title: Treatment of overweight and obesity in children and youth: a systematic review and meta-analysis.
abstract: BACKGROUND
  Childhood obesity is a public health concern. One-third of North American children and youth are overweight or obese. We reviewed the evidence of behavioural and pharmacological weight-management interventions on body mass index (BMI), BMI z-score and the prevalence of overweight and obesity in children and youth.
  
  
  METHODS
  We updated the search of a previous review. We searched 4 databases up to August 2013. We included randomized trials of primary care-relevant behavioural (diet, exercise, lifestyle) and pharmacological (orlistat) interventions for treating overweight and obesity in children and youth aged 2-18 years if 6-month post-baseline data were provided for BMI, BMI z-score or prevalence of overweight and obesity. In addition, we examined secondary health outcomes such as lipid and glucose levels, blood pressure, quality of life and physical fitness. We included any study reporting harms. We performed meta-analyses when possible, and we examined the features of interventions that showed benefits.
  
  
  RESULTS
  Thirty-one studies (29 behavioural, 2 pharmacological and behavioural) were included. Both intervention types showed a significant effect on BMI or BMI z-score in favour of treatment (behavioural: standardized mean difference [SMD] -0.54, 95% confidence interval [CI] -0.73 to -0.36; orlistat plus behavioural: SMD -0.43, 95% CI -0.60 to -0.25). Studies reported no significant difference between groups in the likelihood of reduced prevalence of overweight or overweight and obesity. Pooled estimates for blood pressure and quality of life showed significant benefits in favour of treatment (systolic blood pressure mean difference [MD] -3.42, 95% CI -6.65 to -0.29; diastolic blood pressure MD -3.39, 95% CI -5.17 to -1.60; quality of life MD 2.10, 95% CI 0.60 to 3.60). Gastrointestinal difficulties were more common in youth taking orlistat than in the control group (risk ratio 3.77, 95% CI 2.56 to 5.55). We saw much variability across efficacious interventions.
  
  
  CONCLUSIONS
  Low- to moderate-quality evidence suggests behavioural treatments are associated with a medium effect in terms of reduced BMI or BMI z-score compared with a small effect shown by combined pharmacological-behavioural interventions. Future research should evaluate active weight maintenance interventions in adolescents with longer follow-up and examine the effectiveness of combined pharmacological and behavioural interventions.
  
  
  BACKGROUND
  PROSPERO no. CRD42012002754.
authors.affiliation: McMaster Evidence Review and Synthesis Centre, McMaster University, Hamilton, Ontario ; School of Nursing, McMaster University, Hamilton, Ontario.
authors.forename: Leslea
authors.initials: L
authors.lastname: Peirson
authors.affiliation: McMaster Evidence Review and Synthesis Centre, McMaster University, Hamilton, Ontario ; School of Nursing, McMaster University, Hamilton, Ontario.
authors.forename: Donna
authors.initials: D
authors.lastname: Fitzpatrick-Lewis
authors.affiliation: Department of Pediatrics, McMaster University, Hamilton, Ontario.
authors.forename: Katherine
authors.initials: K
authors.lastname: Morrison
authors.affiliation: McMaster Evidence Review and Synthesis Centre, McMaster University, Hamilton, Ontario ; School of Nursing, McMaster University, Hamilton, Ontario.
authors.forename: Rachel
authors.initials: R
authors.lastname: Warren
authors.affiliation: McMaster Evidence Review and Synthesis Centre, McMaster University, Hamilton, Ontario ; Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario.
authors.forename: Muhammad
authors.initials: M
authors.lastname: Usman Ali
authors.affiliation: McMaster Evidence Review and Synthesis Centre, McMaster University, Hamilton, Ontario ; Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario.
authors.forename: Parminder
authors.initials: P
authors.lastname: Raina
references.citation: Endocr Pract. 2006 Jan-Feb;12(1):18-28
references.pmid: 16524859
references.citation: Arch Pediatr Adolesc Med. 2011 Aug;165(8):714-22
references.pmid: 21464376
references.citation: JAMA. 2012 Feb 1;307(5):483-90
references.pmid: 22253364
references.citation: BMJ. 2009 Sep 03;339:b3308
references.pmid: 19729418
references.citation: JAMA Pediatr. 2014 Feb;168(2):178-84
references.pmid: 24343296
references.citation: Clin Trials. 2011 Dec;8(6):755-64
references.pmid: 22024104
references.citation: JAMA. 2003 Apr 9;289(14):1813-9
references.pmid: 12684360
references.citation: J Obes. 2013;2013:783103
references.pmid: 24455215
references.citation: BMJ. 2013 Jun 10;346:f3092
references.pmid: 23751902
references.citation: J Rural Health. 2009 Summer;25(3):326-30
references.pmid: 19566621
references.citation: Int J Obes (Lond). 2012 Jan;36(1):16-26
references.pmid: 21931327
references.citation: J Nutr. 2010 Oct;140(10 ):1793-8
references.pmid: 20739446
references.citation: J Adolesc Health. 2008 Aug;43(2):172-9
references.pmid: 18639791
references.citation: J Clin Endocrinol Metab. 2011 Sep;96(9):E1542-9
references.pmid: 21778217
references.citation: JAMA. 2005 Jun 15;293(23):2873-83
references.pmid: 15956632
references.citation: N Engl J Med. 2012 Oct 11;367(15):1407-16
references.pmid: 22998339
references.citation: Control Clin Trials. 1986 Sep;7(3):177-88
references.pmid: 3802833
references.citation: J Pediatr Psychol. 1999 Jun;24(3):223-48
references.pmid: 10379137
references.citation: Am J Clin Nutr. 2010 May;91(5):1157-64
references.pmid: 20200257
references.citation: BMC Med Res Methodol. 2007 Feb 15;7:10
references.pmid: 17302989
references.citation: Int J Pediatr Obes. 2011 Jun;6(2-2):e62-9
references.pmid: 21604965
references.citation: Obes Res. 2002 Jan;10(1):22-32
references.pmid: 11786598
references.citation: Diabetes Care. 2011 Jul;34(7):1481-6
references.pmid: 21593294
references.citation: Pediatrics. 2007 Dec;120 Suppl 4:S254-88
references.pmid: 18055654
references.citation: J Obes. 2011;2011:928165
references.pmid: 21197151
references.citation: N Engl J Med. 1997 Sep 25;337(13):869-73
references.pmid: 9302300
references.citation: Int J Obes (Lond). 2007 Apr;31(4):630-6
references.pmid: 17160087
references.citation: JAMA Pediatr. 2013 Aug 1;167(8):759-68
references.pmid: 23778747
references.citation: Med Care. 2001 Aug;39(8):800-12
references.pmid: 11468499
references.citation: Child Care Health Dev. 2013 Jan;39(1):141-9
references.pmid: 22066521
references.citation: J Sports Sci. 1988 Summer;6(2):93-101
references.pmid: 3184250
references.citation: J Clin Epidemiol. 2006 Jun;59(6):587-98
references.pmid: 16713521
references.citation: Cochrane Database Syst Rev. 2011 Dec 07;(12):CD001871
references.pmid: 22161367
references.citation: Pediatrics. 2005 Apr;115(4):e443-9
references.pmid: 15805347
references.citation: Pediatrics. 2007 Dec;120 Suppl 4:S164-92
references.pmid: 18055651
references.citation: JAMA. 2007 Jun 27;297(24):2697-704
references.pmid: 17595270
references.citation: Pediatrics. 2012 Mar;129(3):e611-20
references.pmid: 22331335
references.citation: J Am Diet Assoc. 2006 Jun;106(6):925-45
references.pmid: 16812927
references.citation: Qual Life Res. 2012 Nov;21(9):1587-94
references.pmid: 22161746
references.citation: J Public Health (Oxf). 2014 Sep;36(3):476-89
references.pmid: 24273229
references.citation: Pediatrics. 2007 Mar;119(3):517-25
references.pmid: 17332205
references.citation: Pediatrics. 2007 Aug;120(2):340-5
references.pmid: 17671060
references.citation: J Nutr Educ Behav. 2008 Nov-Dec;40(6):369-73
references.pmid: 18984493
references.citation: N Engl J Med. 2011 Apr 7;364(14):1315-25
references.pmid: 21470009
references.citation: Acad Pediatr. 2012 Jul-Aug;12(4):319-25
references.pmid: 22634075
references.citation: Clin Nutr. 2010 Jun;29(3):331-6
references.pmid: 20106567
references.citation: Obesity (Silver Spring). 2010 Feb;18 Suppl 1:S62-8
references.pmid: 20107463
references.citation: Obesity (Silver Spring). 2014 Jan;22(1):5-13
references.pmid: 24307184
references.citation: Eur J Clin Nutr. 2011 Aug;65(8):903-9
references.pmid: 21487425
references.citation: JAMA. 2005 Jan 5;293(1):70-6
references.pmid: 15632338
references.citation: Arch Public Health. 2014 Jan 29;72(1):3
references.pmid: 24472187
references.citation: J Formos Med Assoc. 2012 Mar;111(3):153-9
references.pmid: 22423669
references.citation: J Acad Nutr Diet. 2013 Oct;113(10):1375-94
references.pmid: 24054714
references.citation: Arch Pediatr Adolesc Med. 2008 Mar;162(3):239-45
references.pmid: 18316661
references.citation: Best Pract Res Clin Endocrinol Metab. 2005 Sep;19(3):421-40
references.pmid: 16150384
references.citation: Child Obes. 2013 Aug;9(4):350-6
references.pmid: 23767805
references.citation: Am J Clin Nutr. 2011 Jul;94(1):156-63
references.pmid: 21562081