Interventions to prevent obesity in children aged 5 to 11 years old

Abstract

Background Prevention of obesity in children is an international public health priority given the prevalence of the condition (and its significant impact on health, development and well‐being). Interventions that aim to prevent obesity involve behavioural change strategies that promote healthy eating or 'activity' levels (physical activity, sedentary behaviour and/or sleep) or both, and work by reducing energy intake and/or increasing energy expenditure, respectively. There is uncertainty over which approaches are more effective and numerous new studies have been published over the last five years, since the previous version of this Cochrane review. Objectives To assess the effects of interventions that aim to prevent obesity in children by modifying dietary intake or ‘activity’ levels, or a combination of both, on changes in BMI, zBMI score and serious adverse events. Search methods We used standard, extensive Cochrane search methods. The latest search date was February 2023. Selection criteria Randomised controlled trials in children (mean age 5 years and above but less than 12 years), comparing diet or 'activity' interventions (or both) to prevent obesity with no intervention, usual care, or with another eligible intervention, in any setting. Studies had to measure outcomes at a minimum of 12 weeks post baseline. We excluded interventions designed primarily to improve sporting performance. Data collection and analysis We used standard Cochrane methods. Our outcomes were body mass index (BMI), zBMI score and serious adverse events, assessed at short‐ (12 weeks to < 9 months from baseline), medium‐ (9 months to < 15 months) and long‐term (≥ 15 months) follow‐up. We used GRADE to assess the certainty of the evidence for each outcome. Main results This review includes 172 studies (189,707 participants); 149 studies (160,267 participants) were included in meta‐analyses. One hundred forty‐six studies were based in high‐income countries. The main setting for intervention delivery was schools (111 studies), followed by the community (15 studies), the home (eight studies) and a clinical setting (seven studies); one intervention was conducted by telehealth and 31 studies were conducted in more than one setting. Eighty‐six interventions were implemented for less than nine months; the shortest was conducted over one visit and the longest over four years. Non‐industry funding was declared by 132 studies; 24 studies were funded in part or wholly by industry. Dietary interventions versus control Dietary interventions, compared with control, may have little to no effect on BMI at short‐term follow‐up (mean difference (MD) 0, 95% confidence interval (CI) ‐0.10 to 0.10; 5 studies, 2107 participants; low‐certainty evidence) and at medium‐term follow‐up (MD ‐0.01, 95% CI ‐0.15 to 0.12; 9 studies, 6815 participants; low‐cer...