title: The impact of interventions to prevent obesity or improve obesity related behaviours in children (0-5 years) from socioeconomically disadvantaged and/or indigenous families: a systematic review.
abstract: BACKGROUND
  Children from disadvantaged families including those from low socioeconomic backgrounds and Indigenous families have higher rates of obesity, making early intervention a priority. The aim of this study was to systematically review the literature to examine the effectiveness of interventions to prevent obesity or improve obesity related behaviours in children 0-5 years from socioeconomically disadvantaged or Indigenous families.
  
  
  METHODS
  Searches of major electronic databases identified articles published from 1993-2013 targeting feeding practices, anthropometric, diet, activity or sedentary behaviour outcomes. This was supplemented with snowballing from existing reviews and primary studies. Data extraction was undertaken by one author and cross checked by another. Quality assessments included both internal and external validity.
  
  
  RESULTS
  Thirty-two studies were identified, with only two (both low quality) in Indigenous groups. Fourteen studies had a primary aim to prevent obesity. Mean differences between intervention and control groups ranged from -0.29 kg/m(2) to -0.54 kg/m(2) for body mass index (BMI) and -2.9 to -25.6% for the prevalence of overweight/obesity. Interventions initiated in infancy (under two years) had a positive impact on obesity related behaviours (e.g. diet quality) but few measured the longer-term impact on healthy weight gain. Findings amongst pre-schoolers (3-5 years) were mixed, with the more successful interventions requiring high levels of parental engagement, use of behaviour change techniques, a focus on skill building and links to community resources. Less than 10% of studies were high quality. Future studies should focus on improving study quality, including follow-up of longer-term anthropometric outcomes, assessments of cost effectiveness, acceptability in target populations and potential for implementation in routine service delivery.
  
  
  CONCLUSIONS
  There is an urgent need for further research on effective obesity prevention interventions for Indigenous children. The findings from the growing body of intervention research focusing on obesity prevention amongst young children from socioeconomically disadvantaged families suggest intervention effects are modest but promising. Further high quality studies with longer term follow up are required.
  
  
  BACKGROUND
  PROSPERO Registration no: CRD42013006536.
authors.affiliation: Centre for Physical Activity and Nutrition Research, Deakin University, 221 Burwood Highway, Burwood, VIC 3125, Australia. r.laws@deakin.edu.au.
authors.forename: Rachel
authors.initials: R
authors.lastname: Laws
authors.forename: Karen J
authors.initials: KJ
authors.lastname: Campbell
authors.forename: Paige
authors.initials: P
authors.lastname: van der Pligt
authors.forename: Georgina
authors.initials: G
authors.lastname: Russell
authors.forename: Kylie
authors.initials: K
authors.lastname: Ball
authors.forename: John
authors.initials: J
authors.lastname: Lynch
authors.forename: David
authors.initials: D
authors.lastname: Crawford
authors.forename: Rachael
authors.initials: R
authors.lastname: Taylor
authors.forename: Deborah
authors.initials: D
authors.lastname: Askew
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Denney-Wilson
mesh_terms: D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D015992:Body Mass Index; D002652:Child Behavior; D004032:Diet; D015444:Exercise; D005247:Feeding Behavior; D015438:Health Behavior; D063766:Pediatric Obesity / Q000208:ethnology / Q000517:prevention & control; D011203:Poverty; D015430:Weight Gain; D000081034:Indigenous Peoples
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