This publication is provided for historical reference only and the information may be out of date.
Research Focus for Clinicians
Purpose of the systematic review. In response to a request from the public, the Johns Hopkins University Evidence-based Practice Center, funded by the Agency for Healthcare Research and Quality (AHRQ), performed a literature review to evaluate the evidence regarding the effectiveness of obesity prevention programs for children and adolescents conducted in schools, homes, primary care clinics, childcare centers, the community, or in a combination of these settings. The effectiveness of consumer health informatics-based interventions was also evaluated.
Overview of the systematic review. Only studies conducted in the United States or other high-income countries were included. Studies were eligible if they tested diet and/or physical activity interventions in children over a period of at least 1 year, with the exception of studies conducted in school-based settings, which were required to be up to 6 months long. The effects of the interventions were assessed on primary outcomes related to body composition including body mass index [BMI], weight, waist circumference, and prevalence of obesity or overweight. The effects of the interventions on clinical outcomes related to obesity (including blood pressure and blood lipids), intermediate behavioral outcomes related to energy balance (including dietary intake, physical activity, and sedentary behaviors), and adverse effects of interventions were also assessed. The systematic review evaluated 131 reports of eligible studies from all the literature in PubMed®, EMBASE®, PsycINFO®, CINAHL®, and the Cochrane Library through August 2012. Articles in the PubMed database dated back to 1966. An online version of this summary provides links directly to the sections of the full report with references for individual findings, inclusion criteria for the studies, and an explanation of the methods for rating the studies and determining the strength of evidence for individual findings. The online version of this summary and the full report are available at www.effectivehealthcare.ahrq.gov/child-obesity-prevention.cfm.
Introduction to this summary. This summary is provided to inform discussions with patients and/or caregivers of options and to assist in decisionmaking along with consideration of a patient's values and preferences. However, reviews about evidence should not be construed to represent clinical recommendations or guidelines.
Background
Childhood overweight and obesity are highly prevalent in the United States, affecting one-third of children and adolescents. Since 1980, rates of obesity doubled for children aged 2 to 5 years and tripled for children aged 6 to 11 years and adolescents aged 12 to 19 years. The risk of obesity is also higher among minority and underserved populations.
Overweight children and adolescents are at greater risk for health problems when compared with their normal-weight peers and are more likely to become obese adults. Obese children and adolescents are more likely to have serious illnesses such as type 2 diabetes, hypertension, high cholesterol, obstructive sleep apnea, stroke, heart disease, nonalcoholic fatty liver disease, certain types of cancer, and bone and joint problems. Other reported health consequences of childhood obesity include eating disorders (such as bulimia nervosa, restrictive eating, binging, purging, generalized food preoccupation, and distorted body image) and mental health issues such as depression and low self-esteem.
A growing body of research suggests that many factors—including genetic and individual factors, home influences (parents, family, and friends), the school environment, factors in the local community (e.g., the presence of sidewalks, parks, safety from traffic, neighborhood disorder or violence), and policies implemented at the local, regional, and national levels—interact to contribute to obesogenic environments and affect children's weight.
A number of leading health organizations and expert panels, including panels from the World Health Organization and an Institute of Medicine expert panel, have recommended comprehensive interventions to fight the growing obesity epidemic. The main goal of most childhood obesity prevention programs is to help children who are not overweight from becoming overweight or obese. Programs designed for obesity prevention may also help overweight or obese children lose or stabilize their weight.
The authors of this review aimed to compare the effectiveness of obesity prevention programs conducted in the school, home, primary care clinic, childcare center, or community setting or in a combination of these settings. The authors of this review also assessed consumer health informatics interventions. Definitions of the types of interventions evaluated in the various settings are provided in Table 1.
Table 1
Types of Obesity Prevention Interventions Assessed in This Review. Interventions were classified by the primary setting where they took place. Several interventions included components that were conducted in settings other than the primary setting.
Conclusions
School-based programs involving dietary or physical activity interventions are effective in preventing childhood obesity. Combining a home or community component with a school-based program also works. The magnitude of effects appear to be modest, although the heterogeneity in study interventions, outcomes, and duration make it difficult to estimate precise effect size. Evidence is limit about the effectiveness of interventions in other settings including those in primary care. This does not mean that such interventions do not work but that more research is needed.
Gaps in Knowledge on Childhood Obesity Prevention
Several gaps in knowledge were identified in the evidence base reviewed for this report, which included:
- A lack of sufficient information on the effectiveness of the following types of obesity and overweight prevention interventions
- Interventions tested in the primary care or childcare settings
- Environment-based and policy-based interventions (e.g., agriculture policies and regulations on food retailing and distribution)
- Consumer health informatics interventions
- The need for greater understanding of the contexts and challenges associated with implementing prevention programs in different settings
- Such an understanding would allow decisionmakers to have a better idea of the applicability of a specific intervention program to their own community.
- A paucity of information on the effects of various interventions in preventing childhood obesity in populations stratified by sex, age, race/ethnicity, demographics, or socioeconomic status
- Limited information on the effectiveness of obesity prevention programs in adolescents
- Obesity in adolescents has been found to be more predictive of obesity during adulthood than is obesity in younger children.
What To Discuss With the Parents of Your Patients and/or Caregivers of Your Patients
- That clinicians are concerned about childhood obesity and the welfare of their patients
- The patient's BMI and how to diagnose overweight/obesity in children
- The possible factors contributing to overweight and obesity in children, including less physical activity, more sedentary/screen time, increased empty and liquid calories in the diet, and inappropriate use of food rewards or eating when not hungry
- What constitutes an appropriate serving size
- The importance of monitoring total daily caloric intake as opposed to total daily food intake
- Important things that can be done at home to keep children at a healthy weight
- The potential health consequences of overweight and obesity in children
- The relative effectiveness of the various interventions in preventing overweight and obesity
- The programs and resources that help children maintain a healthy weight that are available at school or in the community
- If a list of such resources could not be obtained, encourage parents and caregivers to explore schools, school district offices, and community centers for the available resources.
- What can be done if healthy food or safe locations for physical activity are not easily accessible to patients and their families
Resource for Patients
Keeping Children at a Healthy Weight, A Review of the Research on Ways To Avoid Becoming Overweight or Obese is a free companion to this clinician research summary. It can help the parents and caregivers of children talk with their health care professionals about the various programs for preventing childhood obesity that are available.
Ordering Information
For electronic copies of Keeping Children at a Healthy Weight, A Review of the Research on Ways To Avoid Becoming Overweight or Obese, this clinician research summary, and the full systematic review, visit www.effectivehealthcare.ahrq.gov/child-obesity-prevention.cfm. To order free print copies, call the AHRQ Publications Clearinghouse at 800-358-9295.
Source
The information in this summary is based on Childhood Obesity Prevention Programs: Comparative Effectiveness Review and Meta-Analysis, Comparative Effectiveness Review No. 115, prepared by the Johns Hopkins University Evidence-based Practice Center under Contract No. 290-2007-10061-I for the Agency for Healthcare Research and Quality, June 2013. Available at www.effectivehealthcare.ahrq.gov/child-obesity-prevention.cfm. This summary was prepared by the John M. Eisenberg Center for Clinical Decisions and Communications Science at Baylor College of Medicine, Houston, TX.
Publication Details
Author Information and Affiliations
Authors
John M. Eisenberg Center for Clinical Decisions and Communications Science1.Affiliations
Publication History
Issued: September 19, 2013.
Copyright
Publisher
Agency for Healthcare Research and Quality (US), Rockville (MD)
NLM Citation
John M. Eisenberg Center for Clinical Decisions and Communications Science. Childhood Obesity Prevention Programs: Comparative Effectiveness. 2013 Sep 19. In: Comparative Effectiveness Review Summary Guides for Clinicians [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2007-.