title: Effectiveness of lifestyle interventions in child obesity: systematic review with meta-analysis.
abstract: OBJECTIVE
  The effects of lifestyle interventions on cardio-metabolic outcomes in overweight children have not been reviewed systematically. The objective of the study was to examine the impact of lifestyle interventions incorporating a dietary component on both weight change and cardio-metabolic risks in overweight/obese children.
  
  
  METHODS
  English-language articles from 1975 to 2010, available from 7 databases, were used as data sources. Two independent reviewers assessed articles against the following eligibility criteria: randomized controlled trial, participants overweight/obese and ≤18 years, comparing lifestyle interventions to no treatment/wait-list control, usual care, or written education materials. Study quality was critically appraised by 2 reviewers using established criteria; Review Manager 5.1 was used for meta-analyses.
  
  
  RESULTS
  Of 38 eligible studies, 33 had complete data for meta-analysis on weight change; 15 reported serum lipids, fasting insulin, or blood pressure. Lifestyle interventions produced significant weight loss compared with no-treatment control conditions: BMI (-1.25kg/m(2), 95% confidence interval [CI] -2.18 to -0.32) and BMI z score (-0.10, 95% CI -0.18 to -0.02). Studies comparing lifestyle interventions to usual care also resulted in significant immediate (-1.30kg/m(2), 95% CI -1.58 to -1.03) and posttreatment effects (-0.92 kg/m(2), 95% CI -1.31 to -0.54) on BMI up to 1 year from baseline. Lifestyle interventions led to significant improvements in low-density lipoprotein cholesterol (-0.30 mmol/L, 95% CI -0.45 to -0.15), triglycerides (-0.15 mmol/L, 95% CI -0.24 to -0.07), fasting insulin (-55.1 pmol/L, 95% CI -71.2 to -39.1) and blood pressure up to 1 year from baseline. No differences were found for high-density lipoprotein cholesterol.
  
  
  CONCLUSIONS
  Lifestyle interventions can lead to improvements in weight and cardio-metabolic outcomes. Further research is needed to determine the optimal length, intensity, and long-term effectiveness of lifestyle interventions.
authors.affiliation: The Children’s Hospital at Westmead Clinical School, University of Sydney, Sydney, Australia. mandy.ho@sydney.edu.au
authors.forename: Mandy
authors.initials: M
authors.lastname: Ho
authors.forename: Sarah P
authors.initials: SP
authors.lastname: Garnett
authors.forename: Louise
authors.initials: L
authors.lastname: Baur
authors.forename: Tracy
authors.initials: T
authors.lastname: Burrows
authors.forename: Laura
authors.initials: L
authors.lastname: Stewart
authors.forename: Melinda
authors.initials: M
authors.lastname: Neve
authors.forename: Clare
authors.initials: C
authors.lastname: Collins
mesh_terms: D000293:Adolescent; D001786:Blood Glucose / Q000378:metabolism; D001794:Blood Pressure / Q000502:physiology; D001823:Body Composition; D015992:Body Mass Index; D001835:Body Weight; D002648:Child; D004038:Diet, Reducing; D015444:Exercise; D005500:Follow-Up Studies; D006801:Humans; D007328:Insulin / Q000097:blood; D007333:Insulin Resistance / Q000502:physiology; D008019:Life Style; D008055:Lipids / Q000097:blood; D009765:Obesity / Q000503:physiopathology / Q000628:therapy*; D050177:Overweight / Q000503:physiopathology / Q000628:therapy*; D010353:Patient Education as Topic; D016032:Randomized Controlled Trials as Topic; D015431:Weight Loss / Q000502:physiology
chemical_list: D001786:Blood Glucose; D007328:Insulin; D008055:Lipids