Meta-analysis of lifestyle modification interventions addressing overweight and obesity in preschool-age children.

Abstract

Objective: Increased rates of pediatric obesity extend into early childhood. There have been increasing calls for intervention programs specifically designed to address obesity in preschool-age youth. A review of the literature is critical to guide intervention and future research. The objective of this study was to conduct a meta-analysis of randomized, controlled trials examining the efficacy of lifestyle modification interventions to address overweight and obesity in preschool-age children. Method: Six electronic databases were searched for articles through December 8, 2020. After screening articles for inclusion criteria, 14 articles with 12 randomized, controlled trials (41 effect sizes, 2,525 participants) were included in this meta-analysis. Weighted-standardized mean differences for body mass index-related variables were calculated using random-effects models to estimate effect sizes. Risk of bias assessment was conducted. Results: There was a statistically significant impact of the interventions on child weight outcomes. Cohen's d was .32 (95% CI [.09, .55]). The quality of evidence was assigned a "low" GRADE rating. Conclusions: Lifestyle modification interventions for overweight and obesity in preschool-age children produce small but significant changes in child weight status. However, few new trials have been published in the last 5 years and the quality of evidence in this area is low, limiting confidence in the estimates and the power to examine potential moderator effects. Additional quality, randomized, control trials that report study information consistent with consort guidelines, use intent-totreatment procedures, assess and report health behaviors and treatment adherence to explore mechanisms of change, and examine sustained effects of interventions are needed.

A long-term follow-up of treatment for young children with obesity: a randomized controlled trial

“…Long-term follow-up of preschool-aged children with obesity who have participated in treatment is scarce, and no other RCT has followed young children with obesity for as long as 48 months [ 16 ]. In the other RCT for preschool-aged children with obesity, which was of a similar size to ours, by Stark et al [ 13 , 18 ], the initial positive results were not maintained after 18 months.…”

“…While most obesity-related comorbidities first appear in young adulthood [ 3 , 4 ], the trajectory of obesity begins in early childhood [ 5 ] and obesity is associated with severe negative effects on children’s physical [ 6 – 8 ] and mental health [ 9 – 11 ]. The strongest predictor for treatment effectiveness is age at initiation [ 12 ]; however, few programs are designed for families of young children with obesity [ 13 – 16 ]. Intensive combined lifestyle treatment, starting at the age of 2 years, has been recently proposed by the American Academy of Pediatrics [ 17 ].…”

Developing Healthy Lifestyle Behaviors in Early Age—An Intervention Study in Kindergartens

“…The importance is well known of enlisting the support of parents in children's dietary changes by, for example, flyers, videos, parent meetings or web sites [3,50,51]. Some intervention programs involve parents directly, being central in aiding their children to acquire early healthful lifestyles, as well as in helping them overcome the reluctance to trying new foods.…”

“…The prevention of obesity is one of the foremost challenges of public health. In developed countries, more than a quarter of children of kindergarten age are overweight or obese, and the prevalence is increasing [1], leading to long-term effects on morbidity in adolescence and adulthood [2,3]. Already by the age of three, poor eating habits have been observed, including consuming foods and drinks high in energy, with few fruits and vegetables [4,5].…”

“…A review of intervention programs among children aged 3-6 years recommended multiple pursuits, including growing vegetables, joint activities for parents and children, and changes in the learning environment [4,28]. An increasing number of researchers have extended lifestyle modification interventions to groups for overweight and obese preschool-age children, producing small but significant changes in weight which may have long-term effects [3]. These interventions generally focus on modifying behaviors related to energy balance, including nutrition (e.g., increasing fruits/vegetables, decreasing high fat foods and sugar-sweetened beverages), physical activity and sedentary habits [29].…”