Effects of Lifestyle Modification Interventions to Prevent and Manage Child and Adolescent Obesity: A Systematic Review and Meta-Analysis

Abstract

The objective of this review was to assess the impact of lifestyle interventions (including dietary interventions, physical activity, behavioral therapy, or any combination of these interventions) to prevent and manage childhood and adolescent obesity. We conducted a comprehensive literature search across various databases and grey literature without any restrictions on publication, language, or publication status until February 2020. We included randomized controlled trials and quasi-experimental studies from both high income countries (HIC) and low-middle-income countries (LMICs). Participants were children and adolescents from 0 to 19 years of age. Studies conducted among hospitalized children and children with any pre-existing health conditions were excluded from this review. A total of 654 studies (1160 papers) that met the inclusion criteria were included in this review. A total of 359 studies targeted obesity prevention, 280 studies targeted obesity management, while 15 studies targeted both prevention and management. The majority of the studies (81%) were conducted in HICs, 10% of studies were conducted in upper middle income countries, while only 2% of the studies were conducted in LMICs. The most common setting for these interventions were communities and school settings. Evidence for the prevention of obesity among children and adolescents suggests that a combination of diet and exercise might reduce the BMI z-score (MD: −0.12; 95% CI: −0.18 to −0.06; 32 studies; 33,039 participants; I2 93%; low quality evidence), body mass index (BMI) by 0.41 kg/m2 (MD: −0.41 kg/m2; 95% CI: −0.60 to −0.21; 35 studies; 47,499 participants; I2 98%; low quality evidence), and body weight (MD: −1.59; 95% CI: −2.95 to −0.23; 17 studies; 35,023 participants; I2 100%; low quality evidence). Behavioral therapy alone (MD: −0.07; 95% CI: −0.14 to −0.00; 19 studies; 8569 participants; I2 76%; low quality evidence) and a combination of exercise and behavioral therapy (MD: −0.08; 95% CI: −0.16 to −0.00; 9 studies; 7334 participants; I2 74%; low quality evidence) and diet in combination with exercise and behavioral therapy (MD: −0.13; 95% CI: −0.25 to −0.01; 5 studies; 1806 participants; I2 62%; low quality evidence) might reduce BMI z-score when compared to the control group. Evidence for obesity management suggests that exercise only interventions probably reduce BMI z-score (MD: −0.13; 95% CI: −0.20 to −0.06; 12 studies; 1084 participants; I2 0%; moderate quality evidence), and might reduce BMI (MD: −0.88; 95% CI: −1.265 to −0.50; 34 studies; 3846 participants; I2 72%) and body weight (MD: −3.01; 95% CI: −5.56 to −0.47; 16 studies; 1701 participants; I2 78%; low quality evidence) when compared to the control group. and the exercise along with behavioral therapy interventions (MD: −0.08; 95% CI: −0.16 to −0.00; 8 studies; 466 participants; I2 49%; moderate quality evidence), diet along with behavioral therapy interventions (MD: −0.16; 95% CI: −0.26 to −0.07; 4 studies; 329 participants; I2 0%; moderate quality evidence), and combination of diet, exercise and behavioral therapy (MD: −0.09; 95% CI: −0.14 to −0.05; 13 studies; 2995 participants; I2 12%; moderate quality evidence) also probably decreases BMI z-score when compared to the control group. The existing evidence is most favorable for a combination of interventions, such as diet along with exercise and exercise along with behavioral therapy for obesity prevention and exercise alone, diet along with exercise, diet along with behavioral therapy, and a combination of diet, exercise, and behavioral therapy for obesity management. Despite the growing obesity epidemic in LMICs, there is a significant dearth of obesity prevention and management studies from these regions.

Child obesity moderates the association between poverty and academic achievement

“…Moreover, a multicomponent approach that also includes physical activity education for caretakers will increase the effectiveness of strategies that combat child obesity (Barbosa et al, 2020; Luybli et al, 2019; Wang et al, 2015). Ideally, the ultimate goal of home‐based interventions (Pamungkas & Chamroonsawasdi, 2019) and population‐wide policies (Keya et al, 2019) should be lifestyle modification, which is likely to have long‐term positive effects upon child development and overall public health (Hsiang et al, 2020; Salam et al, 2020). Taken together, because parental behaviors, family patterns, household conditions, and community factors shape child developmental and body weight trajectories, intervention programs, and public policies should include nutritional and physical activity education for parents (Chai et al, 2019; Dev et al, 2013; C. Li et al, 2020), make available healthy food choices at reasonable prices in local stores (Dolati et al, 2020), as well as provide financial investment into the physical and social infrastructures of the disadvantaged communities (e.g., creating neighborhood facilities for recreation; Puga et al, 2020).…”

“…It is clear that we need continued research and development of cost‐effective behavioral and systems‐level interventions to curb obesity and promote more successful educational outcomes (Davies et al, 2007). Some nascent approaches appear to be promising, including implementation of nutrition policies in schools (e.g., alternatives to food‐based rewards/celebrations; Ickovics et al, 2019), promotion of healthy school food environments (Teo et al, 2019), classroom‐based lifestyle interventions (Hsiang et al, 2020; Salam et al, 2020), school‐based nutritional education programs (Hawkins et al, 2020), summer and after‐school weight management programs (Mabli et al, 2020; Reesor et al, 2018), as well as initiatives aimed at reducing sedentary behavior and screen time (Goldthorpe et al, 2020), with a synchronized focus on increased physical activity through after‐school clubs, class physical activity breaks (Jones et al, 2020; Santina et al, 2020; Yuksel et al, 2020), and play‐based interventions (Sanchez‐Lopez et al, 2020). Moreover, an important component of any intervention strategy is to incentivize decision‐makers to advocate for increased funding as a way to implement more large‐scale social policy changes to educate and train the next generation of school‐based health practitioners (e.g., occupational therapists) who will undoubtedly have a significant impact on child body weight management and obesity prevention (Hartley, 2019).…”

Racial Disparities in Obesity Treatment Among Children and Adolescents

“…Behavioral therapy is another mainstay of weight management that includes collaboration between patients and their patient care team including physicians, nurses, and nutritionists. There are different types of behavioral therapy including cognitive behavior therapy (CBT) which encourages children and adolescents to self-regulate their nutrition and physical activity [97]. Within these sessions, patients can expect to modify their behaviors through goal setting, accountability, self-monitoring, stimulus control, problem solving, and meal planning [98].…”

Determinants of health in adolescence: cardiorespiratory fitness and body composition

“…No obstante, ambas variables poseen un carácter multifactorial, por lo que la influencia de diferentes elementos sociodemográficos o ambientales resulta determinante (9). De este modo, un estilo de vida fundamentado en la realización de actividad física de forma regular, hábitos de sueño correctos y la adherencia a dietas saludables influye positivamente sobre el estado de salud (10,11).…”