Behavioral interventions to prevent childhood obesity: a systematic review and metaanalyses of randomized trials
Abstract
CONTEXT: The efficacy of lifestyle interventions to encourage healthy lifestyle behaviors to prevent pediatric obesity remains unclear. OBJECTIVE: Our objective was to summarize evidence on the efficacy of interventions aimed at changing lifestyle behaviors (increased physical activity, decreased sedentary activity, increased healthy dietary habits, and decreased unhealthy dietary habits) to prevent obesity. DATA SOURCES: Data sources included librarian-designed searches of nine electronic databases, references from included studies and reviews (from inception until February 2006), and content expert recommendations. STUDY SELECTION: Eligible studies were randomized trials enrolling children and adolescents assessing the impact of interventions on both lifestyle behaviors and body mass index (BMI). DATA EXTRACTION: Two reviewers independently abstracted data on methodological quality, study characteristics, intervention components, and treatment effects. DATA ANALYSIS: We conducted random-effects metaanalyses, quantified inconsistency using I(2), and conducted planned subgroup analyses for each examined outcome. DATA SYNTHESIS: Regarding target behaviors, the pooled effect size for physical activity (22 comparisons; n = 9891 participants) was 0.12 [95% confidence interval (CI) = 0.04-0.20; I(2) = 63%], for sedentary activity (14 comparisons; n = 3003) was -0.29, (CI = -0.35 to -0.22; I(2) = 0%), for healthy dietary habits (14 comparisons, n = 5468) was 0.00 (CI = -0.20; 0.20; I(2) = 83%), and for unhealthy dietary habits (23 comparisons, n = 9578) was -0.20 (CI = -0.31 to -0.09; I(2) = 34%). The effect of these interventions on BMI (43 comparisons, n = 32,003) was trivial (-0.02; CI = -0.06-0.02; I(2) = 17%) compared with control. Trials with interventions lasting more than 6 months (vs. shorter trials) and trials with postintervention outcomes (vs. in-treatment outcomes) yielded marginally larger effects. CONCLUSION: Pediatric obesity prevention programs caused small changes in target behaviors and no significant effect on BMI compared with control. Trials evaluating promising interventions applied over a long period, using responsive outcomes, with longer measurement timeframes are urgently needed.
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In a meta-analysis by Kamath et al., the pooled effect size for physical activity was 0.12.
“The meta-analysis resulted in a pooled effect size for PA of 0.12.”
From How can physical activity be promoted among children and adolescents? A systematic review of reviews across settings (2019) · cites this paper as [92]
Kamath et al. identified a trend in favour of multiple cognitive components (effect size 0.15 vs. 0.00 for one or no cognitive components).
“A trend was identified in favour of multiple cognitive components (0.15; vs. one or no cognitive components, 0.00)”
From How can physical activity be promoted among children and adolescents? A systematic review of reviews across settings (2019) · cites this paper as [92]
Kamath et al. identified a trend in favour of interventions including reinforcement (effect size 0.24 vs. −0.07 for no reinforcement).
“and interventions including reinforcement (0.24; vs. no reinforcement, −0.07).”
From How can physical activity be promoted among children and adolescents? A systematic review of reviews across settings (2019) · cites this paper as [92]
The focus on individual level interventions can be explained by the predominance of evidence-based medicine for the evaluation of interventions.
“Such focus on individual level interventions can be explained by the predominance of evidence-based medicine (92) for the evaluation of interventions.”
From How can physical activity be promoted among children and adolescents? A systematic review of reviews across settings (2019) · cites this paper as [92]
Health promotion interventions can be effective in terms of obesity prevention.
“Overall, the reviews stated that health promotion interventions can be effective in terms of health (89), obesity prevention (92), and the reduction of socioeconomic inequalities in obesity (91).”
From How can physical activity be promoted among children and adolescents? A systematic review of reviews across settings (2019) · cites this paper as [92]
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- Authors
- Kamath, C. C., Vickers, K. S., Ehrlich, A., McGovern, L., Johnson, J., Singhal, V., Paulo, R., Hettinger, A., Erwin, P. J., & Montori, V. M.
- Affiliations
- Mayo Clinic (US)
- Knowledge and Encounter Research Unit (C.C.K., L.M., P.J.E., V.M.M.), Mayo Clinic College of Medicine, Rochester, Minnesota 55905
- Venue
- The Journal of Clinical Endocrinology & Metabolism
- Publisher
- The Endocrine Society
- Published
- 2008-12-01
- Volume
- 93
- Issue
- 12
- Pages
- 4606-4615
- ISSN
- 0021-972X (ISSN-L)
- 1945-7197
- OpenAlex
- W2147276857
- Cited by
- 395
- References
- 49
- Citations by year
- 2026: 2 · 2025: 9 · 2024: 10 · 2023: 12 · 2022: 5 · 2021: 18 · 2020: 30 · 2019: 17 · 2018: 17 · 2017: 33 · 2016: 26 · 2015: 43 · 2014: 30 · 2013: 30 · 2012: 35
- FWCI
- 3.88
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Journal of Clinical Endocrinology & Metabolism (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
- Health Sciences › Medicine › Physiology › Physical Activity and Health
- Health Sciences › Health Professions › Pharmacy › Obesity and Health Practices
- Keywords
- childhood obesity prevention, lifestyle intervention, physical activity, sedentary behavior, dietary habits, body mass index, children and adolescents, intervention efficacy, intervention duration, obesity prevention programs, healthy lifestyle behaviors, healthy eating promotion, physical activity promotion, sedentary behavior reduction, weight gain prevention
- MeSH terms
- Adolescent, Child, Child Behavior, Child, Preschool, Data Interpretation, Statistical, Feeding Behavior, Humans, Life Style, Motor Activity, Obesity, Quality Control, Research Design, Body Mass Index, Randomized Controlled Trials as Topic
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