Intervention Review

Interventions for treating obesity in children

  1. Hiltje Oude Luttikhuis1,*,
  2. Louise Baur2,
  3. Hanneke Jansen3,
  4. Vanessa A Shrewsbury2,
  5. Claire O'Malley4,
  6. Ronald P Stolk3,
  7. Carolyn D Summerbell5

Editorial Group: Cochrane Heart Group

Published Online: 21 JAN 2009

Assessed as up-to-date: 10 OCT 2008

DOI: 10.1002/14651858.CD001872.pub2

Database Title

Additional Information

How to Cite

Oude Luttikhuis H, Baur L, Jansen H, Shrewsbury VA, O'Malley C, Stolk RP, Summerbell CD. Interventions for treating obesity in children. Cochrane Database of Systematic Reviews 2009, Issue 1. Art. No.: CD001872. DOI: 10.1002/14651858.CD001872.pub2.

Author Information

  1. 1

    University Medical Center Groningen, Beatrix Children's Hospital and Department of Epidemiology, Groningen, Netherlands

  2. 2

    The University of Sydney, Department of Paediatrics and Child Health, Westmead, Australia

  3. 3

    University Medical Center Groningen, Department of Epidemiology, Groningen, Netherlands

  4. 4

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

  5. 5

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

*Hiltje Oude Luttikhuis, Beatrix Children's Hospital and Department of Epidemiology, University Medical Center Groningen, PO Box 30.001 (CA80), 9700RB, Groningen, Netherlands. h.oudeluttikhuis@bkk.umcg.nl.

Publication History

  1. Publication Status: Edited (conclusions changed)
  2. Published Online: 21 JAN 2009

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Abstract

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

Background

Child and adolescent obesity is increasingly prevalent, and can be associated with significant short- and long-term health consequences.

Objectives

To assess the efficacy of lifestyle, drug and surgical interventions for treating obesity in childhood.

Search methods

We searched CENTRAL on The Cochrane Library Issue 2 2008, MEDLINE, EMBASE, CINAHL, PsycINFO, ISI Web of Science, DARE and NHS EED. Searches were undertaken from 1985 to May 2008. References were checked. No language restrictions were applied.

Selection criteria

We selected randomised controlled trials (RCTs) of lifestyle (i.e. dietary, physical activity and/or behavioural therapy), drug and surgical interventions for treating obesity in children (mean age under 18 years) with or without the support of family members, with a minimum of six months follow up (three months for actual drug therapy). Interventions that specifically dealt with the treatment of eating disorders or type 2 diabetes, or included participants with a secondary or syndromic cause of obesity were excluded.

Data collection and analysis

Two reviewers independently assessed trial quality and extracted data following the Cochrane Handbook. Where necessary authors were contacted for additional information.

Main results

We included 64 RCTs (5230 participants). Lifestyle interventions focused on physical activity and sedentary behaviour in 12 studies, diet in 6 studies, and 36 concentrated on behaviorally orientated treatment programs. Three types of drug interventions (metformin, orlistat and sibutramine) were found in 10 studies. No surgical intervention was eligible for inclusion. The studies included varied greatly in intervention design, outcome measurements and methodological quality.

Meta-analyses indicated a reduction in overweight at 6 and 12 months follow up in: i) lifestyle interventions involving children; and ii) lifestyle interventions in adolescents with or without the addition of orlistat or sibutramine. A range of adverse effects was noted in drug RCTs.

Authors' conclusions

While there is limited quality data to recommend one treatment program to be favoured over another, this review shows that combined behavioural lifestyle interventions compared to standard care or self-help can produce a significant and clinically meaningful reduction in overweight in children and adolescents. In obese adolescents, consideration should be given to the use of either orlistat or sibutramine, as an adjunct to lifestyle interventions, although this approach needs to be carefully weighed up against the potential for adverse effects. Furthermore, high quality research that considers psychosocial determinants for behaviour change, strategies to improve clinician-family interaction, and cost-effective programs for primary and community care is required.

 

Plain language summary

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

Treating obesity in children

Childhood obesity affects both the physical and psychosocial health of children and may put them at risk of ill health as adults. More information is needed about the best way to treat obesity in children and adolescents. In this review, 64 studies were examined including 54 studies on lifestyle treatments (with a focus on diet, physical activity or behaviour change) and 10 studies on drug treatment to help overweight and obese children and their families with weight control. No surgical treatment studies were suitable to include in this review. This review showed that lifestyle programs can reduce the level of overweight in child and adolescent obesity 6 and 12 months after the beginning of the program. In moderate to severely obese adolescents, a reduction in overweight was found when either the drug orlistat, or the drug sibutramine were given in addition to a lifestyle program, although a range of adverse effects was also noted. Information on the long-term outcome of obesity treatment in children and adolescents was limited and needs to be examined in some high quality studies.

 

摘要

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

背景

治療兒童肥胖的介入方法

兒童族群過重及肥胖的盛行率在全球均是與日俱增的. 兒童的肥胖會顯著地導致短期及長期的健康問題.

目標

評估一些生活型態的介入方法來治療兒童肥胖問題的效果.

搜尋策略

我們搜尋了CCTR, MEDLINE, EMBASE, CINAHL, PsychLIT, Science Citation Index, 及Social Science Citation Index. 每一個資料庫時間為1985年至2001年七月. 我們同時也含括了治療兒童肥胖的專家意見.

選擇標準

我們選取了至少進行6個月以上的隨機對照試驗, 這些試驗是利用生活型態的介入方法來治療兒童肥胖. 生活型態上的介入方法, 例如飲食, 運動, 和/或 行為治療, 合併或不合併家庭相關成員的支持. 任何型態及或不同專業所使用的介入方法均納入考量. 然而, 本文排除了專門針對進食疾病的研究.

資料收集與分析

我們研究團隊中有2位評估研究的品質並擷取資料. 我們也連絡納入本文研究的作者提供進一步的相關資料.

主要結論

本文包含18個隨機對照試驗, 總共有975位參與者. 許多研究係由醫院中肥胖專科中心所執行. 其中5個研究(245位參與者)乃針對運動量及久坐行為進行研究. 另2個研究(107位參與者)將解決問題與一般照護或行為治療進行比較. 另9篇研究(399位參與者)將不同家庭介入程度的行為治療與無治療或一般照護或精通標準及後效強化進行比較. 另2個研究(224位參與者)將認知行為治療與放鬆療法進行比較. 本篇綜論性文章大多數所含括的研究中, 其參與者數目太少以致無法得知治療是否有效. 因為以相同標準進行比較的研究不足, 我們並沒有進行統合分析(metaanalysis). 因此, 我們將各研究結果以敘述式統整.

作者結論

儘管我們選取了18個研究, 但大多數參與者數目非常少,同質性高並具動機, 且在醫院所執行, 因此在這些研究對象身上所能獲得的證據有限. 結論是, 因為具足夠品質的資料數目有限, 所以治療兒童肥胖的介入方案孰優孰劣無法定論. 這需要進一步的研究, 包括納入心理社會因子以改變行為, 改善醫師家屬互動的策略, 以及基層及社區照護的成本效益方案. 我們認為由此綜論性文章並無法有把握地斷定一直接結論.

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

我們需要更多研究以找出治療兒童過重問題的最佳方法. 兒童肥胖會同時影響兒童的生理及心理社會健康, 也會如同成人般會增加遭受生病的風險. 已發展國家中肥胖兒童的數目正以引人注目的速度與日俱增. 許多不同的改變生活方式的介入方案可以幫助父母及兒童控制體重. 儘管有18個相關研究, 但大多數研究對象的數目太少以致於證據有限. 結論是, 因為具足夠品質的資料數目有限, 所以無法有把握地斷定出一有效的治療兒童肥胖的介入方案.

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