiology of childhood obesity. Although a variety of systematic reviews and meta-analyses have reported the effectiveness of several interventions in community-based, school-based, and home-based programs regarding childhood obesity, the prevalence of children with excess body weight remains high. Additionally, researchers and pediatric clinicians are often encountering several challenges and the characteristics of an optimal weight management strategy remain controversial. Strategies involving a combination of physical activity, nutritional, and educational interventions are likely to yield better outcomes compared to single-component strategies but various prohibitory limitations have been reported in practice. This review seeks to (i) provide a brief overview of the current preventative and therapeutic approaches towards childhood obesity, (ii) discuss the complexity and limitations of research in the childhood obesity area, and (iii) suggest an Etiology-Based Personalized Intervention Strategy Targeting Childhood Obesity (EPISTCO). This purposeful approach includes prioritized nutritional, educational, behavioral, and physical activity intervention strategies directly based on the etiology of obesity and interpretation of individual characteristics.

Management of Childhood Obesity-Time to Shift from Generalized to Personalized Intervention Strategies

As a major public health concern, childhood obesity is a multifaceted and multilevel metabolic disorder influenced by genetic and behavioral aspects. While genetic risk factors contribute to and interact with the onset and development of excess body weight, available evidence indicates that several modifiable obesogenic behaviors play a crucial role in the etiology of childhood obesity. Although a variety of systematic reviews and meta-analyses have reported the effectiveness of several interventions in community-based, school-based, and home-based programs regarding childhood obesity, the prevalence of children with excess body weight remains high. Additionally, researchers and pediatric clinicians are often encountering several challenges and the characteristics of an optimal weight management strategy remain controversial. Strategies involving a combination of physical activity, nutritional, and educational interventions are likely to yield better outcomes compared to single-component strategies but various prohibitory limitations have been reported in practice. This review seeks to (i) provide a brief overview of the current preventative and therapeutic approaches towards childhood obesity, (ii) discuss the complexity and limitations of research in the childhood obesity area, and (iii) suggest an Etiology-Based Personalized Intervention Strategy Targeting Childhood Obesity (EPISTCO). This purposeful approach includes prioritized nutritional, educational, behavioral, and physical activity intervention strategies directly based on the etiology of obesity and interpretation of individual characteristics.

The Predictors of Obesity among Urban Girls and Boys Aged 8-10 Years-A Cross-Sectional Study in North-Western Poland

BACKGROUND

Children worldwide are increasingly becoming overweight and obese and developing related health problems, including hypertension, lipid disorders, abnormal glucose tolerance, type 2 diabetes, and secondary psychological disorders. The aim of the study was to determine sociodemographic risk factors that predict an increase in BMI in children at an early school age.

MATERIAL AND METHOD

The study covered 4972 children aged 8-10 years, including boys (N = 2461) and girls (N = 2511). Measurements of basic anthropometric indicators were used, such as body height, body weight, body composition, and physical fitness. The criteria developed by the International Obesity Task Force (IOTF) were adopted. Sociodemographic features were analyzed based on a diagnostic survey. IBM SPSS Statistics v.25 (Mineral Midrange SA, Warsaw, Poland) and IBM SPSS Amos software (Mineral Midrange SA, Warsaw, Poland) were used to perform descriptive statistics, the Kolmogorov-Smirnov test, Pearson's chi-square test, Student's t-test, and the Mann-Whitney U test. The statistical significance index was assumed to be p < 0.05, while p < 0.01 was taken as an indicator of a trend which was not completely statistically significant.

RESULTS

Both the children and their parents had mainly moderate BMI. A total of 78.7% of children were within the weight norm. Among girls, extreme obesity was two times more frequent than extreme underweight. The examined boys were significantly taller, heavier, and had a higher BMI than girls. There were significant differences between boys and girls in BMI; however, gender alone accounted for less than 1% variance. The influence of parents' characteristics was much greater, increasing the explained variance to 10%. Body weight of mothers and fathers (p < 0.001), mother's height (p < 0.01) and both parents' level of education (p < 0.001) were detected as significant predictors of children's BMI.

CONCLUSIONS

The analysis of selected sociodemographic and health factors determining the BMI of the child population indicates the need for preventive action and health promotion both among children and their parents.

Changes in Thyroid and Glycemic Status and Food Intake in Children with Excess Weight Who Were Submitted for a Multi-Component School Intervention for 16 Months

We investigated if children with excess weight who submitted to two types of intervention at school for 16 months showed improvements in thyroid and glycemic function and food intake. Children (8-11 years) with a body mass index-for-age (BMI/A) of ≥1 Z score were divided into two groups: Treatment 1 (n = 73) involved motivation to adopt healthier lifestyle; Treatment 2 (n = 103) involved performing weekly nutritional education, motivational, and physical activities at school. A semi-quantitative food frequency questionnaire was used. The delta BMI/A were similar after 16 months; Treatment 1 showed higher decrease in thyroid-stimulating hormone (TSH; median (range)): -0.45 (-3.19 to 2.17) and 0.06 (-4.57 to 1.63) mIU/L, p = 0.001), FreeT3 (-0.46 (-2.92 to 1.54) and -0.15 (-2.46 to 1.38) pmol/L, p = 0.038), and FreeT4 -1.41 (-6.18 to 3.47) and -0.90 (-4.89 to 2.96) pmol/L, p = 0.018), followed by decrease in energy intake (7304 (6806 to 7840) and 8267 (7739 to 8832) kJ, Ptreatment = 0.439, Ptime <0.001, interaction group-time p < 0.001), macronutrients and sugar. A positive correlation between FreeT3 and BMI/A, and a negative correlation with FreeT4 and insulin were found at baseline (r 0.212, p < 0.01; r -0.155, p < 0.01, respectively) and follow-up (r 0.222, p < 0.01; r -0.221, p < 0.01). The decrease in overall diet and particularly sugar intake was accompanied by a greater reduction in TSH and FreeT3 in Treatment 1, demonstrating the impact of dietary intake on thyroid function.

Prevention and Management of Childhood Obesity and Its Psychological and Health Comorbidities

Childhood obesity has become a global pandemic in developed countries, leading to a host of medical conditions that contribute to increased morbidity and premature death. The causes of obesity in childhood and adolescence are complex and multifaceted, presenting researchers and clinicians with myriad challenges in preventing and managing the problem. This article reviews the state of the science for understanding the etiology of childhood obesity, the preventive interventions and treatment options for overweight and obesity, and the medical complications and co-occurring psychological conditions that result from excess adiposity, such as hypertension, nonalcoholic fatty liver disease, and depression. Interventions across the developmental span, varying risk levels, and service contexts (e.g.,community, school, home, health care systems) are reviewed. Future directions for research are offered with an emphasis on translational issues for taking evidence-based interventions to scale in a manner that will reduce the public health burden of the childhood obesity pandemic.

Effectiveness of a school-based intervention on knowledge, attitude and practice on healthy lifestyle and body composition in Malaysian adolescents

Background

The ‘Eat Right, Be Positive About Your Body and Live Actively’ (EPaL) intervention programme was developed to prevent overweight and disordered eating in Malaysian adolescents. This study aimed to evaluate the effectiveness of the EPaL programme on knowledge, attitudes and practices on healthy lifestyle and body composition (body mass index z-score [zBMI], waist circumference [WC] and body fat percentage [BF%]) among adolescents.

Methods

All measures were taken at three time points: before intervention (Pre), after intervention (Post I) and 3 months after intervention (Post II). The intervention group (IG) participated in the EPaL programme for 16 weeks, whereas the comparison group (CG) received no intervention. Seventy-six adolescents (IG: n = 34; CG: n = 42) aged 13–14 years were included in the final analysis. Repeated measures analysis of covariance (ANCOVA) was used to assess the impact of the EPaL intervention programme on the measures between groups (IG and CG) at Post I and Post II.

Results

The IG reported significantly higher knowledge scores at both Post I (adjusted mean difference = 3.34; 95% confidence interval [CI] = 0.99, 5.69; p = 0.006) and Post II (adjusted mean difference = 2.82; 95% CI = 0.86, 4.78; p = 0.005) compared with the CG. No significant differences between the IG and CG were found at either Post I or Post II in attitudes, practices, zBMI, WC and BF%. The proportion of participants who were overweight or obese was consistent from Pre to Post II in the IG (35.3%) and increased from 26.2% at Pre to 28.5% at Post II in the CG, but the difference was not statistically significant. The proportion of participants who had abdominal obesity in the IG decreased from 17.6% at Pre to 14.7% at Post II and increased from 16.7% at Pre to 21.4% at Post II in the CG, but the differences were not statistically significant.

Conclusion

Despite no significant reduction of body composition, this programme shows the positive effect on the adolescents’ knowledge regarding healthy lifestyle. This study contributes to the evidence on the effectiveness of school-based health interventions in Malaysian adolescents.

Trial registration

UMIN Clinical Trial Registration UMIN000024349. Registered 11 October 2016.

Life on holidays: study protocol for a 3-year longitudinal study tracking changes in children's fitness and fatness during the in-school versus summer holiday period

BACKGROUND

Emerging evidence suggests that children become fatter and less fit over the summer holidays but get leaner and fitter during the in-school period. This could be due to differences in diet and time use between these distinct periods. Few studies have tracked diet and time use across the summer holidays. This study will measure rates of change in fatness and fitness of children, initially in Grade 4 (age 9 years) across three successive years and relate these changes to changes in diet and time use between in-school and summer holiday periods.

METHODS

Grade 4 Children attending Australian Government, Catholic and Independent schools in the Adelaide metropolitan area will be invited to participate, with the aim of recruiting 300 students in total. Diet will be reported by parents using the Automated Self-Administered 24-h Dietary Assessment Tool. Time use will be measured using 24-h wrist-worn accelerometry (GENEActiv) and self-reported by children using the Multimedia Activity Recall for Children and Adults (e.g. chores, reading, sport). Measurement of diet and time use will occur at the beginning (Term 1) and end (Term 4) of each school year and during the summer holiday period. Fitness (20-m shuttle run and standing broad jump) and fatness (body mass index z-score, waist circumference, %body fat) will be measured at the beginning and end of each school year. Differences in rates of change in fitness and fatness during in-school and summer holiday periods will be calculated using model parameter estimate contrasts from linear mixed effects model. Model parameter estimate contrasts will be used to calculate differences in rates of change in outcomes by socioeconomic position (SEP), sex and weight status. Differences in rates of change of outcomes will be regressed against differences between in-school and summer holiday period diet and time use, using compositional data analysis. Analyses will adjust for age, sex, SEP, parenting style, weight status, and pubertal status, where appropriate.

DISCUSSION

Findings from this project may inform new, potent avenues for intervention efforts aimed at addressing childhood fitness and fatness. Interventions focused on the home environment, or alternatively extension of the school environment may be warranted.

TRIAL REGISTRATION

Australia New Zealand Clinical Trials Registry, identifier ACTRN12618002008202 . Retrospectively registered on 14 December 2018.

Feasibility and efficacy of a web-based family telehealth nutrition intervention to improve child weight status and dietary intake: A pilot randomised controlled trial

INTRODUCTION

Innovative eHealth solutions that improve access to child weight management interventions are crucial to address the rising prevalence of childhood obesity globally. The study aimed to evaluate the feasibility and preliminary efficacy of a 12-week online telehealth nutrition intervention to improve child weight and dietary outcomes, and the impact of additional text messages (SMS) targeted to mothers and fathers.

METHODS

Families with children aged 4 to 11 were randomised across three groups: Telehealth, Telehealth+SMS, or Waitlist control. Telehealth and Telehealth+SMS groups received two telehealth consultations delivered by a dietitian, 12 weeks access to a nutrition website and a private Facebook group. The Telehealth+SMS group received additional SMS. Feasibility was assessed through recruitment, retention, and intervention utilisation. Efficacy was assessed through changes in measured child body mass index (BMI), waist circumference and diet.

RESULTS

Forty-four (96%) and 36 (78%) families attended initial and second telehealth consultations, respectively. Thirty-six families (78%) completed week 12 assessments. Child BMI and waist circumference changes from baseline to week 12 were not statistically different within or between groups. Children in Telehealth+SMS had significantly reduced percentage energy from energy-dense nutrient-poor food (95% CI -21.99 to -0.03%E; p = .038) and increased percentage energy from healthy core food (95% CI -0.21 to 21.89%E; p = .045) compared to Waitlist control.

DISCUSSION

A family-focused online telehealth nutrition intervention is feasible. While the modest sample size reduced power to detect between-group changes in weight status, some improvements in child dietary intakes were identified in those receiving telehealth and SMS.

Dose response relationship between program attendance and children's outcomes in a community based weight management program for children and their families

INTRODUCTION

The Go4Fun program in New South Wales, Australia is a community based weight management program for overweight and obese children aged 7-13 years and their families. This study assessed the impact of the number and type of sessions attended on body mass index (BMI) z-score, fruit and vegetable intake and physical activity and sedentary behaviours to determine the number of sessions required to achieve optimal program outcomes.

METHODS

Secondary analysis was conducted on pre and post participant program data collected over 3.5 years. Relationships between session attendance and program outcomes were assessed using Spearman's correlation and multivariate analyses of variance and multivariate regression. Number of sessions required to achieve optimal program outcomes was determined using piecewise linear regression.

RESULTS

For 3090 participants (48.5% of registrants) who attended at least five sessions, outcome measures improved significantly at post program compared with pre (p < 0.01). No relationships were seen between number and type of sessions attended and outcome measures. Children of mothers without a post-school qualification (university degree or vocational qualification) were more likely to achieve lower levels of improvements in BMI z-score (p = 0.02) and vegetable intake (P < 0.01) than those children with post-school qualified mothers (F = 3.68, p = 0.03). Children of mothers without post-school education that attended seven sessions or more achieved significantly better BMI z-score outcomes (p < 0.01) than those who attended fewer sessions.

CONCLUSIONS

Maternal educational attainment influences program attendance and health and behavioural outcomes in a family based obesity treatment program.

Life on holidays: differences in activity composition between school and holiday periods in Australian children

BACKGROUND

Recently, a small number of studies have suggested that gains in fitness and reductions in body fat achieved during the school term are reversed or stagnate during the holiday period. This may be associated with changed activity patterns. The aim of this study was to compare 24-h activity compositions between school and holiday periods in Australian children.

METHODS

The participants in this study were 366 children (53% female, 13.4 ± 2.3 years) who were a subgroup of the 2007 Australian National Children's Nutrition and Physical Activity Survey. Each child recalled use of time on at least one school day, one weekend day and one holiday using the Multimedia Activity Recall for Children and Adults. Composite "in-term" and "holiday" use-of-time profiles were generated by weighting school days by 5, and weekends by 2 where data were available. Difference between holiday and in-term time use was assessed using a compositional multivariate linear model for repeated measures. Subsequent models tested for interaction between time of measurement and socio-economic status or body mass index.

RESULTS

Time use was significantly different between holidays and in-term days (F = 103, p < 0.0001). On holidays, children accumulated 140 min less School-related time, compensated by sleeping 40 min longer, 58 min more Screen Time, and 35 min more Domestic/Social time. Children spent 10 min less in vigorous physical activity, and although sitting time was 33 min/day less during holidays, estimated total daily energy expenditure (TDEE) was 5.4% lower. Differences between holiday and in-term activity compositions did not vary by parental education (F = 1.2, p = 0.25), postcode-level socio-economic status (F = 0.9, p = 0.56) or weight status (F = 1.7, p = 0.07).

CONCLUSIONS

In this subsample of a nationally representative survey of Australian children, holidays were characterised by longer sleep and higher TV and videogame time, lower vigorous activity and lower TDEE. Uncompensated by dietary adjustments, these differences would result in an accumulation of about 650 g of fat over a six-week holiday period. Holiday activity patterns may be a promising focus for obesity prevention efforts.

Development of the iCook 4-H Curriculum for Youth and Adults: Cooking, Eating, and Playing Together for Childhood Obesity Prevention

The objective was to describe the development process of a curriculum (iCook 4-H) targeted to low-income, rural, and/or diverse youths and their adult primary meal preparer to promote cooking, eating, and playing together. Lessons learned highlighted the importance of grounding the curriculum in Social Cognitive Theory and applying the experiential 4-H learning model using a multiphased, community-based participatory approach with cyclical development and evaluation, and key modifications made for dissemination and distribution. Findings across 4 testing phases over 6 years and 5 states demonstrated the time-intensive, cyclical process that required flexibility with fidelity to form a hands-on, interactive curriculum.

The iCook 4-H Study: Report on Physical Activity and Sedentary Time in Youth Participating in a Multicomponent Program Promoting Family Cooking, Eating, and Playing Together

OBJECTIVE

To report physical activity and sedentary time outcomes of youth in iCook 4-H.

STUDY DESIGN AND SETTING

iCook 4-H was a 5-state, randomized, control-treatment, family-based childhood obesity prevention intervention promoting cooking, eating, and playing together.

PARTICIPANTS AND INTERVENTION

Youth aged 9-10 years and the main preparer of their meals participated in the 12-week program followed by monthly newsletters and biyearly booster sessions until 24 months.

MAIN OUTCOME MEASURE(S)

A total of 155 youth were fitted with an Actigraph GT3X+ accelerometer, which they wore for 7 days at baseline and 4, 12, and 24 months to measure mean daily minutes per hour of waking wear time for sedentary time (ST), light physical activity (PA) (LPA), moderate PA, vigorous PA, and moderate to vigorous PA. Self-reported PA was assessed using the Block Kids Physical Activity Screener and additional questions querying for the program goal of the frequency of family actively playing together. Linear mixed models were used to determine differences from baseline to 24 months. Significance was set at P ≤ .05.

RESULTS

There was a significant (P < .05) group × time interaction for LPA (adjusted interaction B estimate, 95% confidence interval; 0.18 [0.05, 0.30]) and ST (-0.15 [-0.26, -0.04]); ST increased and LPA decreased in the treatment group. There were no differences in other accelerometer-derived PA measures, self-report Block Kids Physical Activity Screener measures, or frequency of family actively playing together at any time point.

CONCLUSIONS AND IMPLICATIONS

iCook 4-H was a multicomponent program observing youth aged 9-10 years for 24 months that focused on enhancing cooking skills, mealtime behavior and conversation, and PA through daily family activities. Greater emphasis on developing PA skills, changing environmental factors, and increasing PA both in and after school may be needed.

The Obemat2.0 Study: A Clinical Trial of a Motivational Intervention for Childhood Obesity Treatment

The primary aim of the Obemat2.0 trial was to evaluate the efficacy of a multicomponent motivational program for the treatment of childhood obesity, coordinated between primary care and hospital specialized services, compared to the usual intervention performed in primary care. This was a cluster randomized clinical trial conducted in Spain, with two intervention arms: motivational intervention group vs. usual care group (as control), including 167 participants in each. The motivational intervention consisted of motivational interviewing, educational materials, use of an eHealth physical activity monitor and three group-based sessions. The primary outcome was body mass index (BMI) z score increments before and after the 12 (+3) months of intervention. Secondary outcomes (pre-post intervention) were: adherence to treatment, waist circumference (cm), fat mass index (z score), fat free mass index (z score), total body water (kg), bone mineral density (z score), blood lipids profile, glucose metabolism, and psychosocial problems. Other assessments (pre and post-intervention) were: sociodemographic information, physical activity, sedentary activity, neuropsychological testing, perception of body image, quality of the diet, food frequency consumption and foods available at home. The results of this clinical trial could open a window of opportunity to support professionals at the primary care to treat childhood obesity. The clinicaltrials.gov identifier was NCT02889406.

Prognostic Value of Ultrasound Stratigraphy in Long-Term Weight Loss: Results from a Nutritional Counseling Program

BACKGROUND

Weight control through lifestyle interventions represents a suitable strategy to avoid the metabolic, endocrine, and reproductive comorbidities associated with overweight and obesity. Reduced testosterone (T) levels are a worsening factor in overweight males. However, prognostic parameters of long-term weight loss are not readily available. Here, we tested the prognostic value of early variations of anthropometric and hormonal parameters, with a focus on ultrasound stratigraphy (US) and the reduction in body mass index (BMI) associated with nutritional counseling/lifestyle interventions at 6-month follow-up.

METHODS

Ninety-five male subjects (BMI 25-34.9 kg/m2) who had undergone nutritional/lifestyle interventions, were retrospectively analyzed for: body weight and composition; US evaluation at the triceps (TRC), abdominal (ABD), and thigh (THI) areas; and circulating levels of T, luteinizing hormone, and follicle-stimulating hormone. Sixty patients (63.2%) completed the 6-month follow-up program.

RESULTS

At 6 months, a significant reduction in BMI (26.38 ± 1.55 vs. 31.5 ± 5.0 basal, p < 0.001) and increase in T levels (18 ± 5.4 vs. 9.5 ± 2.3 nmol/L basal, p = 0.04) were observed. Subjects in the highest quartile of the BMI reduction at 6 months (ΔBMI 6 mo), compared to the lowest, showed a significant difference at the 2-month follow-up variation of BMI (p = 0.025), and fat and muscle thickness at the TRC (both p < 0.001) and ABD (p < 0.001 and p = 0.002, respectively) areas. Variation of TRC muscle thickness at 2 months was the only independent predictor of ΔBMI 6 mo in the multiple stepwise regression analysis.

CONCLUSIONS

BMI evaluation and US represent useful monitoring tools in the follow-up of nutritional/lifestyle interventions for overweight-to-mildly obese patients. The important effects on motivation and adherence to the intervention program are to be considered.

Lifestyle weight management programmes for children: A systematic review using Qualitative Comparative Analysis to identify critical pathways to effectiveness

This study aimed to identify critical features of successful lifestyle weight management interventions for overweight children (0-11years). Eleven qualitative UK-based studies examining children's, parents' and providers' perspectives and experiences of programmes were synthesised to identify components felt to be critical. Studies for this views synthesis were identified from existing reviews and an update of one review's search, which was run in December 2015. The identified components were then explored in a synthesis of intervention evaluations (five 'most effective' and 15 'least effective') conducted in western Europe, North America, Australia or New Zealand. The intervention evaluations were identified from existing reviews and an update of one review's search, which was run in March 2016. This evaluation synthesis was carried out using Qualitative Comparative Analysis. Three important mechanisms were present in all the most effective interventions but absent in all the least effective: 1/ showing families how to change: a) providing child physical activity sessions, b) delivering practical behaviour change strategy sessions, c) providing calorie intake advice; 2/ ensuring all the family are on board: a) delivering discussion/education sessions for both children and parents, b) delivering child-friendly sessions, c) aiming to change behaviours across the whole family; 3/ enabling social support for both parents and children by delivering both child group sessions and parent group sessions. To conclude, programmes should ensure the whole family is on board the programme, that parents and children can receive social support and are not just told what to change, but shown how.

Impact evaluation of "Have Fun - Be Healthy" program: A community based health promotion intervention to prevent childhood obesity

ISSUE ADDRESSED

Childhood obesity is rising in prevalence in Australia. This study aimed to evaluate the impact of the "Have Fun-Be Healthy" (HFBH) intervention, delivered in the Playgroup setting, to generate short term changes in dietary, physical activity and sedentary behaviours of children under 5 years and self-efficacy of parents and primary carers.

METHODS

This intervention consisted of eight structured cooking and physical play sessions delivered over a period of 8 weeks by trained facilitators. Pre- and post-intervention data collection was performed using survey questionnaires administered to parents and carers of children under 5 years from low socioeconomic backgrounds recruited through convenience sampling.

RESULTS

A total of 640 pre-intervention surveys and 312 post-intervention surveys were returned. The matched response rate was 45.5%. There was an improvement in mean intake of healthy foods and mean physical activity with a decrease in mean intake of unhealthy food and mean screen time in children (P > .05). Following the intervention, parental/carer self-efficacy in promoting healthy eating and limiting screen time of children improved significantly (P < .05). Children's physical activity levels and consumption of healthy foods were positively correlated with parental/carer self-efficacy (P < .01) while screen time and consumption of unhealthy foods were negatively correlated (P < .01).

CONCLUSIONS

HFBH intervention was successful in improving the dietary, physical activity and screen time in children and parental self-efficacy. SO WHAT?: Being amongst the first of its' kind in Australia, the findings of this study can have implications for developing and implementing similar future health promotion interventions in comparable settings.

How effective are family-based and institutional nutrition interventions in improving children's diet and health? A systematic review

BACKGROUND

Effective strategies to improve dietary intake in young children are a priority to reduce the high prevalence of chronic non-communicable diseases in adulthood. This study aimed to assess the impact of family-based and school/preschool nutrition programs on the health of children aged 12 or younger, including the sustainability of these impacts and the relevance to socio-economic inequalities.

METHODS

A systematic review of literature published from 1980 to December 2014 was undertaken. Randomised controlled trials involving families with children aged up to 12 years in high income countries were included. The primary outcomes were dietary intake and health status. Results were presented in a narrative synthesis due to the heterogeneity of the interventions and outcomes.

RESULTS

The systematic search and assessment identified 39 eligible studies. 82% of these studies were set in school/preschools. Only one school study assessed the impact of involving parents systematically. The family-based programs which provided simple positive dietary advice to parents and regular follow-up reduced fat intake significantly. School and family-based studies, if designed and implemented well, increased F&V intake, particularly fruit. Effective school-based programs have incorporated role-models including peers, teachers and heroic figures, rewards and increased access to healthy foods. School nutrition programs in disadvantaged communities were as effective as programs in other communities.

CONCLUSIONS

Family and school nutrition programs can improve dietary intake, however evidence of the long-term sustainability of these impacts is limited. The modest overall impact of even these successful programs suggest complementary nutrition interventions are needed to build a supportive environment for healthy eating generally.

Diet, physical activity and behavioural interventions for the treatment of overweight or obese adolescents aged 12 to 17 years

BACKGROUND

Adolescent overweight and obesity has increased globally, and can be associated with short- and long-term health consequences. Modifying known dietary and behavioural risk factors through behaviour changing interventions (BCI) may help to reduce childhood overweight and obesity. This is an update of a review published in 2009.

OBJECTIVES

To assess the effects of diet, physical activity and behavioural interventions for the treatment of overweight or obese adolescents aged 12 to 17 years.

SEARCH METHODS

We performed a systematic literature search in: CENTRAL, MEDLINE, Embase, PsycINFO, CINAHL, LILACS, and the trial registers ClinicalTrials.gov and ICTRP Search Portal. We checked references of identified studies and systematic reviews. There were no language restrictions. The date of the last search was July 2016 for all databases.

SELECTION CRITERIA

We selected randomised controlled trials (RCTs) of diet, physical activity and behavioural interventions for treating overweight or obesity in adolescents aged 12 to 17 years.

DATA COLLECTION AND ANALYSIS

Two review authors independently assessed risk of bias, evaluated the overall quality of the evidence using the GRADE instrument and extracted data following the guidelines of the Cochrane Handbook for Systematic Reviews of Interventions. We contacted trial authors for additional information.

MAIN RESULTS

We included 44 completed RCTs (4781 participants) and 50 ongoing studies. The number of participants in each trial varied (10 to 521) as did the length of follow-up (6 to 24 months). Participants ages ranged from 12 to 17.5 years in all trials that reported mean age at baseline. Most of the trials used a multidisciplinary intervention with a combination of diet, physical activity and behavioural components. The content and duration of the intervention, its delivery and the comparators varied across trials. The studies contributing most information to outcomes of weight and body mass index (BMI) were from studies at a low risk of bias, but studies with a high risk of bias provided data on adverse events and quality of life.The mean difference (MD) of the change in BMI at the longest follow-up period in favour of BCI was -1.18 kg/m2 (95% confidence interval (CI) -1.67 to -0.69); 2774 participants; 28 trials; low quality evidence. BCI lowered the change in BMI z score by -0.13 units (95% CI -0.21 to -0.05); 2399 participants; 20 trials; low quality evidence. BCI lowered body weight by -3.67 kg (95% CI -5.21 to -2.13); 1993 participants; 20 trials; moderate quality evidence. The effect on weight measures persisted in trials with 18 to 24 months' follow-up for both BMI (MD -1.49 kg/m2 (95% CI -2.56 to -0.41); 760 participants; 6 trials and BMI z score MD -0.34 (95% CI -0.66 to -0.02); 602 participants; 5 trials).There were subgroup differences showing larger effects for both BMI and BMI z score in studies comparing interventions with no intervention/wait list control or usual care, compared with those testing concomitant interventions delivered to both the intervention and control group. There were no subgroup differences between interventions with and without parental involvement or by intervention type or setting (health care, community, school) or mode of delivery (individual versus group).The rate of adverse events in intervention and control groups was unclear with only five trials reporting harms, and of these, details were provided in only one (low quality evidence). None of the included studies reported on all-cause mortality, morbidity or socioeconomic effects.BCIs at the longest follow-up moderately improved adolescent's health-related quality of life (standardised mean difference 0.44 ((95% CI 0.09 to 0.79); P = 0.01; 972 participants; 7 trials; 8 comparisons; low quality of evidence) but not self-esteem.Trials were inconsistent in how they measured dietary intake, dietary behaviours, physical activity and behaviour.

AUTHORS' CONCLUSIONS

We found low quality evidence that multidisciplinary interventions involving a combination of diet, physical activity and behavioural components reduce measures of BMI and moderate quality evidence that they reduce weight in overweight or obese adolescents, mainly when compared with no treatment or waiting list controls. Inconsistent results, risk of bias or indirectness of outcome measures used mean that the evidence should be interpreted with caution. We have identified a large number of ongoing trials (50) which we will include in future updates of this review.

A Community-Based Nutrition and Physical Activity Intervention for Children Who Are Overweight or Obese and Their Caregivers

There is a need for efficacious interventions to reduce the prevalence of childhood obesity, and a limited body of research suggests that collaborative community-based programs designed for children and their caregivers may be effective in reducing obesity rates. This paper reports the results of a community-based obesity intervention, South County Food, Fitness and Fun (SCFFF), designed for preadolescent children who are overweight or obese and their caregivers. SCFFF was developed in response to community concerns. Families were referred to the program by their physician and participated in the program at no cost. The 16-week intervention includes weekly group nutrition and physical activity sessions. Analyses determined that 65 out of the 97 children who completed SCFFF provided 2-year follow-up data and had reduced BMI z-scores over 2 years following the intervention. These participants decreased their energy, fat, carbohydrate, saturated fat, and sodium intake and increased core body strength and endurance from baseline to the end of the intervention. SCFFF was effective in reducing relative weight and improving diet and core muscle strength and endurance in children who are overweight or obese.

Multicomponent Lifestyle Interventions for Treating Overweight and Obesity in Children and Adolescents: A Systematic Review and Meta-Analyses

BACKGROUND

Treatment of childhood obesity is important in preventing development of obesity-related diseases later in life. This systematic review evaluates the effect of multicomponent lifestyle interventions for children and adolescents from 2 to 18 years.

METHODS AND RESULTS

We performed systematic searches in nine databases. Thirty-nine studies met the criteria for meta-analyses. We found a significant difference in body mass index (BMI) after 6 months (MD -0.99 (95% CI -1.36 to -0.61)), 12 months (MD -0.67 (95% CI -1.01 to -0.32)), and 24 months (MD -0.96 (95% CI -1.63 to -0.29)) in favour of multicomponent lifestyle interventions compared to standard, minimal, and no treatment. We also found a significant difference in BMI Z scores after 6 months (MD -0.12 (95% CI -0.17 to -0.06)), 12 months (MD -0.16 (95% CI -0.21 to -0.11)), and 24 months (MD -0.16 (95% CI -0.21 to -0.10)) in favour of multicomponent lifestyle interventions. Subgroup analyses suggested an increased effect in specialist health care with a group treatment component included in the intervention.

CONCLUSION

Multicomponent lifestyle interventions have a moderate effect on change in BMI and BMI Z score after 6, 12, and 24 months compared with standard, minimal, and no treatment.

Slowing BMI Growth Trajectories in Elementary School-Aged Children: The Northeast Iowa Food and Fitness Initiative

This project examines the Northeast Iowa Food and Fitness Initiative, a policy-, community-, and school-based effort to slow children's body mass index (BMI) growth over 6 years. Kindergarteners (K) to fifth graders (5) from 10 different school districts participated (N = 4101). Students with 0 to 1 years of initiative exposure showed greater growth in BMI compared with children who had 2 to 6 years of exposure, resulting in K-5 BMI savings of 1.5 points (6 lb) for median-height boys and girls. Results suggest that changes to policies, communities, and schools may provide effective obesity reduction in children.

Elementary School-Based Obesity Intervention Using an Educational Curriculum

BACKGROUND

Pediatric obesity is a significant public health problem with a prevalence of 16.9% among US children. School-based obesity interventions show promise for reducing adiposity in elementary age children. This pilot study evaluated the impact of the Let's Go! 5-2-1-0 pediatric obesity intervention program in an elementary school setting.

METHODS

This was a cluster randomized controlled field trial comprising 8 classrooms of second- and third-grade children. The impact of implementation of a standardized 5-2-1-0 curriculum was evaluated in the classrooms by looking at health behavior (self-reported fruit and vegetable and sugar-containing beverage intake, and screen time), physical activity (steps measured by pedometer), and body mass index (BMI). Half of the classrooms were given 5-2-1-0 teaching over a 4-month period.

RESULTS

There was no statistical difference in improvement of healthy habits, BMI, or physical activity in the intervention group compared with the control group.

CONCLUSIONS

The 5-2-1-0 intervention used in this study was feasible. There was no significant change in healthy habits, likely due to the small number of participants in the study. The intervention and control sites were in different classrooms and there could be factors such as teacher enthusiasm, socioeconomic factors, and individual traits affecting habits. Future studies could use pre- and post-intervention quizzes to assess healthy habits knowledge retention, involving the environments the child participates in outside of school, using research-grade pedometers or accelerometers for measuring activity data collection, and recruiting larger samples to ensure adequate statistical power.

Outcome Analysis of The B.E. S.T.R.O.N.G. Childhood Obesity Treatment Program: Effectiveness of an Eight-Week Family-Based Childhood Obesity Program Using an Internet-Based Health Tracker

BACKGROUND

We describe the development, testing, and analysis of the B.E. S.T.R.O.N.G. program, a comprehensive family-based multidisciplinary child obesity treatment program. The program uses an innovative Internet-based health tracker that was developed by the Children's Wellness Institute (CWI) for data collection, analysis, and storage.

METHODS

Data were obtained on 112 subjects who enrolled in the B.E. S.T.R.O.N.G. program in several healthcare institutions during the 2013-2014 academic year. There were 74 females and 38 males. The mean age was 9.75 ± 2.21 years. There were 89 white, 14 African American, 3 Hispanic, and 6 listed as other. Height and weight data were collected during the first, fourth, and seventh week. Diet and exercise data were collected in a HIPAA-compliant manner each week for seven weeks, using the health tracker, and transmitted electronically for statistical analysis and storage.

RESULTS

Subjects involved in the program demonstrated significant weight loss, averaging 3.8% reduction in BMI from their starting point. Weight loss in these subjects was associated with significant and measurable changes in diet, physical activity, and screen time. Participants in the B.E. S.T.R.O.N.G. program increased fruit and vegetable consumption to more than five daily servings and also demonstrated significant increases in the consumption of grains and protein foods. Furthermore, they maintained screen time at less than one hour per day, and increased all forms of physical activity to exceed one hour daily.

CONCLUSIONS

The Internet-based health tracker demonstrated the effectiveness of the B.E. S.T.R.O.N.G. program, delivered by several healthcare institutions, in treating childhood obesity.

Relationship between Czech Parent and Child Pedometer-assessed Weekday and Weekend Physical Activity and Screen Time

AIM

Uncovering the influences of parents' behaviour on their children's physical activity provides an insight into the lifestyle of families and development of effective family-based interventions. The aim of this study was to determine the relationship between parents' behaviour (step count (SC) and screen time (ST)) and children's SC on weekdays and at weekends.

METHODS

The participants (388 parents aged 35-45 and their 485 children aged 9-12) were randomly recruited from 21 Czech government funded primary schools. The participants recorded SC and ST duration for seven consecutive days (≥ 10 h/day) during April-May and September-October 2013. The associations between parents' behaviour (SC and ST) and children's SC were estimated using general linear regression separately for weekdays and weekends. Each 1,000 SC increase in mothers' (fathers') SC/weekday was associated with an extra 261 SC/day in their daughters and 413 (244) SC/day in their sons.

RESULTS

Each 1,000 SC increase in mothers' (fathers') SC/weekend day was associated with an extra 523 (386) SC/day in their daughters and 508 (435) SC/day in their sons. A reduction in mothers' ST by 30 minutes per weekend day was associated with an extra 494 SC/day in their daughters and 467 SC/day in their sons.

CONCLUSIONS

This study reveals a quantifiable relationship between parent-child SC/day and mothers' ST and children's SC at weekends. Weekend days are more suitable for the implementation of family-based interventions.

Implementing Child-focused Activity Meter Utilization into the Elementary School Classroom Setting Using a Collaborative Community-based Approach

INTRODUCTION

The prevalence of pediatric obesity has increased over the past 3 decades and is a pressing public health program. New technology advancements that can encourage more physical in children are needed. The Zamzee program is an activity meter linked to a motivational website designed for children 8-14 years of age. The objective of the study was to use a collaborative approach between a medical center, the private sector and local school staff to assess the feasibility of using the Zamzee Program in the school-based setting to improve physical activity levels in children.

METHODS

This was a pilot 8-week observational study offered to all children in one fifth grade classroom. Body mass index (BMI), the amount of physical activity by 3-day recall survey, and satisfaction with usability of the Zamzee Program were measured pre- and post-study.

RESULTS

Out of 11 children who enrolled in the study, 7 completed all study activities. In those who completed the study, the median (interquartile range) total activity time by survey increased by 17 (1042) minutes and the BMI percentile change was 0 (8). Both children and their caregivers found the Zamzee Activity Meter (6/7) and website (6/7) "very easy" or "easy" to use.

CONCLUSION

The Zamzee Program was found to be usable but did not significantly improve physical activity levels or BMI. Collaborative obesity intervention projects involving medical centers, the private sector and local schools are feasible but the effectiveness needs to be evaluated in larger-scale studies.

The Healthy Migrant Families Initiative: development of a culturally competent obesity prevention intervention for African migrants

Background

Although obesity among immigrants remains an important area of study given the increasing migrant population in Australia and other developed countries, research on factors amenable to intervention is sparse. The aim of the study was to develop a culturally-competent obesity prevention program for sub-Saharan African (SSA) families with children aged 12–17 years using a community-partnered participatory approach.

Methods

A community-partnered participatory approach that allowed the intervention to be developed in collaborative partnership with communities was used. Three pilot studies were carried out in 2008 and 2009 which included focus groups, interviews, and workshops with SSA parents, teenagers and health professionals, and emerging themes were used to inform the intervention content. A cultural competence framework containing 10 strategies was developed to inform the development of the program. Using findings from our scoping research, together with community consultations through the African Review Panel, a draft program outline (skeleton) was developed and presented in two separate community forums with SSA community members and health professionals working with SSA communities in Melbourne.

Results

The ‘Healthy Migrant Families Initiative (HMFI): Challenges and Choices’ program was developed and designed to assist African families in their transition to life in a new country. The program consists of nine sessions, each approximately 1 1/2 hours in length, which are divided into two modules based on the topic. The first module ‘Healthy lifestyles in a new culture’ (5 sessions) focuses on healthy eating, active living and healthy body weight. The second module ‘Healthy families in a new culture’ (4 sessions) focuses on parenting, communication and problem solving. The sessions are designed for a group setting (6–12 people per group), as many of the program activities are discussion-based, supported by session materials and program resources.

Conclusion

Strong partnerships and participation by SSA migrant communities enabled the design of a culturally competent and evidence-based intervention that addresses obesity prevention through a focus on healthy lifestyles and healthy families. Program implementation and evaluation will further inform obesity prevention interventions for ethnic minorities and disadvantaged communities.

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.

Treatment of overweight and obesity in children and youth: a systematic review and meta-analysis

BACKGROUND

Childhood obesity is a public health concern. One-third of North American children and youth are overweight or obese. We reviewed the evidence of behavioural and pharmacological weight-management interventions on body mass index (BMI), BMI z-score and the prevalence of overweight and obesity in children and youth.

METHODS

We updated the search of a previous review. We searched 4 databases up to August 2013. We included randomized trials of primary care-relevant behavioural (diet, exercise, lifestyle) and pharmacological (orlistat) interventions for treating overweight and obesity in children and youth aged 2-18 years if 6-month post-baseline data were provided for BMI, BMI z-score or prevalence of overweight and obesity. In addition, we examined secondary health outcomes such as lipid and glucose levels, blood pressure, quality of life and physical fitness. We included any study reporting harms. We performed meta-analyses when possible, and we examined the features of interventions that showed benefits.

RESULTS

Thirty-one studies (29 behavioural, 2 pharmacological and behavioural) were included. Both intervention types showed a significant effect on BMI or BMI z-score in favour of treatment (behavioural: standardized mean difference [SMD] -0.54, 95% confidence interval [CI] -0.73 to -0.36; orlistat plus behavioural: SMD -0.43, 95% CI -0.60 to -0.25). Studies reported no significant difference between groups in the likelihood of reduced prevalence of overweight or overweight and obesity. Pooled estimates for blood pressure and quality of life showed significant benefits in favour of treatment (systolic blood pressure mean difference [MD] -3.42, 95% CI -6.65 to -0.29; diastolic blood pressure MD -3.39, 95% CI -5.17 to -1.60; quality of life MD 2.10, 95% CI 0.60 to 3.60). Gastrointestinal difficulties were more common in youth taking orlistat than in the control group (risk ratio 3.77, 95% CI 2.56 to 5.55). We saw much variability across efficacious interventions.

INTERPRETATION

Low- to moderate-quality evidence suggests behavioural treatments are associated with a medium effect in terms of reduced BMI or BMI z-score compared with a small effect shown by combined pharmacological-behavioural interventions. Future research should evaluate active weight maintenance interventions in adolescents with longer follow-up and examine the effectiveness of combined pharmacological and behavioural interventions.

REGISTRATION

PROSPERO no. CRD42012002754.

Prevention of overweight and obesity in children and youth: a systematic review and meta-analysis

BACKGROUND

One-third of Canadian children are overweight or obese. This problem carries considerable concern for negative impacts on current and future health. Promoting healthy growth and development is critical. This review synthesized evidence on the effectiveness of behavioural interventions for preventing overweight and obesity in children and adolescents.

METHODS

We updated the search of a previous Cochrane review. Five databases were searched up to August 2013. Randomized trials of primary care-relevant behavioural (diet, exercise and lifestyle) interventions for preventing overweight and obesity in healthy normal- or mixed-weight children or youth aged 0-18 years were included if 12-week postbaseline data were provided for body mass index (BMI), BMI z-score, or prevalence of overweight or obesity. Any study reporting harms was included. Meta-analyses were performed if possible. Features of interventions showing significant benefits were examined.

RESULTS

Ninety studies were included, all with mixed-weight populations. Compared with controls, interventions showed a small but significant effect on BMI and BMI z-score (standardized mean difference -0.07, 95% confidence interval [CI] -0.10 to -0.03, I (2) = 74%), a reduction in BMI (mean difference -0.09 kg/m(2), 95% CI -0.16 to -0.03, I (2) = 76%) and a reduced prevalence of overweight and obesity (risk ratio [RR]; RRintervention - RRcontrol 0.94, 95% CI 0.89 to 0.99, I (2) = 0%; number needed to treat 51, 95% CI 29 to 289). Little evidence was available on harms. There was variability across efficacious interventions, although many of the interventions were short-term, involved school-aged children and were delivered in educational settings.

INTERPRETATION

Behavioural prevention interventions are associated with small improvements in weight outcomes in mixed-weight populations of children and adolescents. No intervention strategy consistently produced benefits.

REGISTRATION

PROSPERO no. CRD42012002754.

Beyond BMI: The Next Chapter in Childhood Obesity Management

Pediatric obesity treatment has traditionally focused on body mass index (BMI) and has had limited success. Recent research has suggested new ways to approach this topic that focuses more on holistic measures of health and inclusion of a larger population of children. This paper discusses new evidence in the prevention of chronic disease and treatment of obesity that has a body positive and mental health lens as well as integrating research from several areas of health, including the prevention of chronic disease. Practical medical and mental health assessments tools are suggested for clinical use. Implications for an individualized, positive treatment future are presented.