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Davison GM, Monocello LT, Lipsey K, Wilfley DE. Evidence Base Update on Behavioral Treatments for Overweight and Obesity in Children and Adolescents. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2023; 52:589-603. [PMID: 37683261 PMCID: PMC10586458 DOI: 10.1080/15374416.2023.2251164] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/10/2023]
Abstract
OBJECTIVE This review provides an update to a previous Evidence Base Update addressing behavioral treatments for overweight and obesity in children and adolescents. METHOD Articles were identified through a systematic search of the biomedical literature in PubMed/MEDLINE (1946-), Elsevier EMBASE (1947-), SCOPUS (1823-), Clarivate Web of Science Core Collection (WOS, 1900-), PsycINFO (1800-), The Cochrane Library and Clinicaltrials.gov published between June 2014 and August 2022. RESULTS Family-based treatment (FBT) remains a well-established treatment for overweight and obesity in children and is now well-established in adolescents and toddlers. Parent-only behavioral treatment remains well-established in children and is now well-established among adolescents and children. Possibly effective treatments continue to include FBT-parent only for adolescents, and behavioral weight loss (BWL) with a family component for adolescents, children, and toddlers. Several variations of FBT and BWL can now be considered possibly effective including FBT+motivational interviewing, FBT+social facilitation maintenance, group-based FBT, low-dose FBT, BWL+stress management, and camp-based BWL. Cognitive behavioral treatment (CBT) for adolescents also met criteria for possibly effective treatments. Current research has also established that behavioral treatments can be effectively delivered in alternative settings (e.g. primary care) and through alternative mediums (e.g. telehealth). CONCLUSIONS Research continues to support the use of multicomponent lifestyle interventions in accordance with recent recommendations from the American Academy of Pediatrics, the American Psychological Association, and the United State Preventative Services Task Force. However, more work is needed to ensure appropriate access for children with comorbid medical and psychiatric disorders and children from socially, politically, and economically marginalized groups.
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Affiliation(s)
- Genevieve M. Davison
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Lawrence T. Monocello
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Kim Lipsey
- Bernard Becker Medical Library, Washington University School of Medicine, St. Louis, MO, USA
| | - Denise E. Wilfley
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
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Baygi F, Djalalinia S, Qorbani M, Larrabee Sonderlund A, Kousgaard Andersen MK, Thilsing T, Heitmann BL, Nielsen JB. The effect of psychological interventions targeting overweight and obesity in school-aged children: a systematic review and meta-analysis. BMC Public Health 2023; 23:1478. [PMID: 37537523 PMCID: PMC10398924 DOI: 10.1186/s12889-023-16339-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 07/18/2023] [Indexed: 08/05/2023] Open
Abstract
BACKGROUND Multi-component psychological interventions may mitigate overweight and obesity in children and adolescents. Evidence is, however, scattered on the effectiveness of such interventions. This study aims to review the available evidence on the effectiveness of multi-component psychological interventions on anthropometric measures of school-aged children with overweight or obesity. METHODS We systematically searched international databases/search engines including PubMed and NLM Gateway (for MEDLINE), Web of Science, SCOPUS, and Google Scholar up to November 2022 for relevant articles pertaining to psychological weight-loss interventions targeting school-aged children. Two reviewers screened and extracted pertinent data. The quality of included studies was assessed using the Cochrane Risk of Bias Tool for Randomized Trials. Random effect meta-analysis was used to calculate, and pool standardized mean differences (SMD). We distinguished between intervention and maintenance effects. Intervention effects were defined as the mean change in outcome measurement detected between baseline and post-treatment. Maintenance effects were defined as the mean change in outcome measurement between post-treatment and last follow-up. RESULTS Of 3,196 studies initially identified, 54 and 30 studies were included in the qualitative and quantitative syntheses, respectively. Most studies reported on group-based interventions. The significant effects of intervention on BMI z-score (SMD -0.66, 95% CI: -1.15, -0.17) and WC (SMD -0.53, 95% CI: -1.03, -0.04) were observed for interventions that centered on motivational interviewing and cognitive behavioral therapy, respectively. Mean BMI and WC did not differ significantly between post-treatment and last follow-up measurement (maintenance effect), indicating that an initial weight loss obtained through the intervention period could be maintained over time. CONCLUSIONS Findings indicate that motivational interviewing and cognitive behavioral therapy as interventions to reduce BMI z-score (generalized obesity) and waist circumference (abdominal obesity) are effective and durable. However, detailed analyses on individual components of the interventions are recommended in future effectiveness studies.
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Affiliation(s)
- Fereshteh Baygi
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark.
| | - Shirin Djalalinia
- Ministry of Health and Medical Education, Deputy of Research & Technology, Tehran, Iran
| | - Mostafa Qorbani
- Non-Communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran.
| | - Anders Larrabee Sonderlund
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | | | - Trine Thilsing
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Berit Lilienthal Heitmann
- Research Unit for Dietary Studies, the Parker Institute, Frederiksberg and Bispebjerg Hospital, Frederiksberg, Denmark
- Section for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Jesper Bo Nielsen
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
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Hassapidou M, Duncanson K, Shrewsbury V, Ells L, Mulrooney H, Androutsos O, Vlassopoulos A, Rito A, Farpourt N, Brown T, Douglas P, Ramos Sallas X, Woodward E, Collins C. EASO and EFAD Position Statement on Medical Nutrition Therapy for the Management of Overweight and Obesity in Children and Adolescents. Obes Facts 2023; 16:29-52. [PMID: 36349767 PMCID: PMC9890183 DOI: 10.1159/000527540] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 09/21/2022] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION This position statement on medical nutrition therapy in the management of overweight or obesity in children and adolescents was prepared by an expert committee convened by the European Association for the Study of Obesity (EASO) and developed in collaboration with the European Federation of the Associations of Dietitians (EFAD). METHODS It is based on the best evidence available from systematic reviews of randomized controlled trials on child and adolescent overweight and obesity treatment and other relevant peer-reviewed literature. RESULTS Multicomponent behavioural interventions are generally considered to be the gold standard treatment for children and adolescents living with obesity. The evidence presented in this position statement confirms that dietary interventions can effectively improve adiposity-related outcomes. Dietary strategies should focus on the reduction of total energy intake through promotion of food-based guidelines that target modification of usual eating patterns and behaviours. These should target increasing intakes of nutrient-rich foods with a lower energy density, specifically vegetables and fruits, and a reduction in intakes of energy-dense nutrient-poor foods and beverages. In addition, higher intensity, longer duration treatments, delivered by interventionists with specialized dietetic-related skills and co-designed with families, are associated with greater treatment effects. DISCUSSION Such interventions should be resourced adequately so that they can be implemented in a range of settings and in different formats, including digital or online delivery, to enhance accessibility.
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Affiliation(s)
- Maria Hassapidou
- Department of Nutritional Sciences & Dietetics, International Hellenic University, Thessaloniki, Greece
- ESDN Obesity, European Federation of the Associations of Dieticians, Naarden, The Netherlands
| | - Kerith Duncanson
- School of Medicine and Public Health, The University of Newcastle Australia, Callaghan, New South Wales, Australia
| | - Vanessa Shrewsbury
- School of Health Sciences, College of Health, Medicine and Wellbeing, The University of Newcastle Australia, Callaghan, New South Wales, Australia
| | - Louisa Ells
- Obesity Institute, School of Health, Leeds Beckett University, Leeds, UK
| | - Hilda Mulrooney
- ESDN Obesity, European Federation of the Associations of Dieticians, Naarden, The Netherlands
- Department of Life Sciences, Pharmacy and Chemistry, SEC Faculty, Kingston University London, Kingston upon Thames, UK
| | - Odysseas Androutsos
- ESDN Obesity, European Federation of the Associations of Dieticians, Naarden, The Netherlands
- Department of Nutrition-Dietetics, University of Thessaly, Trikala, Greece
| | - Antonis Vlassopoulos
- ESDN Obesity, European Federation of the Associations of Dieticians, Naarden, The Netherlands
- Department of Food Science & Human Nutrition, Agricultural University of Athens, Athens, Greece
- *Maria Hassapidou,
| | - Ana Rito
- National Institute of Health Ricardo Jorge I.P., Lisbon, Portugal
| | - Nathalie Farpourt
- Obesity Prevention and Care Program Contrepoids, Service of Endocrinology, Diabetology and Therapeutic Education, Department of Medicine, University Hospitals of Geneva and University of Geneva, Geneva, Switzerland
| | - Tamara Brown
- Applied Obesity Research Centre in the School of Health, Leeds Beckett University, Leeds, UK
| | - Pauline Douglas
- Nutrition Innovation Center for Food and Health (NICHE), School of Biomedical Sciences, Ulster University, Coleraine, UK
| | | | - Euan Woodward
- European Association for the Study of Obesity, Teddington, UK
| | - Clare Collins
- School of Health Sciences, College of Health, Medicine and Wellbeing, The University of Newcastle Australia, Callaghan, New South Wales, Australia
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Comparison of Hospital Consultation and Summer Camp Lifestyle Intervention Programs for Sustained Body Weight Loss in Overweight/Obese Greek Children. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9010086. [PMID: 35053711 PMCID: PMC8774901 DOI: 10.3390/children9010086] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 01/03/2022] [Accepted: 01/05/2022] [Indexed: 11/16/2022]
Abstract
Two lifestyle intervention programs of a health initiative named "Evrostia" were conducted at (a) an outpatient obesity clinic of a children's hospital and (b) summer camp (SC), respectively. Thirty overweight/obese children were randomly selected to participate in each intervention arm to assess the efficacy of the SC intervention and its possible superiority over usual hospital consultation (HC) practice. There was a statistically significant decrease in body weight (BW), and body mass index (BMI) in both programs. A higher duration of reduced BW was observed in the SC compared to HC intervention. Regarding the nutritional behavior, there was a significant increase in the consumption of breakfast, fruit and vegetables, and a reduction in the consumption of beverages and sweets in the SC group. A significant increase in the hours of weekly physical activity was also observed in children of the SC program. The comparison between the two lifestyle intervention programs showed that the SC program improved nutritional behaviors and physical activity and promoted longer preservation of BW loss than that of the HC program. Thus, the holistic and experiential approach of the SC program was more successful in the treatment of overweight and obesity in children than a conventional HC program.
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Caron T, Bernard P, Gadais T. Clinical and school-based intervention strategies for youth obesity prevention: A systematic review. Front Sports Act Living 2022; 4:906857. [PMID: 36923584 PMCID: PMC10008876 DOI: 10.3389/fspor.2022.906857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 12/31/2022] [Indexed: 03/03/2023] Open
Abstract
Introduction In the last couple of decades, numerous intervention strategies (ISs) have been formulated in school/community or clinical sectors using physical activity (PA) in order to prevent youth obesity because they have been highly effective in addressing this issue. These two sectors have revealed some interesting information in terms of efficient results and best practice mechanisms, but comparisons between them to learn about their functioning have been rare. Methods Therefore, the aim of this systematic review was to analyze and synthesize PA ISs from school/community or clinical domains for the period 2013-2017, in French or English, targeting youths aged 5-19 years old through primary, secondary, and tertiary prevention. Results In total, 68 full articles were reserved for data extraction and synthesis and 617 were excluded because they did not meet eligibility criteria (61 of 68 were kept for the final analysis). The results identified a number of differences between the studies of the various IS sectors and also a third type of IS, mixed sector. Mixed ISs (clinical and school-community) have a special advantage because they can benefit from the strengths of both school/community-based and clinical-based ISs. Mixed ISs showed the most promising results. This review also highlighted the differences between sectors and their ISs in terms of intervention teams, prevention objectives, duration, materials, and efficiency. Conclusion Future studies should focus on establishing a prevention program in a given geographical area involving all stakeholders with their respective skills/knowledge, in the area of decision-making and in the development of ISs, to ensure that the program is the most efficient and best adapted to its environment.
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Affiliation(s)
- Théo Caron
- Faculté des Sports et de l'EP, Université D'Artois, Liévin, France
| | - Paquito Bernard
- Département des Sciences de l'activité physique, Université du Québec à Montréal, Montréal, QC, Canada.,Research Center, University Institute of Mental Health at Montreal, Montréal, QC, Canada
| | - Tegwen Gadais
- Département des Sciences de l'activité physique, Université du Québec à Montréal, Montréal, QC, Canada.,UNESCO Chair in Curriculum Development (UCCD), Université du Québec à Montréal, Montréal, QC, Canada
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Can a Multicomponent-Overnight Camp Increase Physical Activity Among Danish Children? A Retrospective Cross-Sectional Study. J Phys Act Health 2021; 18:37-43. [PMID: 33373978 DOI: 10.1123/jpah.2020-0101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 08/25/2020] [Accepted: 10/06/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND In Denmark, most children are not sufficiently physically active and only a few interventions have been found to increase long-term physical activity among overweight and obese children. The aim of our study was to investigate if children are physically active in correspondence to Danish recommendations after attending a multicomponent-overnight camp. METHODS A questionnaire was developed to estimate children's physical activity level and behavior and investigate how transport, economy, availability, time, motivation, and knowledge about physical activity affect children's physical activity level and behavior. RESULTS In this study, 60.9% of the children did vigorous physical activity (VPA) minimum 30 minutes 3 times per week up to 3 years after camp. Most children were physically active at a sports club (44.3%) and only 5.7% of the children did not participate in physical activity. Parental physical activity and child motivation toward physical activity were significantly (P < .05) associated with children doing VPA. CONCLUSION Our findings suggest that 60.9% of children who attended camp engage in VPA after camp, which compared with a recent Danish study, is more frequent than children who did not attend camp. Further investigations are needed to determine the long-term health effects in children attending interventions such as multicomponent-overnight camps.
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Thomsen CF, Goharian TS, Larsen KT, Goetze JP, Andersen LB, Jeppesen JL. Intensive Lifestyle Intervention Increases Plasma Midregional Proatrial Natriuretic Peptide Concentrations in Overweight Children. J Am Heart Assoc 2021; 10:e020676. [PMID: 34180245 PMCID: PMC8403313 DOI: 10.1161/jaha.121.020676] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background Overweight adults have low circulating concentrations of ANP (atrial natriuretic peptide) and proANP fragments. We tested the hypothesis that an intensive lifestyle intervention with an intended weight loss would increase plasma concentrations of a proANP fragment in overweight children. Methods and Results We measured MR‐proANP (midregional proANP) concentrations in plasma from overweight children who participated in the OOIS (Odense Overweight Intervention Study). OOIS randomized 115 overweight children (11–13 years, 55% girls) to an intensive day‐camp intervention arm with increased physical activity and healthy diet or to a less intensive standard intervention arm for 6 weeks. We used linear mixed‐effects modeling for repeated measures to estimate the difference in the mean change with 95% CIs in fasting plasma MR‐proANP concentrations between the 2 arms, and we used partial least squares regression analysis to identify candidate mediators. Differences in weight, fitness, and metabolic factors were also analyzed. At baseline, fasting plasma MR‐proANP concentrations were (median [interquartile range]) 35.0 pmol/L (26.8–42.0) in the day‐camp intervention arm and 37.2 pmol/L (31.7–44.7) in standard intervention arm participants, respectively. After 6 weeks intervention, children in the day‐camp intervention arm had increased their MR‐proANP (5.4 pmol/L [0.8–10.0], P=0.022) and their fitness (2.33 mL O2/min per kg [0.52–4.14], P=0.012) and they had deceased their body mass index (−2.12 kg/m2 [−2.59 to −1.65], P<0.001) as compared with children in standard intervention arm. In the partial least squares analysis, decreases in fasting insulin and in estimated insulin resistance were associated with the observed increase in MR‐proANP concentrations. Conclusions An intensive lifestyle intervention increases plasma MR‐proANP among overweight children. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT01574352.
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Affiliation(s)
- Camilla F Thomsen
- Department of Medicine Amager Hvidovre Hospital in GlostrupUniversity of Copenhagen Glostrup Denmark
| | - Tina S Goharian
- Department of Clinical Biochemistry Nordsjællands Hospital HillerødUniversity of Copenhagen Hillerød Denmark
| | - Kristian T Larsen
- Center of Research in Childhood Health (RICH) Department of Sports Science and Clinical Biomechanics University of Southern Denmark Odense Denmark
| | - Jens P Goetze
- Department of Clinical Biochemistry Rigshospitalet BlegdamsvejUniversity of Copenhagen Denmark.,Department of Biomedical Sciences Faculty of Health and Medical Sciences University of Copenhagen Denmark
| | - Lars B Andersen
- Department of Sport, Food, and Natural Sciences Campus SogndalWestern Norway University of Applied Sciences, Sogndal Norway
| | - Jørgen L Jeppesen
- Department of Medicine Amager Hvidovre Hospital in GlostrupUniversity of Copenhagen Glostrup Denmark.,Department of Clinical Medicine Faculty of Health and Medical Sciences University of Copenhagen Denmark
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Long Q, Zhang T, Chen F, Wang W, Chen X, Ma M. Effectiveness of dietary interventions on weight outcomes in childhood: a systematic review meta-analysis of randomized controlled trials. Transl Pediatr 2021; 10:701-714. [PMID: 34012820 PMCID: PMC8107859 DOI: 10.21037/tp-20-183] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Rapid growth and elevated weight in childhood are significantly associated with obesity in later life, but evidence regarding dietary interventions and weight outcomes is lacking. This study aimed to determine the effectiveness of dietary interventions on body mass index (BMI) and BMI z-score in childhood. METHODS PubMed, EmBase, and the Cochrane library were searched from inception till June 2019. Studies that investigated the effectiveness of dietary interventions on BMI and BMI z-score in childhood were considered eligible in our study. The changes in BMI and BMI z-score between dietary interventions and control were calculated by pooled weighted mean differences (WMDs) and 95% CIs were evaluated using random-effects model. RESULTS Twenty-eight randomized controlled trials involving a total of 17,488 children were included. The summary WMDs indicated that children who received dietary interventions had greater reduction in BMI (WMD: -0.12; 95% CI: -0.20 to -0.05; P=0.001) and BMI z-score (WMD: -0.04; 95% CI: -0.06 to -0.02; P=0.001) when compared to the usual controls. Subgroup analyses revealed that the sample size, mean age, duration of interventions, and study quality could affect the effectiveness of dietary interventions in children. CONCLUSIONS The findings of this meta-analysis suggested that dietary interventions improved BMI and BMI z-score, whereas these results are limited due to substantial heterogeneity and study quality of the included studies.
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Affiliation(s)
- Qi Long
- Department of Clinical Nutrition, Children's Hospital of Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Ting Zhang
- Department of Clinical Nutrition, Children's Hospital of Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Fei Chen
- Department of Clinical Nutrition, Children's Hospital of Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Wenqiao Wang
- Department of Clinical Nutrition, Children's Hospital of Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Xia Chen
- Department of Clinical Nutrition, Children's Hospital of Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Ming Ma
- Department of Clinical Nutrition, Children's Hospital of Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China.,Department of Pediatrics, The Fourth Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
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Albornoz-Guerrero J, García S, de Sevilla GGP, Cigarroa I, Zapata-Lamana R. Characteristics of Multicomponent Interventions to Treat Childhood Overweight and Obesity in Extremely Cold Climates: A Systematic Review of a Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:3098. [PMID: 33802875 PMCID: PMC8002607 DOI: 10.3390/ijerph18063098] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 03/11/2021] [Accepted: 03/14/2021] [Indexed: 12/01/2022]
Abstract
AIM To analyze the characteristics of multicomponent interventions to reduce childhood overweight and obesity in territories with an extremely cold climate. METHODS A systematic review was conducted following the PRISMA statement. MEDLINE, PsycNet, SciELO, and grey literature databases were reviewed in the period between 2010 and 2020. RESULTS 29 articles were included (n = 4434 participants; 9.3 years; 56% women) with an average adherence of 86%, 100% being the highest adherence, for the physical activity and nutrition interventions. The primary variables studied were BMI, BMI Z-score BMI-SDS and, additionally, the secondary variables studied were nutritional status and physical and mental health. In 72% of the interventions presented, positive effects were seen on the reduction of BMI, including in parents and their children. The interventions were carried out mainly by nutritionists in health centers. The duration of the 29 interventions was ≤6 months and ≥12 months, in 59% and 41% of the studies, respectively. 57% of the studies reported post-intervention results. 86% of the interventions included a physical activity component, 80% included a nutrition component, 66% included a behavioral therapy component and 55% included an education component. Concerning the effects of the intervention on the primary outcome, in interventions with a duration equal to or less than six months, the most effective interventions included recreational activities, education, and nutritional programs. In interventions lasting 12 months or more, the most effective interventions included physical activity recommendations, nutritional and physical exercise programs, and cooking classes. CONCLUSIONS This systematic review analyzed the effectiveness of, and characterized, multicomponent interventions lasting for 6 and 12 months, aiming to treat childhood obesity in extremely cold climates. The most frequently used units of measurement were also analyzed and summarized. Evidence derived from RCT. These results can be useful for designing future interventions to treat childhood obesity in territories with an extremely cold climate.
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Affiliation(s)
- Javier Albornoz-Guerrero
- Departamento de Educación y Humanidades, Universidad de Magallanes, Punta Arenas 6200000, Chile;
| | - Sonia García
- Faculty of Sport Sciences, Universidad Europea de Madrid, 28670 Madrid, Spain;
| | | | - Igor Cigarroa
- Escuela de Kinesiología, Facultad de Salud, Universidad Santo Tomás, Los Ángeles 4440000, Chile;
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Bondyra-Wiśniewska B, Myszkowska-Ryciak J, Harton A. Impact of Lifestyle Intervention Programs for Children and Adolescents with Overweight or Obesity on Body Weight and Selected Cardiometabolic Factors-A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18042061. [PMID: 33672502 PMCID: PMC7923753 DOI: 10.3390/ijerph18042061] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 02/08/2021] [Accepted: 02/17/2021] [Indexed: 12/12/2022]
Abstract
Excessive body mass is a health problem among children and adolescents that contributes to the occurrence of lipid disorders and abnormal blood pressure. Effective treatment of excessive body mass in children is essential for the health of population in the future. The aim of the study was to identify universal components of lifestyle interventions in children and adolescents with overweight or obesity leading to weight loss and improvement of selected cardiometabolic parameters. The review included studies from the PubMed and Google Scholar databases published in 2010–2019, which were analyzed for eligibility criteria including age of the participants, BMI defined as overweight or obese, nutritional intervention and the assessment of BMI and/or BMI z-score and at least one lipid profile parameter. Eighteen studies were included in the review, presenting the results of 23 intervention programs in which a total of 1587 children and adolescents participated. All interventions, except one, were multi-component. Data analysis suggests a relationship between a decrease in BMI and/or BMI z-score with diet and physical activity, the involvement of a dietician/nutrition specialist and physician in the treatment team and a longer duration of intervention. Moreover, it seems that a decrease in BMI is mostly associated with decreases in total cholesterol, triglycerides, low density lipoprotein cholesterol and blood pressure. No change in BMI and/or BMI z-score is associated with no change in blood pressure. Our data can be used by public health authorities to design effective weight loss programs for children and adolescents.
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Affiliation(s)
| | | | - Anna Harton
- Correspondence: (B.B.-W.); (A.H.); Tel.: +48-22-593-22 (A.H.)
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Seral-Cortes M, De Miguel-Etayo P, Zapata P, Miguel-Berges ML, Moreno LA. Effectiveness and process evaluation in obesity and type 2 diabetes prevention programs in children: a systematic review and meta-analysis. BMC Public Health 2021; 21:348. [PMID: 33579237 PMCID: PMC7881469 DOI: 10.1186/s12889-021-10297-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 01/20/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Obesity in children is one of the most severe public health challenges of the current century and Type 2 Diabetes Mellitus (T2DM) frequency is also escalating. More so, the importance of process evaluation (PE) in complex interventions is increasingly recognized. The present review, aims to identify the effectiveness in terms of body composition parameters in a generation of articles to prevent obesity and T2DM in children. We hypothesise that those studies reporting PE applying the latest implementation guidelines suggested by the researchers would potentially show positive changes in body composition compared to those not reporting it. Additionally, we will evaluate the implementation degree of PE in those articles considering it and describe the PE subcomponents. Lastly, we aim to assess the intervention target used and its results. METHODS A literature review was performed in parallel by 2 independent reviewers. A final number of 41 studies were selected for inclusion criteria. RESULTS Meta-analysis of BMI and zBMI found non-significant effects of the proposed interventions. Sub-group analysis revealed only a significant effect in studies which performed PE. Moreover, PE was reported in 42% effective studies and 57% non-effective studies. Fidelity and satisfaction were the most implemented PE subcomponents, although there was a generally low grade of PE use (7/41). The highest proportion of effectiveness (83%) was shown in interventions of physical activity alone while the intervention most used was 3-arm target (diet, PA and BS). CONCLUSIONS Overall, obesity and T2DM prevention studies included in this review are not effective in terms of BMI and zBMI. Those studies performing PE reported to be effective in terms of BMI, while studies not reporting PE did not have positive results in terms of BMI and zBMI. In addition, none of the intervention studies included all PE indicators and most studies, which included PE in their interventions, did not provide full report of the PE components, according to the guidelines used for the present review. PROSPERO registration number: CRD42018093667.
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Affiliation(s)
- M Seral-Cortes
- Growth, Exercise, NUtrition and Development (GENUD) Research Group, Instituto Agroalimentario de Aragón (IA2), Instituto de Investigación Sanitaria, Aragón (IIS Aragón), Universidad de Zaragoza, 50009, Zaragoza, Spain
- Department of Psychiatry and Nursing, Faculty of Health Sciences, Universidad de Zaragoza, Zaragoza, Spain
| | - P De Miguel-Etayo
- Growth, Exercise, NUtrition and Development (GENUD) Research Group, Instituto Agroalimentario de Aragón (IA2), Instituto de Investigación Sanitaria, Aragón (IIS Aragón), Universidad de Zaragoza, 50009, Zaragoza, Spain.
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Madrid, Spain.
| | - P Zapata
- Growth, Exercise, NUtrition and Development (GENUD) Research Group, Instituto Agroalimentario de Aragón (IA2), Instituto de Investigación Sanitaria, Aragón (IIS Aragón), Universidad de Zaragoza, 50009, Zaragoza, Spain
- Departamento de nutrición y dietética, Universidad de Antioquia, Medellín, Colombia
| | - M L Miguel-Berges
- Growth, Exercise, NUtrition and Development (GENUD) Research Group, Instituto Agroalimentario de Aragón (IA2), Instituto de Investigación Sanitaria, Aragón (IIS Aragón), Universidad de Zaragoza, 50009, Zaragoza, Spain
- Department of Psychiatry and Nursing, Faculty of Health Sciences, Universidad de Zaragoza, Zaragoza, Spain
| | - L A Moreno
- Growth, Exercise, NUtrition and Development (GENUD) Research Group, Instituto Agroalimentario de Aragón (IA2), Instituto de Investigación Sanitaria, Aragón (IIS Aragón), Universidad de Zaragoza, 50009, Zaragoza, Spain
- Department of Psychiatry and Nursing, Faculty of Health Sciences, Universidad de Zaragoza, Zaragoza, Spain
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Madrid, Spain
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12
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Pamungkas RA, Chamroonsawasdi K. Home-Based Interventions to Treat and Prevent Childhood Obesity: A Systematic Review and Meta-Analysis. Behav Sci (Basel) 2019; 9:bs9040038. [PMID: 31013841 PMCID: PMC6523065 DOI: 10.3390/bs9040038] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Revised: 04/09/2019] [Accepted: 04/11/2019] [Indexed: 01/11/2023] Open
Abstract
Childhood obesity has adverse impacts on premature mortality and morbidity. Managing obesity could prevent premature mortality and several types of complications among high-risk groups. This study aimed to review and examine the effects of home-based interventions to treat and prevent childhood obesity. Three databases, i.e., PubMed, Scopus, and Science Direct, were included to extract articles related to the topic. The terms “childhood obesity”, “home-based intervention”, “parental program”, and “parental involvement” were used as the primary keywords. Appraisal of the systematic review was based on PRISMA formats. Of 1556 publications identified, 22 studies fulfilled the inclusion criteria and were appropriate to conduct a meta-analysis. Overall, the home-based interventions reduced the body mass index (BMI) z-score by 36.99% (z = 36.99, p = 0.00). The data analysis indicated considerable heterogeneity among all interventions (Chi-square = 926.41, df = 22 (p < 0.000001), I2 = 98%). The home-based intervention positively reduced BMI. Our findings could guide future meaningful home-based interventions to treat and prevent childhood obesity.
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Affiliation(s)
- Rian Adi Pamungkas
- Department of Nursing, Faculty of Health Sciences, Esa Unggul University, Jakarta, Indonesia.
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13
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Summer Healthy-Lifestyle Intervention Program for Young Children Who Are Overweight: Results from a Nonrandomized Pilot Trial. J Dev Behav Pediatr 2018; 38:723-727. [PMID: 28914727 DOI: 10.1097/dbp.0000000000000499] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVE To examine initial outcomes of an 8-week Healthy-Lifestyle Intervention Program (HIP) which included children's participation in a daily summer camp along with parents' participation in a parenting program focused on overweight/obesity. METHODS Using a nonrandomized pilot trial design, 16 children (M child age = 6.42 yr; 81% male; 100% Latino) classified as overweight/obese and their mothers completed 3 assessments (baseline, posttreatment, and 6-8 mo follow-up). RESULTS Children who completed HIP experienced significant decreases in their body mass index z-scores (primary outcome) from baseline to posttreatment (d = -1.11) with such decreases being moderately maintained at follow-up (d = -0.64). In terms of secondary outcomes, HIP was effective in improving and maintaining healthy habits in both children and mothers and children's nutritional knowledge and fitness. Objective food data showed that children's dietary intake during HIP improved. High attendance and satisfaction were reported for families who completed HIP. CONCLUSION This pilot treatment development study shows that a family lifestyle intervention conducted in a summer camp setting that targets both children and parents is a promising option for addressing pediatric obesity in young children.
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van der Heijden LB, Feskens EJM, Janse AJ. Maintenance interventions for overweight or obesity in children: a systematic review and meta-analysis. Obes Rev 2018; 19:798-809. [PMID: 29363283 DOI: 10.1111/obr.12664] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 11/28/2017] [Accepted: 12/07/2017] [Indexed: 11/28/2022]
Abstract
Childhood obesity is associated with significant health consequences. Although several intervention programmes for children result in weight loss or stabilization in the short-term, preventing relapse after treatment remains an important challenge. This systematic review summarizes the evidence about maintenance interventions after treatment in childhood obesity. Studies were identified by searching PubMed, Embase, Cochrane Library, Scopus, Web of Science, PsycINFO, CINAHL and SocINDEX. The primary outcome measure for this review was body mass index standard deviation score (BMI-Z-score). Data were pooled using quality effect models. Eleven studies (1,532 participants, age 2-18 years) were included, covering a wide range of maintenance approaches. Included studies varied widely in methodological quality. Pooled analysis showed that the BMI-Z-score of maintenance intervention participants remained stable, whereas control participants experienced a slight increase. No differences were observed regarding intensity and duration of therapy. A slight preference for 'face-to-face' versus 'on distance' interventions was shown. In summary, this review shows that, although there is limited quality data to recommend one maintenance intervention over another, continued treatment does have a stabilizing effect on BMI-Z-score. Considering the magnitude of the problem of childhood obesity, this is an important finding that highlights the need for further research on weight loss maintenance.
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Affiliation(s)
| | - E J M Feskens
- Division of Human Nutrition, Wageningen University & Research, Wageningen, The Netherlands
| | - A J Janse
- Department of Pediatrics, Hospital Gelderse Vallei, Ede, The Netherlands
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15
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Nagarkar AM, Kulkarni SS. Obesity and its Effects on Health in Middle-Aged Women from Slums of Pune. J Midlife Health 2018; 9:79-84. [PMID: 29962806 PMCID: PMC6006801 DOI: 10.4103/jmh.jmh_8_18] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Aim: The study aims to find out the prevalence of obesity and its consequences on the health of middle-aged (45–59 years) women in slum areas. Methodology: The present study includes 559 women between 45 and 59 years of age from slums of Pune city, Maharashtra. Data were collected using a structured questionnaire, anthropometric measurements, physical activity using International Physical Activity Questionnaire long version, information on dietary habits, chronic illnesses, etc., Univariate analysis and further multiple logistic regressions were used to determine associations and risk estimates using Statistical Package for the Social Science version 16. Results: About 60% had body mass index (BMI) above normal, 39% were overweight, and 21.3% obese. The percentage of obesity increased with increasing age. Obesity was significantly associated with working status (P = 0.042), hypertension (P = 0.013), knee pain (P = 0.029), squatting (P = 0.001), walking (P = 0.001), climbing stairs (P = 0.004), and rising from chair (P = 0.040). Functional decline was reported by 62.8% women. Odds of having high blood pressure 1.8 (95% confidence interval [CI]: 1.1–3.0), difficulty in squatting, walking was 1.5 (95% CI: 1.0–2.4) and 1.9 (95% CI: 1.0–3.6) respectively more in overweight. Higher odds of having blood pressure 1.8 (95% CI: 1.0–3.3) and difficulty in walking 2.4 (95% CI: 1.2–4.6) was observed in obese women as compared to women in normal BMI category. Conclusion: The study shows that the prevalence of obesity is higher among women even in the low-income areas. This indicates a need for specific interventions targeted to women in urban slum. The inclusion of multicomponent intervention will prove to be beneficial at the community level.
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Affiliation(s)
- Arati Makarand Nagarkar
- Interdisciplinary School of Health Sciences, Savitribai Phule Pune University, Pune, Maharashtra, India
| | - Snehal Sameer Kulkarni
- Interdisciplinary School of Health Sciences, Savitribai Phule Pune University, Pune, Maharashtra, India
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16
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Larsen KT, Huang T, Møller NC, Andersen LB, Sørensen J. Cost-effectiveness of a day-camp weight-loss intervention programme for children: Results based on a randomised controlled trial with one-year follow-up. Scand J Public Health 2017; 45:666-674. [PMID: 28758542 DOI: 10.1177/1403494816688374] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIMS The aim was to analyse the cost-effectiveness of an intensive weight-loss intervention for children compared with a low-intensity intervention. METHODS One hundred and fifteen overweight children (mean age 12.0 ± 0.4) were randomised to either the camp group (CG) ( N=59) or the standard group (SG) ( N=56). Participants in the CG were offered a six-week day-camp weight-loss programme followed by a family-based supportive programme containing four meetings during the succeeding 46 weeks. Participants in the SG were offered a weekly two-hour exercise session for six weeks. Changes in body mass index (BMI) and BMI z-score 12 months after inclusion were used to compare the effects of the two interventions. Incremental cost-effectiveness ratios (ICER) were estimated from the perspective of a Danish municipality. To achieve the required number of participants, an additional intervention was initiated one year later. RESULTS In comparison with the SG, the CG changed their mean BMI by -1.2 (95% CI -1.8 to -0.5). Compared with the SG children, the CG children changed their BMI z-score by -0.20 (95% CI -0.35 to -0.05). The ICER per decreased BMI point in the CG compared with the SG was DDK 24,928. CONCLUSIONS Compared with the SG, the CG showed favourable effects after 12 months. However, the CG was more costly. The results observed in the present study may be helpful in guiding decision makers to take more informed decisions when choosing different types of intervention.
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Affiliation(s)
- Kristian Traberg Larsen
- 1 Centre of Research in Childhood Health (RICH), Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Denmark
| | - Tao Huang
- 2 Department of Physical Education, Shanghai Jiao Tong University, China
| | - Niels Christian Møller
- 1 Centre of Research in Childhood Health (RICH), Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Denmark
| | - Lars Bo Andersen
- 3 Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
| | - Jan Sørensen
- 4 Center for Health Economic Research (COHERE), Department of Public Health, University of Southern Denmark, Denmark
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Mead E, Brown T, Rees K, Azevedo LB, Whittaker V, Jones D, Olajide J, Mainardi GM, Corpeleijn E, O'Malley C, Beardsmore E, Al‐Khudairy L, Baur L, Metzendorf M, Demaio A, Ells LJ. Diet, physical activity and behavioural interventions for the treatment of overweight or obese children from the age of 6 to 11 years. Cochrane Database Syst Rev 2017; 6:CD012651. [PMID: 28639319 PMCID: PMC6481885 DOI: 10.1002/14651858.cd012651] [Citation(s) in RCA: 210] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Child and adolescent overweight and obesity has increased globally, and can be associated with significant short- and long-term health consequences. This is an update of a Cochrane review published first in 2003, and updated previously in 2009. However, the update has now been split into six reviews addressing different childhood obesity treatments at different ages. OBJECTIVES To assess the effects of diet, physical activity and behavioural interventions (behaviour-changing interventions) for the treatment of overweight or obese children aged 6 to 11 years. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, PsycINFO, CINAHL, LILACS as well as trial registers ClinicalTrials.gov and ICTRP Search Portal. We checked references of studies and systematic reviews. We did not apply any 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 (behaviour-changing interventions) for treating overweight or obese children aged 6 to 11 years, with a minimum of six months' follow-up. We excluded interventions that specifically dealt with the treatment of eating disorders or type 2 diabetes, or included participants with a secondary or syndromic cause of obesity. DATA COLLECTION AND ANALYSIS Two review authors independently screened references, extracted data, assessed risk of bias, and evaluated the quality of the evidence using the GRADE instrument. We contacted study authors for additional information. We carried out meta-analyses according to the statistical guidelines in the Cochrane Handbook for Systematic Reviews of Interventions. MAIN RESULTS We included 70 RCTs with a total of 8461 participants randomised to either the intervention or control groups. The number of participants per trial ranged from 16 to 686. Fifty-five trials compared a behaviour-changing intervention with no treatment/usual care control and 15 evaluated the effectiveness of adding an additional component to a behaviour-changing intervention. Sixty-four trials were parallel RCTs, and four were cluster RCTs. Sixty-four trials were multicomponent, two were diet only and four were physical activity only interventions. Ten trials had more than two arms. The overall quality of the evidence was low or very low and 62 trials had a high risk of bias for at least one criterion. Total duration of trials ranged from six months to three years. The median age of participants was 10 years old and the median BMI z score was 2.2.Primary analyses demonstrated that behaviour-changing interventions compared to no treatment/usual care control at longest follow-up reduced BMI, BMI z score and weight. Mean difference (MD) in BMI was -0.53 kg/m2 (95% confidence interval (CI) -0.82 to -0.24); P < 0.00001; 24 trials; 2785 participants; low-quality evidence. MD in BMI z score was -0.06 units (95% CI -0.10 to -0.02); P = 0.001; 37 trials; 4019 participants; low-quality evidence and MD in weight was -1.45 kg (95% CI -1.88 to -1.02); P < 0.00001; 17 trials; 1774 participants; low-quality evidence.Thirty-one trials reported on serious adverse events, with 29 trials reporting zero occurrences RR 0.57 (95% CI 0.17 to 1.93); P = 0.37; 4/2105 participants in the behaviour-changing intervention groups compared with 7/1991 participants in the comparator groups). Few trials reported health-related quality of life or behaviour change outcomes, and none of the analyses demonstrated a substantial difference in these outcomes between intervention and control. In two trials reporting on minutes per day of TV viewing, a small reduction of 6.6 minutes per day (95% CI -12.88 to -0.31), P = 0.04; 2 trials; 55 participants) was found in favour of the intervention. No trials reported on all-cause mortality, morbidity or socioeconomic effects, and few trials reported on participant views; none of which could be meta-analysed.As the meta-analyses revealed substantial heterogeneity, we conducted subgroup analyses to examine the impact of type of comparator, type of intervention, risk of attrition bias, setting, duration of post-intervention follow-up period, parental involvement and baseline BMI z score. No subgroup effects were shown for any of the subgroups on any of the outcomes. Some data indicated that a reduction in BMI immediately post-intervention was no longer evident at follow-up at less than six months, which has to be investigated in further trials. AUTHORS' CONCLUSIONS Multi-component behaviour-changing interventions that incorporate diet, physical activity and behaviour change may be beneficial in achieving small, short-term reductions in BMI, BMI z score and weight in children aged 6 to 11 years. The evidence suggests a very low occurrence of adverse events. The quality of the evidence was low or very low. The heterogeneity observed across all outcomes was not explained by subgrouping. Further research is required of behaviour-changing interventions in lower income countries and in children from different ethnic groups; also on the impact of behaviour-changing interventions on health-related quality of life and comorbidities. The sustainability of reduction in BMI/BMI z score and weight is a key consideration and there is a need for longer-term follow-up and further research on the most appropriate forms of post-intervention maintenance in order to ensure intervention benefits are sustained over the longer term.
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Affiliation(s)
- Emma Mead
- Teesside UniversityHealth and Social Care InstituteMiddlesbroughUKTS1 3BA
| | - Tamara Brown
- Teesside UniversityHealth and Social Care InstituteMiddlesbroughUKTS1 3BA
- Durham University Queen's CampusSchool of Medicine, Pharmacy and HealthDurhamUKTS17 6BH
| | - Karen Rees
- Warwick Medical School, University of WarwickDivision of Health SciencesCoventryUKCV4 7AL
| | - Liane B Azevedo
- Teesside UniversityHealth and Social Care InstituteMiddlesbroughUKTS1 3BA
| | - Victoria Whittaker
- Teesside UniversityHealth and Social Care InstituteMiddlesbroughUKTS1 3BA
| | - Dan Jones
- Teesside UniversityHealth and Social Care InstituteMiddlesbroughUKTS1 3BA
| | - Joan Olajide
- Teesside UniversityHealth and Social Care InstituteMiddlesbroughUKTS1 3BA
| | - Giulia M Mainardi
- School of Medicine, University of São PauloDepartment of Preventive MedicineSão PauloBrazilCEP 01246 903
| | - Eva Corpeleijn
- University Medical Centre GroningenDepartment of EpidemiologyHanzeplein 1GroningenNetherlands9713 GZ
| | - Claire O'Malley
- Durham University Queen's CampusSchool of Medicine, Pharmacy and HealthDurhamUKTS17 6BH
| | | | - Lena Al‐Khudairy
- Warwick Medical School, University of WarwickDivision of Health SciencesCoventryUKCV4 7AL
| | - Louise Baur
- The University of SydneyDepartment of Paediatrics and Child HealthLocked Bag 4001WestmeadAustraliaNSW 2145
| | - Maria‐Inti Metzendorf
- Institute of General Practice, Medical Faculty of the Heinrich‐Heine‐University DüsseldorfCochrane Metabolic and Endocrine Disorders GroupMoorenstr. 5DüsseldorfGermany40225
| | | | - Louisa J Ells
- Teesside UniversityHealth and Social Care InstituteMiddlesbroughUKTS1 3BA
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Woo JG, Cole TJ. Assessing adiposity using BMI z-Score in children with severe obesity. Obesity (Silver Spring) 2017; 25:662. [PMID: 28296206 DOI: 10.1002/oby.21800] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 01/18/2017] [Indexed: 11/09/2022]
Affiliation(s)
- Jessica G Woo
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Tim J Cole
- Population, Policy and Practice Programme, UCL Great Ormond Street Institute of Child Health, London, UK
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