1
|
Spiga F, Davies AL, Tomlinson E, Moore TH, Dawson S, Breheny K, Savović J, Gao Y, Phillips SM, Hillier-Brown F, Hodder RK, Wolfenden L, Higgins JP, Summerbell CD. Interventions to prevent obesity in children aged 5 to 11 years old. Cochrane Database Syst Rev 2024; 5:CD015328. [PMID: 38763517 PMCID: PMC11102828 DOI: 10.1002/14651858.cd015328.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/21/2024]
Abstract
BACKGROUND Prevention of obesity in children is an international public health priority given the prevalence of the condition (and its significant impact on health, development and well-being). Interventions that aim to prevent obesity involve behavioural change strategies that promote healthy eating or 'activity' levels (physical activity, sedentary behaviour and/or sleep) or both, and work by reducing energy intake and/or increasing energy expenditure, respectively. There is uncertainty over which approaches are more effective and numerous new studies have been published over the last five years, since the previous version of this Cochrane review. OBJECTIVES To assess the effects of interventions that aim to prevent obesity in children by modifying dietary intake or 'activity' levels, or a combination of both, on changes in BMI, zBMI score and serious adverse events. SEARCH METHODS We used standard, extensive Cochrane search methods. The latest search date was February 2023. SELECTION CRITERIA Randomised controlled trials in children (mean age 5 years and above but less than 12 years), comparing diet or 'activity' interventions (or both) to prevent obesity with no intervention, usual care, or with another eligible intervention, in any setting. Studies had to measure outcomes at a minimum of 12 weeks post baseline. We excluded interventions designed primarily to improve sporting performance. DATA COLLECTION AND ANALYSIS We used standard Cochrane methods. Our outcomes were body mass index (BMI), zBMI score and serious adverse events, assessed at short- (12 weeks to < 9 months from baseline), medium- (9 months to < 15 months) and long-term (≥ 15 months) follow-up. We used GRADE to assess the certainty of the evidence for each outcome. MAIN RESULTS This review includes 172 studies (189,707 participants); 149 studies (160,267 participants) were included in meta-analyses. One hundred forty-six studies were based in high-income countries. The main setting for intervention delivery was schools (111 studies), followed by the community (15 studies), the home (eight studies) and a clinical setting (seven studies); one intervention was conducted by telehealth and 31 studies were conducted in more than one setting. Eighty-six interventions were implemented for less than nine months; the shortest was conducted over one visit and the longest over four years. Non-industry funding was declared by 132 studies; 24 studies were funded in part or wholly by industry. Dietary interventions versus control Dietary interventions, compared with control, may have little to no effect on BMI at short-term follow-up (mean difference (MD) 0, 95% confidence interval (CI) -0.10 to 0.10; 5 studies, 2107 participants; low-certainty evidence) and at medium-term follow-up (MD -0.01, 95% CI -0.15 to 0.12; 9 studies, 6815 participants; low-certainty evidence) or zBMI at long-term follow-up (MD -0.05, 95% CI -0.10 to 0.01; 7 studies, 5285 participants; low-certainty evidence). Dietary interventions, compared with control, probably have little to no effect on BMI at long-term follow-up (MD -0.17, 95% CI -0.48 to 0.13; 2 studies, 945 participants; moderate-certainty evidence) and zBMI at short- or medium-term follow-up (MD -0.06, 95% CI -0.13 to 0.01; 8 studies, 3695 participants; MD -0.04, 95% CI -0.10 to 0.02; 9 studies, 7048 participants; moderate-certainty evidence). Five studies (1913 participants; very low-certainty evidence) reported data on serious adverse events: one reported serious adverse events (e.g. allergy, behavioural problems and abdominal discomfort) that may have occurred as a result of the intervention; four reported no effect. Activity interventions versus control Activity interventions, compared with control, may have little to no effect on BMI and zBMI at short-term or long-term follow-up (BMI short-term: MD -0.02, 95% CI -0.17 to 0.13; 14 studies, 4069 participants; zBMI short-term: MD -0.02, 95% CI -0.07 to 0.02; 6 studies, 3580 participants; low-certainty evidence; BMI long-term: MD -0.07, 95% CI -0.24 to 0.10; 8 studies, 8302 participants; zBMI long-term: MD -0.02, 95% CI -0.09 to 0.04; 6 studies, 6940 participants; low-certainty evidence). Activity interventions likely result in a slight reduction of BMI and zBMI at medium-term follow-up (BMI: MD -0.11, 95% CI -0.18 to -0.05; 16 studies, 21,286 participants; zBMI: MD -0.05, 95% CI -0.09 to -0.02; 13 studies, 20,600 participants; moderate-certainty evidence). Eleven studies (21,278 participants; low-certainty evidence) reported data on serious adverse events; one study reported two minor ankle sprains and one study reported the incident rate of adverse events (e.g. musculoskeletal injuries) that may have occurred as a result of the intervention; nine studies reported no effect. Dietary and activity interventions versus control Dietary and activity interventions, compared with control, may result in a slight reduction in BMI and zBMI at short-term follow-up (BMI: MD -0.11, 95% CI -0.21 to -0.01; 27 studies, 16,066 participants; zBMI: MD -0.03, 95% CI -0.06 to 0.00; 26 studies, 12,784 participants; low-certainty evidence) and likely result in a reduction of BMI and zBMI at medium-term follow-up (BMI: MD -0.11, 95% CI -0.21 to 0.00; 21 studies, 17,547 participants; zBMI: MD -0.05, 95% CI -0.07 to -0.02; 24 studies, 20,998 participants; moderate-certainty evidence). Dietary and activity interventions compared with control may result in little to no difference in BMI and zBMI at long-term follow-up (BMI: MD 0.03, 95% CI -0.11 to 0.16; 16 studies, 22,098 participants; zBMI: MD -0.02, 95% CI -0.06 to 0.01; 22 studies, 23,594 participants; low-certainty evidence). Nineteen studies (27,882 participants; low-certainty evidence) reported data on serious adverse events: four studies reported occurrence of serious adverse events (e.g. injuries, low levels of extreme dieting behaviour); 15 studies reported no effect. Heterogeneity was apparent in the results for all outcomes at the three follow-up times, which could not be explained by the main setting of the interventions (school, home, school and home, other), country income status (high-income versus non-high-income), participants' socioeconomic status (low versus mixed) and duration of the intervention. Most studies excluded children with a mental or physical disability. AUTHORS' CONCLUSIONS The body of evidence in this review demonstrates that a range of school-based 'activity' interventions, alone or in combination with dietary interventions, may have a modest beneficial effect on obesity in childhood at short- and medium-term, but not at long-term follow-up. Dietary interventions alone may result in little to no difference. Limited evidence of low quality was identified on the effect of dietary and/or activity interventions on severe adverse events and health inequalities; exploratory analyses of these data suggest no meaningful impact. We identified a dearth of evidence for home and community-based settings (e.g. delivered through local youth groups), for children living with disabilities and indicators of health inequities.
Collapse
Affiliation(s)
- Francesca Spiga
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Annabel L Davies
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Eve Tomlinson
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Theresa Hm Moore
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- NIHR Applied Research Collaboration West (ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Sarah Dawson
- NIHR Applied Research Collaboration West (ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Katie Breheny
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Jelena Savović
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- NIHR Applied Research Collaboration West (ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Yang Gao
- Department of Sport, Physical Education and Health, Hong Kong Baptist University, Kowloon, Hong Kong
| | - Sophie M Phillips
- Department of Sport and Exercise Science, Durham University, Durham, UK
- Fuse - Centre for Translational Research in Public Health, Newcastle upon Tyne, UK
- Child Health and Physical Activity Laboratory, School of Occupational Therapy, Western University, London, Ontario, Canada
| | - Frances Hillier-Brown
- Fuse - Centre for Translational Research in Public Health, Newcastle upon Tyne, UK
- Human Nutrition Research Centre and Population Health Sciences Institute, University of Newcastle, Newcastle, UK
| | - Rebecca K Hodder
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, Australia
- School of Medicine and Public Health, The University of Newcastle, Callaghan, Australia
- Population Health Research Program, Hunter Medical Research Institute, New Lambton, Australia
- National Centre of Implementation Science, The University of Newcastle, Callaghan, Australia
| | - Luke Wolfenden
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, Australia
- School of Medicine and Public Health, The University of Newcastle, Callaghan, Australia
| | - Julian Pt Higgins
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- NIHR Applied Research Collaboration West (ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
- NIHR Bristol Biomedical Research Centre at University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol, Bristol, UK
| | - Carolyn D Summerbell
- Department of Sport and Exercise Science, Durham University, Durham, UK
- Fuse - Centre for Translational Research in Public Health, Newcastle upon Tyne, UK
| |
Collapse
|
2
|
Klein DH, Mohamoud I, Olanisa OO, Parab P, Chaudhary P, Mukhtar S, Moradi A, Kodali A, Okoye C, Arcia Franchini AP. Impact of School-Based Interventions on Pediatric Obesity: A Systematic Review. Cureus 2023; 15:e43153. [PMID: 37692730 PMCID: PMC10484325 DOI: 10.7759/cureus.43153] [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: 07/09/2023] [Accepted: 08/08/2023] [Indexed: 09/12/2023] Open
Abstract
Childhood obesity is a global public health problem with significant implications for the health and well-being of children. The prevalence of childhood obesity is increasing every decade, making it a recognized public health concern. This systematic review aims to explore and evaluate the impact of school-based interventions on reducing pediatric obesity among school-aged children. A systematic review of literature according to the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 was conducted. Google Scholar, PubMed, and Cochrane were the databases used. After screening for bias, inclusion and exclusion criteria, and quality, 27 studies were included in the systematic review, and data were synthesized. The results show that physical activity reduces obesity and improves cardiovascular health. The nutritional change reduces the risk of obesity more than physical activity alone. When blended, the two provide the most benefits for participants. Motivation, self-efficacy, and behavioral change could help maintain the improvements. Schools should adopt a blend of physical activity and nutritional change to reduce prevent, reduce, and manage obesity.
Collapse
Affiliation(s)
- Dhadon H Klein
- Internal Medicine, Saint James School of Medicine, Park Ridge, USA
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Iman Mohamoud
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Olawale O Olanisa
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Panah Parab
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Priti Chaudhary
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Sonia Mukhtar
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Ali Moradi
- Medicine, Semmelweis University, Budapest, HUN
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Athri Kodali
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Chiugo Okoye
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Ana P Arcia Franchini
- Research, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| |
Collapse
|
3
|
Hodder RK, O'Brien KM, Lorien S, Wolfenden L, Moore TH, Hall A, Yoong SL, Summerbell C. Interventions to prevent obesity in school-aged children 6-18 years: An update of a Cochrane systematic review and meta-analysis including studies from 2015-2021. EClinicalMedicine 2022; 54:101635. [PMID: 36281235 PMCID: PMC9581512 DOI: 10.1016/j.eclinm.2022.101635] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 08/09/2022] [Accepted: 08/09/2022] [Indexed: 11/16/2022] Open
Abstract
Background Childhood obesity remains a global public health priority due to the enormous burden it generates. Recent surveillance data suggests there has been a sharp increase in the prevalence of childhood obesity during the COVID-19 pandemic. The Cochrane review of childhood obesity prevention interventions (0-18 years) updated to 2015 is the most rigorous and comprehensive review of randomised controlled trials (RCTs) on this topic. A burgeoning number of high quality studies have been published since that are yet to be synthesised. Methods An update of the Cochrane systematic review was conducted to include RCT studies in school-aged children (6-18 years) published to 30 June 2021 that assessed effectiveness on child weight (PROSPERO registration: CRD42020218928). Available cost-effectiveness and adverse effect data were extracted. Intervention effects on body mass index (BMI) were synthesised in random effects meta-analyses by setting (school, after-school program, community, home), and meta-regression examined the association of study characteristics with intervention effect. Findings Meta-analysis of 140 of 195 included studies (183,063 participants) found a very small positive effect on body mass index for school-based studies (SMD -0·03, 95%CI -0·06,-0·01; trials = 93; participants = 131,443; moderate certainty evidence) but not after-school programs, community or home-based studies. Subgroup analysis by age (6-12 years; 13-18 years) found no differential effects in any setting. Meta-regression found no associations between study characteristics (including setting, income level) and intervention effect. Ten of 53 studies assessing adverse effects reported presence of an adverse event. Insufficient data was available to draw conclusions on cost-effectiveness. Interpretation This updated synthesis of obesity prevention interventions for children aged 6-18 years, found a small beneficial impact on child BMI for school-based obesity prevention interventions. A more comprehensive assessment of interventions is required to identify mechanisms of effective interventions to inform future obesity prevention public health policy, which may be particularly salient in for COVID-19 recovery planning. Funding This research was funded by the National Health and Medical Research Council (NHMRC), Australia (Application No APP1153479).
Collapse
Affiliation(s)
- Rebecca K. Hodder
- Hunter New England Population Health, Hunter New England Local Health District, Locked Bag 10, Longworth Avenue, Wallsend, NSW 2287, Australia
- College of Health Medicine and Wellbeing, University of Newcastle, University Drive, Callaghan, NSW 2308, Australia
- National Centre of Implementation Science, University of Newcastle, University Drive, Callaghan, NSW 2308, Australia
- Hunter Medical Research Institute, 29 Kookaburra Drive, New Lambton Heights, NSW 2305, Australia
| | - Kate M. O'Brien
- Hunter New England Population Health, Hunter New England Local Health District, Locked Bag 10, Longworth Avenue, Wallsend, NSW 2287, Australia
- College of Health Medicine and Wellbeing, University of Newcastle, University Drive, Callaghan, NSW 2308, Australia
- National Centre of Implementation Science, University of Newcastle, University Drive, Callaghan, NSW 2308, Australia
- Hunter Medical Research Institute, 29 Kookaburra Drive, New Lambton Heights, NSW 2305, Australia
| | - Sasha Lorien
- Hunter New England Population Health, Hunter New England Local Health District, Locked Bag 10, Longworth Avenue, Wallsend, NSW 2287, Australia
- College of Health Medicine and Wellbeing, University of Newcastle, University Drive, Callaghan, NSW 2308, Australia
- National Centre of Implementation Science, University of Newcastle, University Drive, Callaghan, NSW 2308, Australia
- Hunter Medical Research Institute, 29 Kookaburra Drive, New Lambton Heights, NSW 2305, Australia
| | - Luke Wolfenden
- Hunter New England Population Health, Hunter New England Local Health District, Locked Bag 10, Longworth Avenue, Wallsend, NSW 2287, Australia
- College of Health Medicine and Wellbeing, University of Newcastle, University Drive, Callaghan, NSW 2308, Australia
- National Centre of Implementation Science, University of Newcastle, University Drive, Callaghan, NSW 2308, Australia
- Hunter Medical Research Institute, 29 Kookaburra Drive, New Lambton Heights, NSW 2305, Australia
| | - Theresa H.M. Moore
- The National Institute for Health Research Applied Research Collaboration West (NIHR ARC West) at University Hospitals Bristol National Health Service Foundation Trust, Whitefriars, Lewins Mean, Bristol, BS1 2NT, United Kingdom
- Population Health Sciences, Bristol Medical School, University of Bristol, Beacon House, Queens Road, Bristol, United Kingdom
| | - Alix Hall
- Hunter New England Population Health, Hunter New England Local Health District, Locked Bag 10, Longworth Avenue, Wallsend, NSW 2287, Australia
- College of Health Medicine and Wellbeing, University of Newcastle, University Drive, Callaghan, NSW 2308, Australia
- National Centre of Implementation Science, University of Newcastle, University Drive, Callaghan, NSW 2308, Australia
- Hunter Medical Research Institute, 29 Kookaburra Drive, New Lambton Heights, NSW 2305, Australia
| | - Sze Lin Yoong
- Hunter New England Population Health, Hunter New England Local Health District, Locked Bag 10, Longworth Avenue, Wallsend, NSW 2287, Australia
- College of Health Medicine and Wellbeing, University of Newcastle, University Drive, Callaghan, NSW 2308, Australia
- National Centre of Implementation Science, University of Newcastle, University Drive, Callaghan, NSW 2308, Australia
- Hunter Medical Research Institute, 29 Kookaburra Drive, New Lambton Heights, NSW 2305, Australia
- Global Obesity Centre, Institute for Health Transformation, Deakin University, Burwood, VIC 3125, Australia
| | - Carolyn Summerbell
- Department of Sport and Exercise Sciences, Durham University, Stockton Road, Durham DH1 3LE, United Kingdom
- Fuse, The NIHR Centre for Translational Research in Public Health, United Kingdom
| |
Collapse
|