Cited by 1,455Obesity, Physical Activity, DietObesity and Health PracticesPhysical Activity and Health

Interventions for preventing obesity in children

Waters, Elizabeth, de Silva-Sanigorski, Andrea, Burford, Belinda J, Brown, Tamara, Campbell, Karen J, Gao, Yang, Armstrong, Rebecca, Prosser, Lauren +1 more·2011·Cochrane Database of Systematic Reviews

Abstract

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 Body Mass 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 review includes data from childhood obesity prevention studies that used a controlled study design (with or without 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. 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 (I(2)=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/m(2) (95% CI:-0.53 to 0.00) (0-5 years), -0.15kg/m(2) (95% CI -0.23 to -0.08) (6-12 years), and -0.09kg/m(2) (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 activitiesHowever, 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.

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Crossref · 10.1002/14651858.cd001871.pub3

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Authors
Waters, E., de Silva-Sanigorski, A., Burford, B. J., Brown, T., Campbell, K. J., Gao, Y., Armstrong, R., Prosser, L., & Summerbell, C. D.
Affiliations
  • The University of Melbourne (AU)
  • The University of Melbourne; Jack Brockhoff Child Health and Wellbeing Program, The McCaughey Centre, Melbourne School of Population and Global Health; Parkville Victoria Australia 3052
  • University of Liverpool (GB)
  • Deakin University (AU)
  • Chinese University of Hong Kong (HK)
  • Dental Health Services Victoria; 720 Swanston St Carlton Victoria Australia 3050
  • Durham University (GB)
Venue
Cochrane Database of Systematic Reviews
Publisher
Wiley
Published
2011-12-07
Issue
12
Pages
CD001871-CD001871
ISSN
  • 1361-6137 (ISSN-L)
  • 1465-1858
OpenAlex
W2792127029
Cited by
1,455
References
207
Citations by year
2026: 11 · 2025: 27 · 2024: 27 · 2023: 36 · 2022: 47 · 2021: 79 · 2020: 101 · 2019: 126 · 2018: 138 · 2017: 147 · 2016: 146 · 2015: 187 · 2014: 152 · 2013: 133 · 2012: 67
FWCI
17.50
Type
journal article
Language
en
Open access
closed
Locations
  • Cochrane Database of Systematic Reviews (publishedVersion)
  • PubMed (publishedVersion)
  • Durham Research Online (Durham University) (acceptedVersion)
Funders
Economic and Social Research Council (ES/G007470/1)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
  • Health Sciences › Health Professions › Pharmacy › Obesity and Health Practices
  • Health Sciences › Medicine › Physiology › Physical Activity and Health
Keywords
childhood obesity prevention, childhood obesity, body mass index, obesity intervention, physical activity, diet, school-based intervention, family intervention, community-based intervention, health promotion, intervention effectiveness, cost-effectiveness, health equity, adverse effects, children aged 6-12, adolescents, health policy, health promotion evaluation, health promotion funding
MeSH terms
Adolescent, Child, Child, Preschool, Humans, Life Style, Obesity, Randomized Controlled Trials as Topic, Treatment Outcome, Adiposity

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