Interventions for preventing obesity in children.
BACKGROUND
Obesity prevention is an international public health priority. The prevalence of obesity and overweight is increasing in child populations throughout the world, impacting on short and long-term health. Obesity prevention strategies for children can change behaviour but efficacy in terms of preventing obesity remains poorly understood.


OBJECTIVE
To assess the effectiveness of interventions designed to prevent obesity in childhood through diet, physical activity and/or lifestyle and social support.


METHODS
MEDLINE, PsycINFO, EMBASE, CINAHL and CENTRAL were searched from 1990 to February 2005. Non-English language papers were included and experts contacted.


METHODS
Randomised controlled trials and controlled clinical trials with minimum duration twelve weeks.


METHODS
Two reviewers independently extracted data and assessed study quality.


RESULTS
Twenty-two studies were included; ten long-term (at least 12 months) and twelve short-term (12 weeks to 12 months). Nineteen were school/preschool-based interventions, one was a community-based intervention targeting low-income families, and two were family-based interventions targeting non-obese children of obese or overweight parents. Six of the ten long-term studies combined dietary education and physical activity interventions; five resulted in no difference in overweight status between groups and one resulted in improvements for girls receiving the intervention, but not boys. Two studies focused on physical activity alone. Of these, a multi-media approach appeared to be effective in preventing obesity. Two studies focused on nutrition education alone, but neither were effective in preventing obesity. Four of the twelve short-term studies focused on interventions to increase physical activity levels, and two of these studies resulted in minor reductions in overweight status in favour of the intervention. The other eight studies combined advice on diet and physical activity, but none had a significant impact. The studies were heterogeneous in terms of study design, quality, target population, theoretical underpinning, and outcome measures, making it impossible to combine study findings using statistical methods. There was an absence of cost-effectiveness data.


CONCLUSIONS
The majority of studies were short-term. Studies that focused on combining dietary and physical activity approaches did not significantly improve BMI, but some studies that focused on dietary or physical activity approaches showed a small but positive impact on BMI status. Nearly all studies included resulted in some improvement in diet or physical activity. Appropriateness of development, design, duration and intensity of interventions to prevent obesity in childhood needs to be reconsidered alongside comprehensive reporting of the intervention scope and process.
Summerbell
C D
CD
School of Health and Social Care, University of Teesside, Parkside West, Middlesbrough, Teesside, UK, TS1 3BA. carolyn.summerbell@tees.ac.uk
Waters
E
E
Edmunds
L D
LD
Kelly
S
S
Brown
T
T
Campbell
K J
KJ
D000293:Adolescent; D002648:Child; D018849:Controlled Clinical Trials as Topic; D004032:Diet; D015444:Exercise; D006801:Humans; D009765:Obesity / Q000178:diet therapy / Q000517:prevention & control*; D016896:Treatment Outcome