Parent-focused behavioural interventions for the prevention of early childhood obesity (TOPCHILD): a systematic review and individual participant data meta-analysis

Kylie E Hunter¹, David Nguyen², Sol Libesman², Jonathan G Williams², Mason Aberoumand², Jannik Aagerup³, Brittany J Johnson⁴, Rebecca K Golley⁴, Angie Barba², James X Sotiropoulos², Nipun Shrestha⁵, Talia Palacios², Samantha J Pryde⁴, Luke Wolfenden⁶, Rachael W Taylor⁷, Peter J Godolphin⁸, Karen Matvienko-Sikar⁹, Lee M Sanders¹⁰, Kristy P Robledo², Vicki Brown¹¹, Charles T Wood¹², Sarah Taki¹³, H Shonna Yin¹⁴, Alison J Hayes², Denise A O'Connor¹⁵, Wendy Smith¹⁶, David E Espinoza², Lisa Askie², Paul M Chadwick¹⁷, Chris Rissel¹⁸, Angela C Webster¹⁸, Kylie D Hesketh¹⁹, Maria Bryant²⁰, Jessica L Thomson²¹, Rajalakshmi Lakshman²², Alexander G Fiks²³, Christine Helle²⁴, Cathleen Odar Stough²⁵, Ken K Ong²², Eliana M Perrin²⁶, Levie Karssen²⁷, Junilla K Larsen²⁷, Ana M Linares²⁸, Mary Jo Messito¹⁴, Li Ming Wen¹³, Emily Oken²⁹, Nina Cecilie Øverby³⁰, Cristina Palacios³¹, Ian M Paul³², Finn E Rasmussen³³, Elizabeth A Reifsnider³⁴, Russell L Rothman³⁵, Rebecca A Byrne³⁶, Tiffany M Rybak³⁷, Sarah-Jeanne Salvy³⁸, Heather M Wasser³⁹, Amanda L Thompson³⁹, Ata Ghaderi⁴⁰, Barry J Taylor⁷, Claudio Maffeis⁴¹, Huilan Xu¹³, Jennifer S Savage⁴², Kaumudi J Joshipura⁴³, Kayla de la Haye⁴⁴, Margrethe Røed²⁴, Bethan Copsey⁴⁵, Natalia Golova⁴⁶, Rachel S Gross¹⁴, Stephanie Anzman-Frasca⁴⁷, Jinan Banna⁴⁸, Louise A Baur¹⁸, Anna Lene Seidler³; TOPCHILD Collaboration

Affiliations

¹ NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia. Electronic address: kylie.hunter@sydney.edu.au.
² NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia.
³ NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia; Department of Child and Adolescent Psychiatry, University Medical Centre Rostock, Rostock, Germany; German Center for Child and Adolescent Health (DZKJ), Partner Site Greifswald/Rostock, Rostock, Germany.
⁴ Flinders University, College of Nursing and Health Sciences, Caring Futures Institute, Bedford Park, SA, Australia.
⁵ University of Sydney, Sydney, NSW, Australia; Health Evidence Synthesis, Recommendations and Impact (HESRI), School of Public Health, The University of Adelaide, Adelaide, SA, Australia.
⁶ The University of Newcastle, Newcastle, NSW, Australia.
⁷ University of Otago, Dunedin, New Zealand.
⁸ MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, University College London, London, UK.
⁹ University College Cork, Cork, Ireland.
¹⁰ Stanford University, Stanford, CA, USA.
¹¹ Deakin Health Economics, Institute for Health Transformation, Deakin University, Geelong, VIC, Australia.
¹² Duke University School of Medicine, Durham, NC, USA.
¹³ University of Sydney, Sydney, NSW, Australia; Sydney Local Health District, Sydney, NSW, Australia.
¹⁴ NYU Grossman School of Medicine, New York, NY, USA.
¹⁵ Monash University, Melbourne, VIC, Australia.
¹⁶ Sydney Local Health District, Sydney, NSW, Australia.
¹⁷ University College London, London, UK.
¹⁸ University of Sydney, Sydney, NSW, Australia.
¹⁹ Institute for Physical Activity and Nutrition, Deakin University, Geelong, VIC, Australia.
²⁰ University of York, York, UK.
²¹ USDA Agricultural Research Service, Stoneville, MS, USA.
²² University of Cambridge, MRC Epidemiology Unit, Cambridge, UK.
²³ Children's Hospital of Philadelphia, Philadelphia, PA, USA.
²⁴ University of Agder, Kristiansand, Norway.
²⁵ University of Cincinnati, Cincinnati, OH, USA.
²⁶ Johns Hopkins University Schools of Medicine and Nursing, Baltimore, MD, USA.
²⁷ Radboud University, Nijmegen, Netherlands.
²⁸ University of Kentucky, Lexington, KY, USA.
²⁹ Harvard Pilgrim Health Care Institute, Boston, MA, USA.
³⁰ University of Agder, Faculty of Health and Sport Sciences, Department of Nutrition and Public Health, Kristiansand, Norway.
³¹ Florida International University, Miami, FL, USA.
³² Penn State College of Medicine, Hershey, PA, USA.
³³ Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
³⁴ Arizona State University, Phoenix, AZ, USA.
³⁵ Vanderbilt University Medical Center, Nashville, TN, USA.
³⁶ Queensland University of Technology, Brisbane, QLD, Australia.
³⁷ Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
³⁸ Cedars Sinai Medical Center, Los Angeles, CA, USA.
³⁹ University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
⁴⁰ Karolinska Institutet, Stockholm, Sweden.
⁴¹ University of Verona, Verona, Italy.
⁴² Penn State University, University Park, PA, USA.
⁴³ Ahmedabad University, Bagchi School of Public Health, Ahmedabad, India; Harvard TH Chan School of Public Health, Boston, MA, USA.
⁴⁴ University of Southern California, Los Angeles, CA, USA.
⁴⁵ University of Leeds, Leeds, UK.
⁴⁶ Lifespan, Brown University Health, Providence, RI, USA.
⁴⁷ University at Buffalo, Buffalo, NY, USA.
⁴⁸ University of Hawaii, Honolulu, HI, USA.

PMID: 40945528
DOI: 10.1016/S0140-6736(25)01144-4

Meta-Analysis

Parent-focused behavioural interventions for the prevention of early childhood obesity (TOPCHILD): a systematic review and individual participant data meta-analysis

Kylie E Hunter et al. Lancet. 2025.

. 2025 Sep 20;406(10509):1235-1254.

doi: 10.1016/S0140-6736(25)01144-4. Epub 2025 Sep 10.

Authors

Affiliations

¹ NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia. Electronic address: kylie.hunter@sydney.edu.au.
² NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia.
³ NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia; Department of Child and Adolescent Psychiatry, University Medical Centre Rostock, Rostock, Germany; German Center for Child and Adolescent Health (DZKJ), Partner Site Greifswald/Rostock, Rostock, Germany.
⁴ Flinders University, College of Nursing and Health Sciences, Caring Futures Institute, Bedford Park, SA, Australia.
⁵ University of Sydney, Sydney, NSW, Australia; Health Evidence Synthesis, Recommendations and Impact (HESRI), School of Public Health, The University of Adelaide, Adelaide, SA, Australia.
⁶ The University of Newcastle, Newcastle, NSW, Australia.
⁷ University of Otago, Dunedin, New Zealand.
⁸ MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, University College London, London, UK.
⁹ University College Cork, Cork, Ireland.
¹⁰ Stanford University, Stanford, CA, USA.
¹¹ Deakin Health Economics, Institute for Health Transformation, Deakin University, Geelong, VIC, Australia.
¹² Duke University School of Medicine, Durham, NC, USA.
¹³ University of Sydney, Sydney, NSW, Australia; Sydney Local Health District, Sydney, NSW, Australia.
¹⁴ NYU Grossman School of Medicine, New York, NY, USA.
¹⁵ Monash University, Melbourne, VIC, Australia.
¹⁶ Sydney Local Health District, Sydney, NSW, Australia.
¹⁷ University College London, London, UK.
¹⁸ University of Sydney, Sydney, NSW, Australia.
¹⁹ Institute for Physical Activity and Nutrition, Deakin University, Geelong, VIC, Australia.
²⁰ University of York, York, UK.
²¹ USDA Agricultural Research Service, Stoneville, MS, USA.
²² University of Cambridge, MRC Epidemiology Unit, Cambridge, UK.
²³ Children's Hospital of Philadelphia, Philadelphia, PA, USA.
²⁴ University of Agder, Kristiansand, Norway.
²⁵ University of Cincinnati, Cincinnati, OH, USA.
²⁶ Johns Hopkins University Schools of Medicine and Nursing, Baltimore, MD, USA.
²⁷ Radboud University, Nijmegen, Netherlands.
²⁸ University of Kentucky, Lexington, KY, USA.
²⁹ Harvard Pilgrim Health Care Institute, Boston, MA, USA.
³⁰ University of Agder, Faculty of Health and Sport Sciences, Department of Nutrition and Public Health, Kristiansand, Norway.
³¹ Florida International University, Miami, FL, USA.
³² Penn State College of Medicine, Hershey, PA, USA.
³³ Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
³⁴ Arizona State University, Phoenix, AZ, USA.
³⁵ Vanderbilt University Medical Center, Nashville, TN, USA.
³⁶ Queensland University of Technology, Brisbane, QLD, Australia.
³⁷ Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
³⁸ Cedars Sinai Medical Center, Los Angeles, CA, USA.
³⁹ University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
⁴⁰ Karolinska Institutet, Stockholm, Sweden.
⁴¹ University of Verona, Verona, Italy.
⁴² Penn State University, University Park, PA, USA.
⁴³ Ahmedabad University, Bagchi School of Public Health, Ahmedabad, India; Harvard TH Chan School of Public Health, Boston, MA, USA.
⁴⁴ University of Southern California, Los Angeles, CA, USA.
⁴⁵ University of Leeds, Leeds, UK.
⁴⁶ Lifespan, Brown University Health, Providence, RI, USA.
⁴⁷ University at Buffalo, Buffalo, NY, USA.
⁴⁸ University of Hawaii, Honolulu, HI, USA.

PMID: 40945528
DOI: 10.1016/S0140-6736(25)01144-4

Abstract

Background: Childhood obesity is a global public health issue, which has prompted governments to invest in prevention programmes. We aimed to investigate the effectiveness of parent-focused early childhood obesity prevention interventions globally.

Methods: We did a systematic review and individual participant data meta-analysis. We searched databases and trial registries (MEDLINE, Embase, CENTRAL, CINAHL, PsycInfo, ClinicalTrials.gov, and WHO International Clinical Trials Registry Platform) from inception until Sept 30, 2024, for randomised controlled trials commencing before 12 months of age examining parent-focused behavioural interventions to prevent obesity in children, compared with usual care, no intervention, or attention control. Individual participant data were checked, harmonised, and assessed for integrity and risk of bias. We excluded trials that were quasi-randomised, investigated pregnancy-only interventions, or did not collect any child weight-related outcomes. The primary outcome was BMI Z score at age 24 months (±6 months). We did an intention-to-treat, two-stage, random effects meta-analysis to examine effects overall and for prespecified subgroups. We assessed certainty of evidence using Grading of Recommendations Assessment, Development, and Evaluation. This study is registered with PROSPERO, CRD42020177408.

Findings: Of 19 990 identified records, 47 (0·24%) trials were completed and eligible. Of these, 18 (38%) assessed our primary outcome, BMI Z score. We obtained individual participant data for 17 (94%; n=9128) of these 18 trials (n=9383), representing 97% of eligible participants. Of these 9128 participants, 4549 (50%) were boys, 4415 (48%) were girls, and 164 (2%) had unknown sex. We found no evidence of an effect of interventions on BMI Z score at age 24 months (±6 months; mean difference -0·01 [95% CI -0·08 to 0·05]; high certainty evidence, τ²=0·01; n=6505; 2623 missing). Findings were robust to prespecified sensitivity analyses (eg, different analysis methods and missing data), and we found no evidence of differential intervention effects for prespecified subgroups including priority populations and trial-level factors.

Interpretation: These findings indicate that examined parent-focused behavioural interventions are insufficient to prevent obesity at age 24 months (±6 months). This evidence highlights a need to re-think childhood obesity prevention approaches.

Funding: Australian National Health and Medical Research Council.

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Conflict of interest statement

Declaration of interests KEH declares support for the current study as an investigator from the Australian National Health and Medical Research Council (NHMRC; GNT1186363 and GNT2006999) and had travel supported by the EPOCH-Translate Centre of Research Excellence (CRE; 2023 and 2024). RKG declares support for the current study as an investigator from the NHMRC (GNT1186363, GNT2006999, and GNT1101675, and for BJJ salary support). LAB and LMW declare grant funding from the NHMRC (393112 and 1003780) and the NHMRC CRE (1101675 and 2006999). JXS is supported by an NHMRC Postgraduate Research Scholarship. LW declares salary support from the NHMRC Investigator Grant Scheme. RWT declares salary support from the Karitane Products Society. PJG is supported by the UK Medical Research Council (MC_UU_00004/06). LMS declares funding for their included trial Greenlight from the Patient-Centered Outcomes Research Institute (PCORI). KPR declares support from the NHMRC (Investigator Grant 2025-2029). VB declares support for the current study as an investigator from the NHMRC (GNT2006999). AJH declares payments to their institution from the NHMRC (GNT1186363). KDH declares grant funding from the NHMRC (GNT425801 and GNT1008879), and Future Leader Fellowship funding from the Heart Foundation Australia (105929). LA declares support for the current study as an investigator from the NHMRC (GNT1186363 and GNT2006999). MB declares salary support as the Principal Investigator of their included trial HENRY from the National Institute for Health and Care Research (NIHR) and has a role as member of the Board of Trustees, UK Association for the Study of Obesity (Chair 2019–22). AGF declares grants or contracts from the US National Institutes of Health (NIH), PCORI, and Agency for Healthcare Research and Quality (AHRQ); received consulting fees from the University of California, Los Angeles (UCLA), Rutgers, PCORI, and Duke University; was paid for presentations by Emory University; had travel supported by the NIH and PCORI; participated on the Data and Safety Monitoring Board for NIH trials; has a role in the American Academy of Pediatrics; and declares funding for their included trial from University Research Council faculty grant at the University of Cincinnati. KKO declares programme funding from the UK Medical Research Council (MC_UU_00006/2) and has a role as Chair of the Maternal and Child Nutrition Subgroup of the UK Scientific Advisory Committee on Nutrition. LK declares support from the Behavioural Science Institute, Radboud University. JKL declares salary and included trial support from Fonds NutsOhra (100.939). AML declares funding for their included trial from the NIH (UL1TR000117 and UL1TR001998). EO declares they are the recipient of a grant from the NIH. MJM declares support for their included trail from the US Department of Agriculture (USDA) National Institute of Food and Agriculture (2011-68001-30207 and 2017-68001-26350). IMP declares that payment to support their time was received from National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK; R01DK088244) and received consulting fees from Danone North America. EAR declares they are the recipient of a grant from the NIH and is President of the Southern Nursing Research Society. RLR declares funding for their included trials Greenlight from the NIH and Greenlight Plus from the PCORI and has received grants or contracts from the AHRQ, PCORI, NIH, US Centers for Disease Control and Prevention (CDC), and Cardiohealth Alliance. TMR declares funding for their included trial THRIVE from NIDDK (T32 DK063929) and declares they have received grants or contracts from the NIDDK (R01DK135497), Cincinnati Children's Hospital Medical Center. HMW declares funding for their included trial Mothers and Others from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD; R01HD073237) and declares their time was funded by the NIDDK (K01DK111793). ALT declares funding for their included trial Mothers and Others from the NICHD (R01HD073237). HX declares support for the trial Healthy Beginnings involvement was provided by Sydney Local Health District (SLHD). KJJ declares salary support as the Principal Investigator of their included trial from the NIH. KdlH declares funding for their involvement from the NICHD (1R01HD092483). BC declares funding for their included trial HENRY III from the NIHR (NIHR135081). RSG declares support and has received funding from the NIH and USDA. JB declares funding and travel support from the Hawaii Community Foundation, USDA, and Kellog Foundation; and payments for presentations through various organisations. ALS declares support for the current study as an investigator from the NHMRC (GNT1186363, GNT1101675, GNT2006999, and GNT2009432). All other authors declare no competing interests.

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Parent-focused behavioural interventions for the prevention of early childhood obesity (TOPCHILD): a systematic review and individual participant data meta-analysis

Affiliations

Parent-focused behavioural interventions for the prevention of early childhood obesity (TOPCHILD): a systematic review and individual participant data meta-analysis

Authors

Affiliations

Abstract

Conflict of interest statement

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LinkOut - more resources

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