title: Diet and physical activity interventions to prevent or treat obesity in South Asian children and adults: a systematic review and meta-analysis.
abstract: OBJECTIVE
  The metabolic risks associated with obesity are greater for South Asian populations compared with White or other ethnic groups, and levels of obesity in childhood are known to track into adulthood. Tackling obesity in South Asians is therefore a high priority. The rationale for this systematic review is the suggestion that there may be differential effectiveness in diet and physical activity interventions in South Asian populations compared with other ethnicities. The research territory of the present review is an emergent, rather than mature, field of enquiry, but is urgently needed. Thus the aim of this systematic review and meta-analysis was to assess the effectiveness of diet and physical activity interventions to prevent or treat obesity in South Asians living in or outside of South Asia and to describe the characteristics of effective interventions.
  
  
  METHODS
  Systematic review of any type of lifestyle intervention, of any length of follow-up that reported any anthropometric measure for children or adults of South Asian ethnicity. There was no restriction on the type of comparator; randomised controlled trials, controlled clinical trials, and before-after studies were included. A comprehensive search strategy was implemented in five electronic databases: ASSIA, Cochrane Controlled Trials Register, Embase, Medline and Social Sciences Citation Index. The search was limited to English language abstracts published between January 2006 and January 2014. References were screened; data extraction and quality assessment were carried out by two reviewers. RESULTS are presented in narrative synthesis and meta-analysis.
  
  
  RESULTS
  Twenty-nine studies were included, seven children, 21 adult and one mixed age. No studies in children under six were identified. Sixteen studies were conducted in South Asia, ten in Europe and three in USA. Effective or promising trials include physical activity interventions in South Asian men in Norway and South Asian school-children in the UK. A home-based, family-orientated diet and physical activity intervention improved obesity outcomes in South Asian adults in the UK, when adjusted for baseline differences. Meta-analyses of interventions in children showed no significant difference between intervention and control for body mass index or waist circumference. Meta-analyses of adult interventions showed significant improvement in weight in data from two trials adjusted for baseline differences (mean difference -1.82 kgs, 95% confidence interval -2.48 to -1.16) and in unadjusted data from three trials following sensitivity analysis (mean difference -1.20 kgs, 95% confidence interval -2.23 to -0.17). Meta-analyses showed no significant differences in body mass index and waist circumference for adults. Twenty of 24 intervention groups showed improvements in adult body mass index from baseline to follow-up; average change in high quality studies (n = 7) ranged from 0.31 to -0.8 kg/m2. There was no evidence that interventions were more or less effective according to whether the intervention was set in South Asia or not, or by socio-economic status.
  
  
  CONCLUSIONS
  Meta-analysis of a limited number of controlled trials found an unclear picture of the effects of interventions on body mass index for South Asian children. Meta-analyses of a limited number of controlled trials showed significant improvement in weight for adults but no significant differences in body mass index and waist circumference. One high quality study in South Asian children found that a school-based physical activity intervention that was delivered within the normal school day which was culturally sensitive, was effective. There is also evidence of culturally appropriate approaches to, and characteristics of, effective interventions in adults which we believe could be transferred and used to develop effective interventions in children.
authors.affiliation: Obesity Related Behaviours (ORB) Research Group, School of Medicine, Pharmacy and Health, Wolfson Research Institute for Health and Wellbeing, Queen's Campus, Durham University, Stockton-on-Tees, TS17 6BH, UK. tamara.brown@durham.ac.uk.
authors.forename: Tamara
authors.initials: T
authors.lastname: Brown
authors.affiliation: Obesity Related Behaviours (ORB) Research Group, School of Medicine, Pharmacy and Health, Wolfson Research Institute for Health and Wellbeing, Queen's Campus, Durham University, Stockton-on-Tees, TS17 6BH, UK. sarah.smith@durham.ac.uk.
authors.forename: Sarah
authors.initials: S
authors.lastname: Smith
authors.affiliation: Edinburgh Ethnicity and Health Research Group, Centre for Population Health Sciences, University of Edinburgh, Teviot Place, Edinburgh, EH89AG, UK. raj.bhopal@ed.ac.uk.
authors.forename: Raj
authors.initials: R
authors.lastname: Bhopal
authors.affiliation: Wolfson Research Institute for Health and Wellbeing, Queen's Campus, Durham University, Stockton-on-Tees TS17 6BH, UK. a.s.kasim@durham.ac.uk.
authors.forename: Adetayo
authors.initials: A
authors.lastname: Kasim
authors.affiliation: Obesity Related Behaviours (ORB) Research Group, School of Medicine, Pharmacy and Health, Wolfson Research Institute for Health and Wellbeing, Queen's Campus, Durham University, Stockton-on-Tees, TS17 6BH, UK. carolyn.summerbell@durham.ac.uk.
authors.forename: Carolyn
authors.initials: C
authors.lastname: Summerbell
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001211:Asia, Western; D002648:Child; D005260:Female; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D009043:Motor Activity; D009765:Obesity / Q000178:diet therapy* / Q000517:prevention & control*; D055815:Young Adult