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. 2015 Dec 21;2015(12):CD012008.
doi: 10.1002/14651858.CD012008.

Parent-only interventions for childhood overweight or obesity in children aged 5 to 11 years

Emma Loveman  1 , Lena Al-Khudairy, Rebecca E Johnson, Wendy Robertson, Jill L Colquitt, Emma L Mead, Louisa J Ells, Maria-Inti Metzendorf, Karen Rees
Affiliations

Parent-only interventions for childhood overweight or obesity in children aged 5 to 11 years

Emma Loveman et al. Cochrane Database Syst Rev. .

Abstract

Background: Child and adolescent overweight and obesity have increased globally, and are associated with short- and long-term health consequences.

Objectives: To assess the efficacy of diet, physical activity and behavioural interventions delivered to parents only for the treatment of overweight and obesity in children aged 5 to 11 years.

Search methods: We performed a systematic literature search of databases including the Cochrane Library, MEDLINE, EMBASE, PsycINFO, CINAHL and LILACS as well trial registers. We checked references of identified trials and systematic reviews. We applied no language restrictions. The date of the last search was March 2015 for all databases.

Selection criteria: We selected randomised controlled trials (RCTs) of diet, physical activity and behavioural interventions delivered to parents only for treating overweight or obesity in children aged 5 to 11 years.

Data collection and analysis: Two review authors independently assessed trials for risk of bias and evaluated overall study quality using the GRADE instrument. Where necessary, we contacted authors for additional information.

Main results: We included 20 RCTs, including 3057 participants. The number of participants ranged per trial between 15 and 645. Follow-up ranged between 24 weeks and two years. Eighteen trials were parallel RCTs and two were cluster RCTs. Twelve RCTs had two comparisons and eight RCTs had three comparisons. The interventions varied widely; the duration, content, delivery and follow-up of the interventions were heterogeneous. The comparators also differed. This review categorised the comparisons into four groups: parent-only versus parent-child, parent-only versus waiting list controls, parent-only versus minimal contact interventions and parent-only versus other parent-only interventions.Trial quality was generally low with a large proportion of trials rated as high risk of bias on individual risk of bias criteria.In trials comparing a parent-only intervention with a parent-child intervention, the body mass index (BMI) z score change showed a mean difference (MD) at the longest follow-up period (10 to 24 months) of -0.04 (95% confidence interval (CI) -0.15 to 0.08); P = 0.56; 267 participants; 3 trials; low quality evidence. In trials comparing a parent-only intervention with a waiting list control, the BMI z score change in favour of the parent-only intervention at the longest follow-up period (10-12 months) had an MD of -0.10 (95% CI -0.19 to -0.01); P = 0.04; 136 participants; 2 trials; low quality evidence. BMI z score change of parent-only interventions when compared with minimal contact control interventions at the longest follow-up period (9 to 12 months) showed an MD of 0.01 (95% CI -0.07 to 0.09); P = 0.81; 165 participants; 1 trial; low quality evidence. There were few similarities between interventions and comparators across the included trials in the parent-only intervention versus other parent-only interventions and we did not pool these data. Generally, these trials did not show substantial differences between their respective parent-only groups on BMI outcomes.Other outcomes such as behavioural measures, parent-child relationships and health-related quality of life were reported inconsistently. Adverse effects of the interventions were generally not reported, two trials stated that there were no serious adverse effects. No trials reported on all-cause mortality, morbidity or socioeconomic effects.All results need to be interpreted cautiously because of their low quality, the heterogeneous interventions and comparators, and the high rates of non-completion.

Authors' conclusions: Parent-only interventions may be an effective treatment option for overweight or obese children aged 5 to 11 years when compared with waiting list controls. Parent-only interventions had similar effects compared with parent-child interventions and compared with those with minimal contact controls. However, the evidence is at present limited; some of the trials had a high risk of bias with loss to follow-up being a particular issue and there was a lack of evidence for several important outcomes. The systematic review has identified 10 ongoing trials that have a parent-only arm, which will contribute to future updates. These trials will improve the robustness of the analyses by type of comparator, and may permit subgroup analysis by intervention component and the setting. Trial reports should provide adequate details about the interventions to be replicated by others. There is a need to conduct and report cost-effectiveness analyses in future trials in order to establish whether parent-only interventions are more cost-effective than parent-child interventions.

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Conflict of interest statement

EL: none known.

LAK: none known.

RJ: none known.

WR: none known.

JC: none known.

EM: none known.

LE: none known.

MIM: none known.

KR: none known.

Figures

1
1
Study flow diagram.
2
2
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies (blank cells indicate that the particular outcome was not investigated in some studies).
3
3
Risk of bias summary: review authors' judgements about each risk of bias item for each included study (blank cells indicate that the study did not report that particular outcome).
1.1
1.1. Analysis
Comparison 1 Parent‐only interventions versus parent‐child interventions, Outcome 1 BMI z score change post intervention.
1.2
1.2. Analysis
Comparison 1 Parent‐only interventions versus parent‐child interventions, Outcome 2 BMI z score change longest follow‐up.
2.1
2.1. Analysis
Comparison 2 Parent‐only interventions versus waiting list interventions, Outcome 1 BMI z score change post intervention.
2.2
2.2. Analysis
Comparison 2 Parent‐only interventions versus waiting list interventions, Outcome 2 BMI z score change longest follow‐up.
2.3
2.3. Analysis
Comparison 2 Parent‐only interventions versus waiting list interventions, Outcome 3 BMI percentile change post intervention.
2.4
2.4. Analysis
Comparison 2 Parent‐only interventions versus waiting list interventions, Outcome 4 BMI percentile change longest follow‐up.
2.5
2.5. Analysis
Comparison 2 Parent‐only interventions versus waiting list interventions, Outcome 5 BMI change post intervention.
2.6
2.6. Analysis
Comparison 2 Parent‐only interventions versus waiting list interventions, Outcome 6 BMI change longest follow‐up.
3.1
3.1. Analysis
Comparison 3 Parent‐only interventions versus minimal contact interventions, Outcome 1 BMI z score change post intervention.
3.2
3.2. Analysis
Comparison 3 Parent‐only interventions versus minimal contact interventions, Outcome 2 BMI z score change longest follow‐up.
3.3
3.3. Analysis
Comparison 3 Parent‐only interventions versus minimal contact interventions, Outcome 3 BMI percentile change post intervention.
3.4
3.4. Analysis
Comparison 3 Parent‐only interventions versus minimal contact interventions, Outcome 4 BMI percentile change longest follow‐up.
3.5
3.5. Analysis
Comparison 3 Parent‐only interventions versus minimal contact interventions, Outcome 5 BMI change post intervention.
3.6
3.6. Analysis
Comparison 3 Parent‐only interventions versus minimal contact interventions, Outcome 6 BMI change longest follow‐up.
4.1
4.1. Analysis
Comparison 4 Parent‐only intervention versus parent‐only intervention, Outcome 1 BMI z score change post intervention.
4.2
4.2. Analysis
Comparison 4 Parent‐only intervention versus parent‐only intervention, Outcome 2 BMI z score change longest follow‐up.
4.3
4.3. Analysis
Comparison 4 Parent‐only intervention versus parent‐only intervention, Outcome 3 BMI change post intervention.
4.4
4.4. Analysis
Comparison 4 Parent‐only intervention versus parent‐only intervention, Outcome 4 BMI change longest follow‐up.
4.5
4.5. Analysis
Comparison 4 Parent‐only intervention versus parent‐only intervention, Outcome 5 BMI percentile change post intervention [%].
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