Obesity Prevention Interventions and Implications for Energy Balance in the United States and Mexico: A Systematic Review of the Evidence and Meta‐Analysis

Abstract

Objective Obesity is preventable and yet continues to be a major risk factor for chronic disease. Multiple prevention approaches have been proposed across multiple settings where people live, work, learn, worship, and play. This review searched the vast literature on obesity prevention interventions to assess their effects on daily energy consumed and energy expended. Methods This systematic review (PROSPERO registration CRD42017077083) searched seven databases for systematic reviews and studies reporting energy intake and expenditure. Two independent reviewers screened 5,977 citations; data abstraction supported an evidence map, comprehensive evidence tables, and meta‐analysis; critical appraisal assessed risk of bias; and the quality of evidence was evaluated using Grading of Recommendations Assessment, Development and Evaluation (GRADE). Results Hundreds of published reviews were identified. However, few studies reported on energy intake and expenditure to determine intervention success. Ninety‐nine studies across all intervention domains were identified. Few areas demonstrated statistically significant effects across studies; school‐based approaches and health care initiatives reduced energy consumed, education reduced energy consumed and increased energy expended, and social‐group approaches increased energy expenditure. Conclusions Despite the amount of research on obesity prevention interventions, very few studies have provided relevant information on energy intake and expenditure, two factors determining weight gain. Future research needs to fill this gap to identify successful public health policies.

Simple Energy Balance or Microbiome for Childhood Obesity Prevention?

“…A review of the forest plots from a meta-analysis of school-based child obesity prevention interventions revealed that the vast majority of effects hovered near zero [ 11 ]. When reviewing the impact of all child obesity prevention trials on energy balance [ 12 ], only small, weak effects on energy consumed and energy expended were noted. Even longer term (one year or longer) trials did not impact BMI [ 13 ].…”

Microsimulation projections of obesity interventions on cardiometabolic health disparities in the United States

“…This holds even though we used an intervention estimate that had the strongest effect on reducing energy intake in meta-analyses (11). This is not sufficient to reverse obesity trends.…”

“…Specifically, we assume that health education campaigns reduce individuals’ daily energy intake by 73 kcal. This estimate was derived as the mean difference in daily caloric intake between treated and control groups in 10 RCTs (11) weighted by the size of the study population. We convert this to a change in body weight using a model (26) that accounts for biological dynamics when individuals lose weight, such as the eventual plateau after initial weight loss.…”

“…This study simulates long‐term population health consequences of education campaigns to examine impacts on outcomes if the programs had the effect size reported in a meta‐analysis of population‐based health education interventions (11). To our knowledge, no additional randomized trial of education campaigns reporting effects on energy intake has been published since, nor a more recent systematic review and meta‐analysis.…”

Energy Imbalance Gap, Anthropometric Measures, Lifestyle, and Sociodemographic Correlates in Latin American Adults—Results from the ELANS Study

“…In the literature reviewed, some research studies on different populations address EB, particularly to understand the global trend toward obesity [13][14][15][16]. Additionally, the term 'energy imbalance gap' has been introduced to better understand for public health policies, 3 of 17 in which the difference between energy intake and expenditure can used a reference to establish whether weight can reach equilibrium and prevent weight gain [17,18].…”