Treatment Interventions for Early Childhood Obesity: A Systematic Review

Abstract

Context With 25% of pre-school age children in the United States being overweight or obese, effective interventions for these children would have significant public health implications. Randomized trials targeting this age group have been done since the last systematic review. Objective To systematically review the literature on treatment interventions for overweight or obesity in pre-school age children. Data Sources Medline (1948–July 2014), the Cochrane Central Registry (1991–July 2014), CINAHL (1990–July2014) and PAS abstracts (2000–2014). Study Selection Inclusion criteria were children age 0–6 in the study and adiposity as an outcome. Exclusions were having normal weight children in the trial and not having a comparison group. Data Extraction Data were extracted independently by two authors using a template. Results The initial search yielded 1,981 results, narrowed to 289 abstracts after initial review. Further analysis and cross-referencing led to the selection of six randomized controlled trials representing 1222 children. Two studies used systems changes and motivational interviewing and showed no significant effect on adiposity. Two studies used an intensive, multi-disciplinary approach over six months and demonstrated significant decreases in adiposity. One study tested parental coaching and showed a significant reduction in adiposity at six months. One study used education on a dairy-rich diet and showed a possible effect on adiposity. Limitations The study designs were too heterogeneous for meta-analysis; few ethnic minority subjects were included. Conclusions Multi-disciplinary, intensive interventions have some evidence of efficacy in reducing adiposity in pre-school children.

Low-Cost, Scalable Classroom-Based Approach to Promoting Physical Activity in Preschool Children

“…Many complex multifaceted interventions have been tried to improve the activity levels of young children [24]. However, many of these interventions require complex strategies and few are subject to stringent evaluation.…”

“…School-based interventions in pre-school children are often poorly validated using untested techniques and uncontrolled study designs [24,26]. We applied a controlled design, robust technologies and established evaluation methodologies.…”

Treating Obesity in Preschoolers

“…While the literature suggests multicomponent interventions are a promising approach to preschool obesity reduction, 15 research is needed to identify which behavioral components should be included in multi-component programs, the degree of change targeted, and the most effective and efficient approaches for achieving recommended lifestyle changes and subsequently preschool weight control. The Multiphase Optimization Strategy (MOST) 104–107 and Sequential Multiple Assignment Randomized Trials (SMART) 107–109 are two innovative approaches with distinct advantages for advancing the preschool obesity treatment literature (See Table 5).…”

“…A recent comprehensive review of the preschool obesity intervention literature by Foster and colleagues 15 concluded multidisciplinary, intensive behavioral programs appear most promising for achieving the goal of obesity reduction in children <6 years-old. The purpose of this paper is to move beyond examining efficacy to explore the current state of the preschool obesity treatment literature by critically evaluating the sociodemographic characteristics of who preschool obesity interventions are reaching (i.e., who is enrolling), which lifestyle behaviors and behavior change strategies are most efficient and effective for yielding improvements in preschooler weight status, and how to best evaluate program effectiveness.…”

“…Integrated into this discussion is a call to focus on early stage intervention development to address critical gaps in each domain and to concentrate efforts on developing programs for families from low-income and minority backgrounds. The same criteria for intervention inclusion as Foster and colleagues 15 were applied for this review: 1) enrolled children ages 0–6 years-old (or tailoring to preschoolers if sample included older children), 2) included measure of weight status, 3) only included children with BMI≥85 th percentile. We identified one additional publication 16 than Foster and colleagues, bringing the total number of studies included to seven.…”