The long‐term effects of primary school‐based obesity prevention interventions in children: A systematic review and meta‐analysis

Abstract

Introduction: This systematic review and meta-analysis investigate the long-term effects of primary school-based obesity prevention interventions on body-mass index (and z-scores), waist circumference (and z-scores) and weight status.Methods: Four databases were searched for studies from date of inception until June 8th, 2021. We included randomized controlled trials (RCT) and non-RCTs investigating effects ≥12 months post-intervention of primary school-based interventions with intervention duration ≥6 months and containing a diet and/or physical activity component on outcomes of interest. Articles were assessed on risk of bias and methodological quality by RoB2 and ROBINS-I. Meta-analysis was performed and results were narratively summarized. Evidence quality was assessed with GRADE.Results: Nineteen studies were included, 9 were pooled in a meta-analysis. No longterm effects were found on body-mass index (+0.06 kg/m 2 ; CI95% = À0.38, 0.50; I 2 = 66%), body-mass index z-scores (À0.08; CI95% = À0.20, 0.04; I 2 = 36%), and waist circumference (+0.57 cm; CI95% = À0.62, 1.75; I 2 = 13%). Non-pooled studies reported mixed findings regarding long-term effects on body-mass index, bodymass index z-scores and weight status, and no effects on waist circumference and waist circumference z-scores. Evidence certainty was moderate to very low. Discussion: No clear evidence regarding long-term effects of primary school-based interventions on obesity-related outcomes was found. Recommendations for further research and policy are discussed. Prospero registration ID: CRD42021240446.

Nutrition Interventions for Pediatric Obesity Prevention: An Umbrella Review of Systematic Reviews

“…Thirty-one SRs were included in this umbrella review . SRs examined nutrition interventions for pediatric obesity prevention in all settings combined [20,22,30,33,34,43,44,47] or in the home and family [20,22,35], healthcare [22,37,49,50], school [20,22,23,25,[27][28][29]36,38,[40][41][42]46], or community settings [21,22], or examined the efficacy of food assistance programs [24,26,27,31,32,39] or electronic interventions [45,48]. The study selection process is described in Figure 1.…”

“…Thirteen SRs examined the impact of obesity prevention interventions with nutrition in the school setting in all age groups combined [20,23,[27][28][29]38,40], children ≤ 5 years old [22], children 6-12 years old [22,25,36,41,42,46] and adolescents 13-18 years old [22]. No studies reported the cost-effectiveness of these interventions.…”

“…Six SRs examined nutrition interventions for obesity prevention in children 6-12 years old [22,25,36,41,42,46]. Brown et al 2019 andSmit et al 2023 had a high quality score [22,46], and the remaining SRs had a critically low quality score (Table S7). 3) [46].…”

“…Brown et al 2019 andSmit et al 2023 had a high quality score [22,46], and the remaining SRs had a critically low quality score (Table S7). 3) [46].…”

Generation Healthy Kids: Protocol for a cluster-randomized controlled trial of a multi-component and multi-setting intervention to promote healthy weight and wellbeing in 6–11-year-old children in Denmark

“…Previous interventions to prevent childhood overweight and obesity focused mainly on dietary and/or physical activity interventions in schools (13)(14)(15)(16)(17)(18)(19). The prior interventions generally showed no or only small effects on weight development (13)(14)(15)(16)(17)(18)(19), and the evidence of long-term effects is limited (14,20). It is therefore increasingly argued that preventing childhood overweight and obesity requires multi-component and multi-setting interventions, which focus not only on individual health behaviors, but also on changing the structural environments in which children and their families live (21-23).…”