Interventions for preventing obesity in children

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A B S T R A C T

Background
Prevention of childhood obesity is an international public health priority given the significant impact of obesity on acute and chronic
diseases, general health, development and well-being. The international evidence base for strategies that governments, communities
and families can implement to prevent obesity, and promote health, has been accumulating but remains unclear.
Objectives
This review primarily aims to update the previous Cochrane review of childhood obesity prevention research and determine the
effectiveness of evaluated interventions intended to prevent obesity in children, assessed by change in BodyMass Index (BMI). Secondary
aims were to examine the characteristics of the programs and strategies to answer the questions “What works for whom, why and for what cost?”

Search methods

The searches were re-run in CENTRAL, MEDLINE, EMBASE, PsychINFO and CINAHL in March 2010 and searched relevant
websites. Non-English language papers were included and experts were contacted.

Selection criteria

The reviewincludes data fromchildhood obesity prevention studies that used a controlled study design (with orwithout randomisation).
Studies were included if they evaluated interventions, policies or programs in place for twelve weeks or more. If studies were randomised at a cluster level, 6 clusters were required.

Interventions for preventing obesity in children (Review)
Copyright © 2011 The Cochrane Collaboration. Published by JohnWiley & Sons, Ltd.

Data collection and analysis

Two review authors independently extracted data and assessed the risk of bias of included studies. Data was extracted on intervention
implementation, cost, equity and outcomes. Outcome measures were grouped according to whether they measured adiposity, physical
activity (PA)-related behaviours or diet-related behaviours. Adverse outcomes were recorded. A meta-analysis was conducted using
available BMI or standardised BMI (zBMI) score data with subgroup analysis by age group (0-5, 6-12, 13-18 years, corresponding to
stages of developmental and childhood settings).

Main results

This review includes 55 studies (an additional 36 studies found for this update). The majority of studies targeted children aged 6-
12 years. The meta-analysis included 37 studies of 27,946 children and demonstrated that programmes were effective at reducing
adiposity, although not all individual interventions were effective, and there was a high level of observed heterogeneity (I2=82%).
Overall, children in the intervention group had a standardised mean difference in adiposity (measured as BMI or zBMI) of -0.15kg/m
2 (95% confidence interval (CI): -0.21 to -0.09). Intervention effects by age subgroups were -0.26kg/m2 (95% CI:-0.53 to 0.00) (0-
5 years), -0.15kg/m2 (95% CI -0.23 to -0.08) (6-12 years), and -0.09kg/m2 (95% CI -0.20 to 0.03) (13-18 years). Heterogeneity was
apparent in all three age groups and could not explained by randomisation status or the type, duration or setting of the intervention.
Only eight studies reported on adverse effects and no evidence of adverse outcomes such as unhealthy dieting practices, increased
prevalence of underweight or body image sensitivities was found. Interventions did not appear to increase health inequalities although this was examined in fewer studies.

Authors’ conclusions

We found strong evidence to support beneficial effects of child obesity prevention programmes on BMI, particularly for programmes
targeted to children aged six to 12 years. However, given the unexplained heterogeneity and the likelihood of small study bias, these
findings must be interpreted cautiously. A broad range of programme components were used in these studies and whilst it is not possible to distinguish which of these components contributed most to the beneficial effects observed, our synthesis indicates the following to be promising policies and strategies:
· school curriculum that includes healthy eating, physical activity and body image
· increased sessions for physical activity and the development of fundamental movement skills throughout the school week
· improvements in nutritional quality of the food supply in schools
· environments and cultural practices that support children eating healthier foods and being active throughout each day
· support for teachers and other staff to implement health promotion strategies and activities (e.g. professional development,
capacity building activities)
· parent support and home activities that encourage children to be more active, eat more nutritious foods and spend less time in
screen based activities
However, study and evaluation designs need to be strengthened, and reporting extended to capture process and implementation factors, outcomes in relation to measures of equity, longer term outcomes, potential harms and costs.
Childhood obesity prevention research must now move towards identifying how effective intervention components can be embedded
within health, education and care systems and achieve long term sustainable impacts.

ElizabethWaters1, Andrea de Silva-Sanigorski2, Belinda J Hall2, Tamara Brown3, Karen J Campbell4, Yang Gao5, Rebecca Armstrong
2, Lauren Prosser2, Carolyn D Summerbell6
1Jack Brockhoff Child Health and Wellbeing Program, The McCaughey Centre, Melbourne School of Population Health, The University
of Melbourne, Carlton, Australia. 2Jack Brockhoff Child Health andWellbeing Program, The McCaughey Centre, Melbourne
School of Population Health, The University of Melbourne, Parkville, Australia. 3Liverpool Reviews and Implementation Group,
Division of Clinical Effectiveness, School of Population, Community and Behavioural Sciences, University of Liverpool, Liverpool,
UK. 4School of Exercise and Nutrition Sciences, Deakin University, Burwood, VIC, Australia. 5School of Public Health and Primary
Care, The Chinese University of Hong Kong, Hong Kong, Hong Kong. 6School of Medicine and Health,Wolfson Research Institute,
Queen’s Campus, Durham University, Stockton-on-Tees, UK
Contact address: ElizabethWaters, Jack Brockhoff Child Health andWellbeing Program, The McCaughey Centre, Melbourne School
of Population Health, The University ofMelbourne, Level 5/207 Bouverie St, Carlton, VIC, 3010, Australia. ewaters@unimelb.edu.au.
Editorial group: Cochrane Heart Group.
Publication status and date: Edited (no change to conclusions), published in Issue 12, 2011.
Review content assessed as up-to-date: 22 September 2010.
Citation: Waters E, de Silva-Sanigorski A, Hall BJ, Brown T, Campbell KJ, Gao Y, Armstrong R, Prosser L, Summerbell CD.
Interventions for preventing obesity in children. Cochrane Database of Systematic Reviews 2011, Issue 12. Art. No.: CD001871. DOI:
10.1002/14651858.CD001871.pub3.
Copyright © 2011 The Cochrane Collaboration. Published by JohnWiley & Sons, Ltd.