Lifestyle Interventions in the Treatment of Childhood Overweight: A Meta-Analytic Review of Randomized Controlled Trials

Department of Psychiatry, Washington University School of Medicine, MO 63110, USA.
Health Psychology (Impact Factor: 3.59). 10/2007; 26(5):521-32. DOI: 10.1037/0278-6133.26.5.521
Source: PubMed


Evaluating the efficacy of pediatric weight loss treatments is critical.
This is the first meta-analysis of the efficacy of RCTs comparing pediatric lifestyle interventions to no-treatment or information/education-only controls.
Medline, PsycINFO, and Cochrane Controlled Trials Register.
Fourteen RCTs targetting change in weight status were eligible, yielding 19 effect sizes.
Standardized coding was used to extract information on design, participant characteristics, interventions, and results.
For trials with no-treatment controls, the mean effect size was 0.75 (k = 9, 95% confidence interval [CI] = 0.52-0.98) at end of treatment and 0.60 (k = 4, CI = 0.27-0.94) at follow-up. For trials with information/education-only controls, the mean ES was 0.48 (k = 4, CI = 0.13-0.82) at end of treatment and 0.91 (k = 2, CI = 0.32-1.50) at follow-up. No moderator effects were identified.
Lifestyle interventions for pediatric overweight are efficacious in the short term with some evidence for extended persistence. Future research is required to identify moderators and mediators and to determine the optimal length and intensity of treatment required to produce enduring changes in weight status.

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Available from: Leonard H Epstein, Oct 05, 2015
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    • "Numerous studies have demonstrated significant associations between parent PA and youth PA (Davidson, Cutting, & Birch, 2003; Ferreira et al., 2006; Prochaska, Rodgers, & Sallis, 2002), and it is hypothesized that parental modeling, encouragement, and support are key mechanisms of this relationship. Nonetheless, despite the long-term health benefits of PA and the important role of parents in influencing their child's activity level, relatively few studies to date have examined changes in PA at long-term follow-up, changes in parent PA, or associations between change in parent PA and change in child PA within the context of a weightmanagement intervention (McGovern et al., 2008; Wilfley et al., 2007). If interventions neglect to measure these essential treatment components when evaluating the success or failure of a particular lifestyle intervention, the potential long-term success of the intervention may be difficult to assess. "
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    ABSTRACT: Objectives: To examine differences in self-reported physical activity (PA) between participants enrolled in the treatment versus active control condition of a pediatric obesity intervention, and to test associations between parent and child PA. Methods: Participants (N = 93) included children aged 7-17 years and their parent. Analyses tested whether participants in the treatment condition reported greater PA at postintervention and 12-month follow-up compared with the control condition. Further, researchers examined change in PA across time and whether change in parent PA was associated with change in child PA. Results: Children in the treatment condition reported greater PA at 12-month follow-up. Parents in the treatment group reported a significant increase in PA between baseline and postintervention. Change in parent PA was associated with changes in child PA across multiple periods. Conclusions: Family-based obesity interventions may promote long-term change in self-reported PA among youths, and change in parent PA may be a contributing factor.
    Journal of Pediatric Psychology 09/2014; 40(2). DOI:10.1093/jpepsy/jsu077 · 2.91 Impact Factor
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    • "To improve weight management care, the individual factors that differentiate those boys and girls whose health outcomes improve versus those with no improvements or worsening health outcomes, as well as factors related to attrition and recidivism require additional study. Changes to lifestyle (nutrition, physical activity, sedentary activity) habits are usually promoted through individual and/or group-based counseling to encourage their adoption and maintenance [9,11]. The valuable outcomes of behavioral lifestyle interventions in the treatment of childhood obesity have been recently highlighted [8,12]. "
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    ABSTRACT: Background Over recent decades, the prevalence of pediatric obesity has increased markedly in developed and developing countries, and the impact of obesity on health throughout the lifespan has led to urgent calls for action. Family-based weight management interventions that emphasize healthy lifestyle changes can lead to modest improvements in weight status of children with obesity. However, these interventions are generally short in duration, reported in the context of randomized controlled trials and there are few reports of outcomes of these treatment approaches in the clinical setting. Answering these questions is critical for improving the care of children with obesity accessing outpatient health services for weight management. In response, the CANadian Pediatric Weight management Registry (CANPWR) was designed with the following three primary aims: 1. Document changes in anthropometric, lifestyle, behavioural, and obesity-related co-morbidities in children enrolled in Canadian pediatric weight management programs over a three-year period; 2. Characterize the individual-, family-, and program-level determinants of change in anthropometric and obesity-related co-morbidities; 3. Examine the individual-, family-, and program-level determinants of program attrition. Methods/Design This prospective cohort, multi-centre study will include children (2–17 years old; body mass index ≥85th percentile) enrolled in one of eight Canadian pediatric weight management centres. We will recruit 1,600 study participants over a three-year period. Data collection will occur at presentation and 6-, 12-, 24-, and 36-months follow-up. The primary study outcomes are BMI z-score and change in BMI z-score over time. Secondary outcomes include anthropometric (e.g., height, waist circumference,), cardiometabolic (e.g., blood pressure, lipid profile, glycemia), lifestyle (e.g., dietary intake, physical activity, sedentary activity), and psychosocial (e.g., health-related quality of life) variables. Potential determinants of change and program attrition will include individual-, family-, and program-level variables. Discussion This study will enable our interdisciplinary team of clinicians, researchers, and trainees to address foundational issues regarding the management of pediatric obesity in Canada. It will also serve as a harmonized, evidence-based registry and platform for conducting future intervention research, which will ultimately enhance the weight management care provided to children with obesity and their families.
    BMC Pediatrics 06/2014; 14(1):161. DOI:10.1186/1471-2431-14-161 · 1.93 Impact Factor
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    • "The calculation of the sample size takes as its primary outcome intervention efficacy - the reduction of BMI SD scores after the intervention, as specified in a published meta-analytic review of trials [24]. The sample size was calculated in order to detect one BMI SD scores reduction (effect size = 0.60 [24]), according an 80.0% statistical power, 5% significance level to detect differences between groups with two independent samples. It is assumed a 20% dropout rate was estimated. "
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    ABSTRACT: Obesity is mainly attributed to environmental factors. In developed countries, the time spent on physical activity tasks is decreasing, whereas sedentary behaviour patterns are increasing.The purpose of the intervention is to evaluate the effectiveness of an intensive family-based behavioural multi-component intervention (Nereu programme) and compared it to counselling intervention such as a health centre intervention programme for the management of children's obesity. The study design is a randomized controlled multicenter clinical trial using two types of interventions: Nereu and Counselling. The Nereu programme is an 8-month intensive family-based multi-component behavioural intervention. This programme is based on a multidisciplinary intervention consisting of 4 components: physical activity sessions for children, family theoretical and practical sessions for parents, behaviour strategy sessions involving both, parents and children, and lastly, weekend extra activities for all. Counselling is offered to the family in the form of a monthly physical health and eating habits session. Participants will be recruited according the following criteria: 6 to 12 year-old-children, referred from their paediatricians due to overweight or obesity according the International Obesity Task Force criteria and with a sedentary profile (less than 2 hours per week of physical activity), they must live in or near the municipality of Lleida (Spain) and their healthcare paediatric unit must have previously accepted to cooperate with this study. The following variables will be evaluated: a) cardiovascular risk factors (anthropometric parameters, blood test and blood pressure), b) sedentary and physical activity behaviour and dietary intake, c) psychological aspects d) health related quality of life (HRQOL), e) cost-effectiveness of the intervention in relation to HRQOL. These variables will be then be evaluated 4 times longitudinally: at baseline, at the end of the intervention (8 months later), 6 and 12 months after the intervention. We have considered necessary to recruit 100 children and divide them in 2 groups of 50 to detect the differences between the groups. This trial will provide new evidence for the long-term effects of childhood obesity management, as well as help to know the impact of the present intervention as a health intervention tool for healthcare centres.Trial, NCT01878994.
    BMC Public Health 10/2013; 13(1):1000. DOI:10.1186/1471-2458-13-1000 · 2.26 Impact Factor
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