Intervention Review

Interventions for preventing obesity in children

  1. Elizabeth Waters1,*,
  2. Andrea de Silva-Sanigorski2,
  3. Belinda J Hall2,
  4. Tamara Brown3,
  5. Karen J Campbell4,
  6. Yang Gao5,
  7. Rebecca Armstrong2,
  8. Lauren Prosser2,
  9. Carolyn D Summerbell6

Editorial Group: Cochrane Heart Group

Published Online: 7 DEC 2011

Assessed as up-to-date: 22 SEP 2010

DOI: 10.1002/14651858.CD001871.pub3

Database Title

Additional Information

How to Cite

Waters E, de Silva-Sanigorski A, Hall BJ, Brown T, Campbell KJ, Gao Y, Armstrong R, Prosser L, Summerbell CD. Interventions for preventing obesity in children. Cochrane Database of Systematic Reviews 2011, Issue 12. Art. No.: CD001871. DOI: 10.1002/14651858.CD001871.pub3.

Author Information

  1. 1

    The University of Melbourne, Jack Brockhoff Child Health and Wellbeing Program, The McCaughey Centre, Melbourne School of Population Health, Carlton, VIC, Australia

  2. 2

    The University of Melbourne, Jack Brockhoff Child Health and Wellbeing Program, The McCaughey Centre, Melbourne School of Population Health, Parkville, Victoria, Australia

  3. 3

    Division of Clinical Effectiveness, School of Population, Community and Behavioural Sciences, University of Liverpool, Liverpool Reviews and Implementation Group, Liverpool, UK

  4. 4

    Deakin University, School of Exercise and Nutrition Sciences, Burwood, VIC, Australia

  5. 5

    The Chinese University of Hong Kong, School of Public Health and Primary Care, Hong Kong, Hong Kong

  6. 6

    Queen's Campus, Durham University, School of Medicine and Health, Wolfson Research Institute, Stockton-on-Tees, UK

*Elizabeth Waters, Jack Brockhoff Child Health and Wellbeing Program, The McCaughey Centre, Melbourne School of Population Health, The University of Melbourne, Level 5/207 Bouverie St, Carlton, VIC, 3010, Australia. ewaters@unimelb.edu.au.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 7 DEC 2011

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Prevention of childhood obesity is an international public health priority given the significant impact of obesity on acute and chronic diseases, general health, development and well-being. The international evidence base for strategies that governments, communities and families can implement to prevent obesity, and promote health, has been accumulating but remains unclear.

Objectives

This review primarily aims to update the previous Cochrane review of childhood obesity prevention research and determine the effectiveness of evaluated interventions intended to prevent obesity in children, assessed by change in Body Mass Index (BMI). Secondary aims were to examine the characteristics of the programs and strategies to answer the questions "What works for whom, why and for what cost?"

Search methods

The searches were re-run in CENTRAL, MEDLINE, EMBASE, PsychINFO and CINAHL in March 2010 and searched relevant websites. Non-English language papers were included and experts were contacted.

Selection criteria

The review includes data from childhood obesity prevention studies that used a controlled study design (with or without randomisation). Studies were included if they evaluated interventions, policies or programs in place for twelve weeks or more. If studies were randomised at a cluster level, 6 clusters were required.

Data collection and analysis

Two review authors independently extracted data and assessed the risk of bias of included studies.  Data was extracted on intervention implementation, cost, equity and outcomes. Outcome measures were grouped according to whether they measured adiposity, physical activity (PA)-related behaviours or diet-related behaviours.  Adverse outcomes were recorded. A meta-analysis was conducted using available BMI or standardised BMI (zBMI) score data with subgroup analysis by age group (0-5, 6-12, 13-18 years, corresponding to stages of developmental and childhood settings).

Main results

This review includes 55 studies (an additional 36 studies found for this update). The majority of studies targeted children aged 6-12 years.  The meta-analysis included 37 studies of 27,946 children and demonstrated that programmes were effective at reducing adiposity, although not all individual interventions were effective, and there was a high level of observed heterogeneity (I2=82%).  Overall, children in the intervention group had a standardised mean difference in adiposity (measured as BMI or zBMI) of -0.15kg/m2 (95% confidence interval (CI): -0.21 to -0.09).  Intervention effects by age subgroups were -0.26kg/m2 (95% CI:-0.53 to 0.00) (0-5 years), -0.15kg/m2 (95% CI -0.23 to -0.08) (6-12 years), and -0.09kg/m2 (95% CI -0.20 to 0.03) (13-18 years). Heterogeneity was apparent in all three age groups and could not explained by randomisation status or the type, duration or setting of the intervention.  Only eight studies reported on adverse effects and no evidence of adverse outcomes such as unhealthy dieting practices, increased prevalence of underweight or body image sensitivities was found.  Interventions did not appear to increase health inequalities although this was examined in fewer studies.

Authors' conclusions

We found strong evidence to support beneficial effects of child obesity prevention programmes on BMI, particularly for programmes targeted to children aged six to 12 years. However, given the unexplained heterogeneity and the likelihood of small study bias, these findings must be interpreted cautiously. A broad range of programme components were used in these studies and whilst it is not possible to distinguish which of these components contributed most to the beneficial effects observed, our synthesis indicates the following to be promising policies and strategies:

·         school curriculum that includes healthy eating, physical activity and body image

·         increased sessions for physical activity and the development of fundamental movement skills throughout the school week

·         improvements in nutritional quality of the food supply in schools

·         environments and cultural practices that support children eating healthier foods and being active throughout each day

·         support for teachers and other staff to implement health promotion strategies and activities (e.g. professional development, capacity building activities)

·         parent support and home activities that encourage children to be more active, eat more nutritious foods and spend less time in screen based activities

However, study and evaluation designs need to be strengthened, and reporting extended to capture process and implementation factors, outcomes in relation to measures of equity, longer term outcomes, potential harms and costs.

Childhood obesity prevention research must now move towards identifying how effective intervention components can be embedded within health, education and care systems and achieve long term sustainable impacts.  

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Interventions for preventing obesity in children

Childhood obesity can cause social, psychological and health problems, and is linked to obesity later in life and poor health outcomes as an adult.  Obesity development is related to physical activity and nutrition. To prevent obesity, 55 studies conducted internationally have looked at programmes aiming to improve either or both of these behaviours.  Although many studies were able to improve children’s nutrition or physical activity to some extent, only some studies were able to see an effect of the programme on children’s levels of fatness.  When we combined the studies, we were able to see that these programmes made a positive difference, but there was much variation between the study findings which we could not explain. Also, it appeared that the findings may be biased by missing small studies with negative findings. We also tried to work out why some programmes work better than others, and whether there was potential harm associated with children being involved in the programmes.  Although only a few studies looked at whether programmes were harmful, the results suggest that those obesity prevention strategies do not increase body image concerns, unhealthy dieting practices, level of underweight, or unhealthy attitudes to weight, and that all children can benefit.  It is important that more studies in very young children and adolescents are conducted to find out more about obesity prevention in these age groups, and also that we assess how long the intervention effects last.  Also, we need to develop ways of ensuring that research findings benefit all children by embedding the successful programme activities into everyday practices in homes, schools, child care settings, the health system and the wider community.     

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

預防兒童肥胖的介入方法

預防肥胖是一個國際性公共衛生領域的優先課題.兒童肥胖與過重的盛行率在全球均是逐年增加,對於兒童健康造成短期與長期的影響.針對兒童擬定一預防肥胖的策略可以改變其行為,然而其確切的效果目前仍不明.

目標

評估預防兒童肥胖的介入方法的效果,包括經由飲食,運動,生活型態的調整,以及社會支持等方法.

搜尋策略

搜尋1990年至2005年2月的MEDLINE, PsycINFO, EMBASE, CINAHL and CENTRAL資料庫. 本研究涵蓋了非英文論文及專家的意見.

選擇標準

進行至少12週的隨機對照試驗及對照臨床試驗.

資料收集與分析

兩位審查者獨立地擷取資料且評估研究品質.

主要結論

本研究包含了22個研究 10個長期研究(至少進行12個月)及12個短期研究(進行12週至12個月). 其中19個研究為學齡及學齡前的介入性研究, 1個為針對低收入家庭的社區性介入性研究, 另外2個則為針對肥胖父母與非肥胖兒童的家庭性介入性研究. 10個長期研究中有6個以合併飲食衛教及運動進行介入 其中5個的結果發現此介入對於減重無效, 而另外1個研究則發現針對肥胖女童的減重有效, 然而針對男童則無效. 另外2個長期研究則僅以運動介入, 在這些研究中發現多媒體的方法對於預防肥胖似乎是有效的. 另外2個長期研究則僅以飲食衛教介入, 但均顯示對於預防肥胖是無效的. 12個短期研究中有4個以增加運動量進行介入, 其中2個發現可輕微降低體重. 另外8個短期研究則是合併飲食衛教及運動, 但結果均呈無效. 這些研究中, 無論是設計方式, 品質, 研究族群, 理論基礎, 以及成果指標均有所不同, 導致無法將這些研究的資料合併進行統計學計算. 此外, 這些研究也缺乏成本效益的相關資料.

作者結論

這些研究大多數為短期的. 有些研究以合併飲食衛教及運動進行介入發現並無法改善身體質量指數(BMI), 但有些研究則發現此法具有輕微減重成效. 幾乎所有的研究導致飲食及運動的進步. 預防兒童肥胖介入方法的發展, 設計, 時間, 及強度, 其適當性須要參考介入方法範圍及過程的綜合性報告後, 進一步重新考慮.

翻譯人

本摘要由臺北榮民總醫院楊智宇翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

預防兒童肥胖的介入方法: 目前的證據顯示許多以飲食及運動預防兒童肥胖的介入方法, 對於預防體重增加是無效的, 但是卻可以有效地促進飲食健康及增加運動量. 過度過重(肥胖)會導致兒童出現健康, 心理, 及社會問題. 如同成人一般, 肥胖的兒童較易發生體重及健康的問題. 預防肥胖的方案係針對一個以上的因子進行介入以修正之. 本篇綜論性文章包含了22篇研究, 其中測試了許多介入方案, 包括單獨或合併增加運動量及改變飲食習慣. 研究對象年齡小於18歲, 居住地包括亞洲, 南美洲, 歐洲, 或北美洲. 儘管包含改變飲食和運動量, 心理社會支持, 及改變環境的綜合性策略可能有幫助, 目前這些研究中並沒有足夠的證據證實任何一個特定的介入方案可以預防兒童肥胖. 目前的趨勢係較新穎的介入方法, 其中包含了研究對象其個別的社區型態, 並加入評估方法等. 未來的研究可以有效地評估代表整個族群的改變, 包括學校飲食樣式的進步, 學校提供學童運動的安全環境, 並且也應該以數年的時間針對健康的促進進行成本效益分析. 本篇綜論性文章中所探討的研究係使用不同的介入方案來預防肥胖, 因此直接比較是有困難性的. 此外, 這些研究的時間由12週至3年之久, 然而多數研究時間少於1年.

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