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Meta-Analysis
. 2015 Jul;16(7):547-65.
doi: 10.1111/obr.12277. Epub 2015 Apr 20.

What childhood obesity prevention programmes work? A systematic review and meta-analysis

Y Wang  1   2   3   4 , L Cai  2   5 , Y Wu  2   3 , R F Wilson  6 , C Weston  6 , O Fawole  6 , S N Bleich  6 , L J Cheskin  3 , N N Showell  7 , B D Lau  8 , D T Chiu  2 , A Zhang  6 , J Segal  4   6
Affiliations
Meta-Analysis

What childhood obesity prevention programmes work? A systematic review and meta-analysis

Y Wang et al. Obes Rev. 2015 Jul.

Abstract

Previous reviews of childhood obesity prevention have focused largely on schools and findings have been inconsistent. Funded by the US Agency for Healthcare Research and Quality (AHRQ) and the National Institutes of Health, we systematically evaluated the effectiveness of childhood obesity prevention programmes conducted in high-income countries and implemented in various settings. We searched MEDLINE®, Embase, PsycINFO, CINAHL®, ClinicalTrials.gov and the Cochrane Library from inception through 22 April 2013 for relevant studies, including randomized controlled trials, quasi-experimental studies and natural experiments, targeting diet, physical activity or both, and conducted in children aged 2-18 in high-income countries. Two reviewers independently abstracted the data. The strength of evidence (SOE) supporting interventions was graded for each study setting (e.g. home, school). Meta-analyses were performed on studies judged sufficiently similar and appropriate to pool using random effect models. This paper reported our findings on various adiposity-related outcomes. We identified 147 articles (139 intervention studies) of which 115 studies were primarily school based, although other settings could have been involved. Most were conducted in the United States and within the past decade. SOE was high for physical activity-only interventions delivered in schools with home involvement or combined diet-physical activity interventions delivered in schools with both home and community components. SOE was moderate for school-based interventions targeting either diet or physical activity, combined interventions delivered in schools with home or community components or combined interventions delivered in the community with a school component. SOE was low for combined interventions in childcare or home settings. Evidence was insufficient for other interventions. In conclusion, at least moderately strong evidence supports the effectiveness of school-based interventions for preventing childhood obesity. More research is needed to evaluate programmes in other settings or of other design types, especially environmental, policy and consumer health informatics-oriented interventions.

Keywords: Childhood; obesity; prevention; systematic review.

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Conflict of interest statement

Conflict of interest statement

No conflict of interest was declared.

Figures

Figure 1
Figure 1
Results of the literature search on childhood obesity prevention studies/interventions in high-income countries. *Sum of excluded abstracts exceeds 6,175 because reviewers were not required to agree on reasons for exclusion. #Sum of excluded abstracts exceeds 530 because reviewers were not required to agree on reasons for exclusion. The key questions (KQs) of this review were organized by study setting/design as follows: What is the comparative effectiveness of school-based interventions (KQ1), home-based interventions (KQ2), primary care-based interventions (KQ3), childcare setting-based interventions (KQ4) and community-based interventions (KQ5) for the prevention of obesity or overweight in children? Note that our original Agency for Healthcare Research and Quality study also included KQ6 ‘What is the comparative effectiveness of consumer health informatics applications for the prevention of obesity or overweight in children?’ and KQ7 ‘What is the comparative effectiveness of multi-setting interventions for the prevention of obesity or overweight in children?’, but, in the present study, the interventions previously classified under these headings were grouped into KQ1 or KQ2 based on if the intervention was primarily school or home based, or another KQ based on the key intervention setting. We merged KQ6 and KQ7 with the other KQ groups to help simplify the presentation of information and because of the relatively small number of studies originally grouped into KQ6 and KQ7.
Figure 2
Figure 2
Meta-analyses of changes in body mass index (BMI) and BMI z-score of school-based, diet–physical activity combined childhood obesity prevention studies. (a) Change in BMI z-score in studies taking place only in school. (b) Change in BMI in studies taking place only in school. (c) Change in BMI in studies taking place in school with a home-based intervention component. WMD, weighted mean difference.
See this image and copyright information in PMC

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Appendix A1 PA-only interventions implemented in a school only-based setting

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Appendix A2 Combined interventions implemented in a school only-based setting

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Appendix A3 Interventions implemented in schools and included a home component

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Appendix A4 School-based interventions with home and community components

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Appendix A5 School-based interventions with a community component

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Appendix A6 School-based interventions with a consumer health informatics component

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