Clinical review: behavioral interventions to prevent childhood obesity: a systematic review and metaanalyses of randomized trials.
BACKGROUND
The efficacy of lifestyle interventions to encourage healthy lifestyle behaviors to prevent pediatric obesity remains unclear.


OBJECTIVE
Our objective was to summarize evidence on the efficacy of interventions aimed at changing lifestyle behaviors (increased physical activity, decreased sedentary activity, increased healthy dietary habits, and decreased unhealthy dietary habits) to prevent obesity.


METHODS
Data sources included librarian-designed searches of nine electronic databases, references from included studies and reviews (from inception until February 2006), and content expert recommendations.


METHODS
Eligible studies were randomized trials enrolling children and adolescents assessing the impact of interventions on both lifestyle behaviors and body mass index (BMI).


METHODS
Two reviewers independently abstracted data on methodological quality, study characteristics, intervention components, and treatment effects.


METHODS
We conducted random-effects metaanalyses, quantified inconsistency using I(2), and conducted planned subgroup analyses for each examined outcome.


RESULTS
Regarding target behaviors, the pooled effect size for physical activity (22 comparisons; n = 9891 participants) was 0.12 [95% confidence interval (CI) = 0.04-0.20; I(2) = 63%], for sedentary activity (14 comparisons; n = 3003) was -0.29, (CI = -0.35 to -0.22; I(2) = 0%), for healthy dietary habits (14 comparisons, n = 5468) was 0.00 (CI = -0.20; 0.20; I(2) = 83%), and for unhealthy dietary habits (23 comparisons, n = 9578) was -0.20 (CI = -0.31 to -0.09; I(2) = 34%). The effect of these interventions on BMI (43 comparisons, n = 32,003) was trivial (-0.02; CI = -0.06-0.02; I(2) = 17%) compared with control. Trials with interventions lasting more than 6 months (vs. shorter trials) and trials with postintervention outcomes (vs. in-treatment outcomes) yielded marginally larger effects.


CONCLUSIONS
Pediatric obesity prevention programs caused small changes in target behaviors and no significant effect on BMI compared with control. Trials evaluating promising interventions applied over a long period, using responsive outcomes, with longer measurement timeframes are urgently needed.
Kamath
Celia C
CC
Knowledge and Encounter Research Unit, Mayo Clinic, W18A, 200 First Street SW, Rochester, Minnesota 55905, USA.
Vickers
Kristin S
KS
Ehrlich
Angela
A
McGovern
Lauren
L
Johnson
Jonathan
J
Singhal
Vibha
V
Paulo
Remberto
R
Hettinger
Allison
A
Erwin
Patricia J
PJ
Montori
Victor M
VM
D000293:Adolescent; D015992:Body Mass Index; D002648:Child; D002652:Child Behavior; D002675:Child, Preschool; D003627:Data Interpretation, Statistical; D005247:Feeding Behavior; D006801:Humans; D008019:Life Style; D009043:Motor Activity; D009765:Obesity / Q000517:prevention & control*; D011786:Quality Control; D016032:Randomized Controlled Trials as Topic / Q000592:standards / Q000706:statistics & numerical data; D012107:Research Design