title: Maintenance interventions for overweight or obese children and adolescents who participated in a treatment program: study protocol for a systematic review.
abstract: BACKGROUND
  Childhood overweight and obesity are associated with significant health consequences. Early and successful treatment of this public health issue is necessary. Although several intervention programs for children result in weight loss or stabilisation in the short term, preventing relapse after weight loss remains an important challenge. Weight loss maintenance approaches in childhood are thought to be promising, but a structured overview of these maintenance interventions is lacking. The aim of the systematic review described in this protocol is to provide an overview of reports published about maintenance interventions in childhood overweight and obesity following initial treatment, in order to guide future directions in the development of maintenance programs for childhood obesity.
  
  
  METHODS
  The electronic databases PubMed, Embase, Cochrane Library, CINAHL, Web of Science, PsycINFO, Scopus, and SocINDEX will be searched for this review. Reference lists of eligible study reports will be scanned for relevant references. Article selection including risk of bias assessment will be performed independently in an unblinded standardised manner by three authors. All reports describing a maintenance intervention in overweight or obese children with a mean or median age of <18 years who have followed a treatment program, regardless of the type of intervention, will be included. Data extraction will be performed using a predesigned pilot-tested data extraction sheet that covers participant characteristics, details about the treatment preceding the maintenance intervention, and the maintenance intervention itself. Body mass index standard deviation score (BMI-SDS or BMI-Z-score) will be used to compare studies. If possible, a meta-analysis will be performed using the inverse-variance random-effects method. Studies that are not included in the meta-analysis will be described in a narrative way in tables and/or in the text.
  
  
  CONCLUSIONS
  This systematic review will give an overview of the existing knowledge on programs and initiatives aimed at long-term maintenance of a healthy or reduced weight in children and adolescents following initial treatment of overweight. It will form a basis for future research and practice in this area, a topic on which studies are scarce but highly necessary.
  
  
  BACKGROUND
  PROSPERO CRD42014008698.
authors.forename: Laila B
authors.initials: LB
authors.lastname: van der Heijden
authors.forename: Edith J M
authors.initials: EJ
authors.lastname: Feskens
authors.affiliation: Department of Pediatrics, Hospital Gelderse Vallei, P,O, Box 9025, 6710 HN Ede, The Netherlands. jansea1@zgv.nl.
authors.forename: Arieke J
authors.initials: AJ
authors.lastname: Janse
mesh_terms: D000293:Adolescent; D015992:Body Mass Index; D002648:Child; D006801:Humans; D008019:Life Style; D063766:Pediatric Obesity / Q000628:therapy*; D015397:Program Evaluation; D012107:Research Design; D000078202:Systematic Reviews as Topic; D015431:Weight Loss; D015201:Meta-Analysis as Topic