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Meta-Analysis
. 2025 Mar;20(3):e13193.
doi: 10.1111/ijpo.13193. Epub 2025 Jan 16.

Effectiveness of behavioural and psychological interventions for managing obesity in children and adolescents: A systematic review and meta-analysis framed using minimal important difference estimates based on GRADE guidance to inform a clinical practice guideline

M Henderson  1   2   3 , S A Moore  4   5 , S Harnois-Leblanc  1   6 , B C Johnston  7   8 , D Fitzpatrick-Lewis  9   10 , A M Usman  10   11 , D Sherifali  9   10 , R Merdad  12 , A M Rigsby  7 , Z Esmaeilinezhad  7 , K M Morrison  13   14 , J Hamilton  15   16 , G D C Ball  17 , C S Birken  16   18 ; Steering Committee for Updating Canada's Clinical Practice Guideline for Managing Pediatric Obesity
Collaborators, Affiliations
Meta-Analysis

Effectiveness of behavioural and psychological interventions for managing obesity in children and adolescents: A systematic review and meta-analysis framed using minimal important difference estimates based on GRADE guidance to inform a clinical practice guideline

M Henderson et al. Pediatr Obes. 2025 Mar.

Abstract

Objective: Conduct a systematic review and meta-analysis of randomized controlled trials (RCTs) of behavioural and psychological interventions for managing paediatric obesity.

Methods: Eligible studies, published between 1985 and 2022, included 0 to 18 year olds with outcomes reported ≥3 months post-baseline, including patient-reported outcome measures (PROMs), cardiometabolic and anthropometric outcomes, and adverse events (AEs). We pooled data using a random effects model and assessed certainty of evidence (CoE) related to minimally important difference estimates for outcomes using GRADE.

Results: We included 73 unique RCTs (n = 6305 participants, 53% female). Intervention types included physical activity (n = 1437), nutrition (n = 447), psychological (n = 1336), technology-based (n = 901) or multicomponent (≥2 intervention types, n = 2184). Physical activity had a small effect on health-related quality of life (HRQoL), varying effects ranging from moderate to very large on blood pressure, lipids and insulin resistance, and a small effect on BMIz. Nutrition had a small effect on lipids, insulin resistance and BMIz. Psychological interventions showed a small effect on HRQoL and triglycerides and moderate benefits on depressive symptoms, while technology interventions showed small benefits on blood pressure and BMIz. Multicomponent interventions had a large benefit on anxiety, small benefit on depressive symptoms, with large to very large benefits on lipids, and small benefits for diastolic blood pressure, insulin resistance and BMIz. AEs were reported infrequently, and when reported, were described as mild.

Conclusion: Physical activity and multicomponent interventions showed improvements in PROMs, cardiometabolic and anthropometric outcomes. Future trials should consistently measure PROMs, evaluate outcomes beyond the intervention period, and study children <6 years of age.

Keywords: behavioural interventions; lifestyle interventions; meta‐analysis; paediatric obesity; randomized controlled trials; systematic review.

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Conflict of interest statement

The following individuals have disclosed potential conflicts of interest related to their involvement in the systematic review and meta‐analysis on pediatric obesity: Geoff Ball has received research funding from the Canadian Institutes of Health Research, the Women and Children's Health Research Institute (University of Alberta), and the Alberta Health Services Chair in Obesity Research. He has received consulting fees from Novo Nordisk Canada as a member of their national advisory board and received reimbursed travel expenses from Obesity Canada. He co‐led the Steering Committee for Updating Canada's Clinical Practice Guideline for Managing Pediatric Obesity, which this review helped to inform. Catherine Birken has received research funding from the Canadian Institutes of Health Research, the Heart & Stroke Foundation of Canada, Physician Services Inc., The Edwin S.H. Leong Centre for Healthy Children, University of Toronto and Hospital for Sick Children; Centre for Addiction and Mental Health, Joannah & Brian Lawson Centre for Child Nutrition, and a Walmart Canada Regional Community Grant administered through SickKids Foundation. She has been a member of the Steering Committee for Updating Canada's Clinical Practice Guideline for Managing Pediatric Obesity, which this review helped to inform. Annick Buchholz has served as a member of the Steering Committee for Updating Canada's Clinical Practice Guideline for Managing Pediatric Obesity, which this review helped to inform. Julius Erdstein has received reimbursed travel expenses from Obesity Canada and Novo Nordisk Canada and has also been a member of the Steering Committee for Updating Canada's Clinical Practice Guideline for Managing Pediatric Obesity, which this review helped to inform. Donna Fitzpatrick‐Lewis has been a member of the Steering Committee for Updating Canada's Clinical Practice Guideline for Managing Pediatric Obesity, which this review helped to inform. Stasia Hadjiyannakis has attended advisory board meetings for Rhythm Pharmaceuticals and Novo Nordisk, which may influence her perspectives on pediatric obesity. She has been a member of the Steering Committee for Updating Canada's Clinical Practice Guideline for Managing Pediatric Obesity, which this review helped to inform. Jill Hamilton has received funding for both industry‐sponsored (LevoTherapeutics, Rhythm Pharmaceuticals, Pfizer, Novo Nordisk Canada, Eli Lilly) and investigator‐initiated (Sunlife, PWS Foundation) research. She holds a Research Chair supported by Mead Johnson. She has received consulting fees from Novo Nordisk (consultant participation, Pediatric Obesity National Advisory Board), EMD Serono (consultant participation, Pediatric Growth Hormone Deficiency National Advisory Board), Eversana (consultant participation, Advisory Board), Rhythm Pharmaceuticals (Chair, Paediatric Advisory Board and participant, National Advisory Board Meeting on the Management of Rare Forms of Obesity and IMCIVREE Use in Paediatrics). She has received honoraria from Pfizer as speaker and from Rhythm Pharmaceuticals as speaker and for conducting HCP questionnaire for advisory board. She has received reimbursed travel expenses from European Congress on Obesity for presenting at annual meeting. She also is Medical Director for the Healthy Living Clinic. She has been a member of the Steering Committee for Updating Canada's Clinical Practice Guideline for Managing Pediatric Obesity, which this review helped to inform. Soren Harnois‐Leblanc hasreceived doctoral funding from the Québec Research Funds – Health and postdoctoral fellowship grants from Obesity Canada and the American Diabetes Association. Dawn Hatanaka has received travel reimbursement from the Obesity Society and the Obesity Policy Engagement Network and has served on an advisory board for a training network program funded by the Canadian Institutes of Health Research. She has been a member of the Steering Committee for Updating Canada's Clinical Practice Guideline for Managing Pediatric Obesity, which this review helped to inform. Mélanie Henderson has received research grants from Canadian Institutes of Health Research, and a salary award from Québec Research Funds – Health. She is Chair of the Comité scientifique sur la prévention de l'obésité of the Institut national de santé publique du Québec, and member of the Groupe de consultation de la prise en charge de l'obésité chez l'enfant et l'adolescent and the Comité consultatif québécois en médecine bariatrique of the Québec's Minister of Health and Social Services. She has been a member of the Steering Committee for Updating Canada's Clinical Practice Guideline for Managing Pediatric Obesity, which this review helped to inform. Bradley Johnston received a start‐up grant from Texas A&M AgriLife Research to fund investigator‐initiated research related to saturated and polyunsaturated fats. The grant was from Texas A&M AgriLife institutional funds from interest and investment earnings, not a sponsoring organization, industry, or company. He also holds NIH NIDDK R25 funds for developing and delivering educational programs and materials on Evidence‐Based Nutrition. He has received funding from Obesity Canada, Alberta Health Services Obesity Chair program, and the European Association for the Study of Obesity to attend and present at Obesity Week, Obesity Canada, and the annual EASO meetings. He also is a working group member of GRADE and EvidenceBasedNutrition.org. He co‐chaired the Guideline Panel to update Canada's Clinical Practice Guideline for Managing Pediatric Obesity, which this review helped to inform. Roah Merdad has been a member of the Steering Committee for Updating Canada's Clinical Practice Guideline for Managing Pediatric Obesity, which this review helped to inform. Sarah Moore has received research funding or in‐kind support from the Canadian Institutes of Health Research, Department of Communities, Culture, Tourism and Heritage (Government of Nova Scotia), ParticipACTION, Outdoor Play Canada, Obesity Canada, Dalhousie University, and Women and Children's Health Research Institute (University of Alberta). She has received consulting fees from PHE Canada to review a Disability and Physical Activity Guidebook and partial reimbursement from Obesity Canada for travel to the Canadian Obesity Summit. She also serves as a Project Lead for the MacEachen Institute for Public Policy and Governance and receive some administrative support, as well as funding for events, to support RAs. She has been a member of the Steering Committee for Updating Canada's Clinical Practice Guideline for Managing Pediatric Obesity, which this review helped to inform. Katherine Morrison received grants unrelated to this work from Canadian Institutes of Health Research and Diabetes Canada. She has received consulting fees as a member of advisory boards from Novo Nordisk Canada and Rhythm Pharmaceuticals. She participated on a Data Safety Monitoring Board of Novartis. She also co‐led the Steering Committee and Guideline Panel to update Canada's Clinical Practice Guideline for Managing Pediatric Obesity, which this review helped to inform. Diana Sherifali has received grant from Obesity Canada to conduct review. She has received honoraria from Lilly for participation in a panel discussion and from Novo Nordisk for a presentation at a community engagement forum. She has been a member of the Steering Committee for Updating Canada's Clinical Practice Guideline for Managing Pediatric Obesity, which this review helped to inform. No other authors have any known conflicts of interest to disclose.

References

    1. Ball GDC, Savu A, Kaul P. Changes in the prevalence of overweight, obesity, and severe obesity between 2010 and 2017 in preschoolers: a population‐based study. Pediatr Obes. 2019;14(11):e12561. - PubMed
    1. Rao DP, Kropac E, Do MT, Roberts KC, Jayaraman GC. Childhood overweight and obesity trends in Canada. Health Promot Chronic Dis Prev Can. 2016;36(9):194‐198. - PMC - PubMed
    1. Caprio S, Santoro N, Weiss R. Childhood obesity and the associated rise in cardiometabolic complications. Nat Metab. 2020;2(3):223‐232. - PMC - PubMed
    1. Rodd C, Sharma AK. Recent trends in the prevalence of overweight and obesity among Canadian children. CMAJ. 2016;188(13):E313‐E320. - PMC - PubMed
    1. Rankin J, Matthews L, Cobley S, et al. Psychological consequences of childhood obesity: psychiatric comorbidity and prevention. Adolesc Health Med Ther. 2016;7:125‐146. - PMC - PubMed