Diet, physical activity and behavioural interventions for the treatment of overweight or obese children from the age of 6 to 11 years

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dc.contributor Sistema FMUSP-HC: Faculdade de Medicina da Universidade de São Paulo (FMUSP) e Hospital das Clínicas da FMUSP
dc.contributor.author MEAD, Emma
BROWN, Tamara
REES, Karen
AZEVEDO, Liane B.
WHITTAKER, Victoria
JONES, Dan
OLAJIDE, Joan
MAINARDI, Giulia M. FMUSP-HC
CORPELEIJN, Eva
O'MALLEY, Claire
BEARDSMORE, Elizabeth
AL-KHUDAIRY, Lena
BAUR, Louise
METZENDORF, Maria-Inti
DEMAIO, Alessandro
ELLS, Louisa J.
dc.date.issued 2017
dc.identifier.citation COCHRANE DATABASE OF SYSTEMATIC REVIEWS, n.6, article ID CD012651, 622p, 2017
dc.identifier.issn 1469-493X
dc.identifier.uri http://observatorio.fm.usp.br/handle/OPI/22196
dc.description.abstract Background Child and adolescent overweight and obesity has increased globally, and can be associated with significant short-and long-term health consequences. This is an update of a Cochrane review published first in 2003, and updated previously in 2009. However, the update has now been split into six reviews addressing different childhood obesity treatments at different ages. Objectives To assess the effects of diet, physical activity and behavioural interventions (behaviour-changing interventions) for the treatment of overweight or obese children aged 6 to 11 years. Search methods We searched CENTRAL, MEDLINE, Embase, PsycINFO, CINAHL, LILACS as well as trial registers ClinicalTrials. gov and ICTRP Search Portal. We checked references of studies and systematic reviews. We did not apply any language restrictions. The date of the last search was July 2016 for all databases. Selection criteria We selected randomised controlled trials (RCTs) of diet, physical activity, and behavioural interventions (behaviour-changing interventions) for treating overweight or obese children aged 6 to 11 years, with aminimum of sixmonths' follow-up. We excluded interventions that specifically dealt with the treatment of eating disorders or type 2 diabetes, or included participants with a secondary or syndromic cause of obesity. Data collection and analysis Two review authors independently screened references, extracted data, assessed risk of bias, and evaluated the quality of the evidence using the GRADE instrument. We contacted study authors for additional information. We carried out meta-analyses according to the statistical guidelines in the Cochrane Handbook for Systematic Reviews of Interventions. Main results We included 70 RCTs with a total of 8461 participants randomised to either the intervention or control groups. The number of participants per trial ranged from 16 to 686. Fifty-five trials compared a behaviour-changing intervention with no treatment/usual care control and 15 evaluated the effectiveness of adding an additional component to a behaviour-changing intervention. Sixty-four trials were parallel RCTs, and four were cluster RCTs. Sixty-four trials were multicomponent, two were diet only and four were physical activity only interventions. Ten trials had more than two arms. The overall quality of the evidence was low or very low and 62 trials had a high risk of bias for at least one criterion. Total duration of trials ranged from six months to three years. The median age of participants was 10 years old and the median BMI z score was 2.2. Primary analyses demonstrated that behaviour-changing interventions compared to no treatment/usual care control at longest followup reduced BMI, BMI z score and weight. Mean difference (MD) in BMI was -0.53 kg/m(2) (95% confidence interval (CI) -0.82 to 0.24); P < 0.00001; 24 trials; 2785 participants; low-quality evidence. MD in BMI z score was -0.06 units (95% CI -0.10 to -0.02); P = 0.001; 37 trials; 4019 participants; low-quality evidence and MD in weight was -1.45 kg (95% CI -1.88 to -1.02); P < 0.00001; 17 trials; 1774 participants; low-quality evidence. Thirty-one trials reported on serious adverse events, with 29 trials reporting zero occurrences RR 0.57 (95% CI 0.17 to 1.93); P = 0.37; 4/2105 participants in the behaviour-changing intervention groups compared with 7/1991 participants in the comparator groups). Few trials reported health-related quality of life or behaviour change outcomes, and none of the analyses demonstrated a substantial difference in these outcomes between intervention and control. In two trials reporting on minutes per day of TV viewing, a small reduction of 6.6 minutes per day (95% CI -12.88 to -0.31), P = 0.04; 2 trials; 55 participants) was found in favour of the intervention. No trials reported on all-cause mortality, morbidity or socioeconomic effects, and few trials reported on participant views; none of which could be meta-analysed. As the meta-analyses revealed substantial heterogeneity, we conducted subgroup analyses to examine the impact of type of comparator, type of intervention, risk of attrition bias, setting, duration of post-intervention follow-up period, parental involvement and baseline BMI z score. No subgroup effects were shown for any of the subgroups on any of the outcomes. Some data indicated that a reduction in BMI immediately post-intervention was no longer evident at follow-up at less than six months, which has to be investigated in further trials. Authors' conclusions Multi-component behaviour-changing interventions that incorporate diet, physical activity and behaviour change may be beneficial in achieving small, short-term reductions in BMI, BMI z score and weight in children aged 6 to 11 years. The evidence suggests a very low occurrence of adverse events. The quality of the evidence was low or very low. The heterogeneity observed across all outcomes was not explained by subgrouping. Further research is required of behaviour-changing interventions in lower income countries and in children from different ethnic groups; also on the impact of behaviour-changing interventions on health-related quality of life and comorbidities. The sustainability of reduction in BMI/BMI z score and weight is a key consideration and there is a need for longerterm follow-up and further research on the most appropriate forms of post-intervention maintenance in order to ensure intervention benefits are sustained over the longer term.
dc.description.sponsorship · University Medical Center, Groningen, Netherlands
· Children's Hospital at Westmead, Sydney, Australia
· Centre for Food Physical Activity and Obesity Research, University of Teesside, UK
· Wolfson Research Institute, University of Durham, UK
· Evidence and Programme Guidance Unit, Department of Nutrition for Health and Development, World Health Organization, Switzerland
· Bill AMP
· Melinda Gates Foundation, USA
· Bill AMP;Melinda Gates Foundation
dc.language.iso eng
dc.publisher WILEY
dc.relation.ispartof Cochrane Database of Systematic Reviews
dc.rights restrictedAccess
dc.subject.other randomized controlled-trial; weight-management program; body-mass index; family-based treatment; life-style intervention; quality-of-life; pediatric primary-care; american-indian schoolchildren; health-education intervention; cardiovascular risk-factors
dc.title Diet, physical activity and behavioural interventions for the treatment of overweight or obese children from the age of 6 to 11 years
dc.type article
dc.rights.holder Copyright WILEY
dc.description.group LIM/38
dc.identifier.doi 10.1002/14651858.CD012651
dc.identifier.pmid 28639319
dc.type.category review
dc.type.version publishedVersion
hcfmusp.author MAINARDI, Giulia M.:HC:LIM/38
hcfmusp.author.external · MEAD, Emma:Teesside Univ, Hlth & Social Care Inst, Middlesbrough TS1 3BA, Cleveland, England
· BROWN, Tamara:Teesside Univ, Hlth & Social Care Inst, Middlesbrough TS1 3BA, Cleveland, England; Univ Durham, Sch Med Pharm & Hlth, Queens Campus, Durham, England
· REES, Karen:Univ Warwick, Div Hlth Sci, Warwick Med Sch, Coventry, W Midlands, England
· AZEVEDO, Liane B.:Teesside Univ, Hlth & Social Care Inst, Middlesbrough TS1 3BA, Cleveland, England
· WHITTAKER, Victoria:Teesside Univ, Hlth & Social Care Inst, Middlesbrough TS1 3BA, Cleveland, England
· JONES, Dan:Teesside Univ, Hlth & Social Care Inst, Middlesbrough TS1 3BA, Cleveland, England
· OLAJIDE, Joan:Teesside Univ, Hlth & Social Care Inst, Middlesbrough TS1 3BA, Cleveland, England
· CORPELEIJN, Eva:Univ Groningen, Univ Med Ctr Groningen, Dept Epidemiol, Groningen, Netherlands
· O'MALLEY, Claire:Univ Durham, Sch Med Pharm & Hlth, Queens Campus, Durham, England
· BEARDSMORE, Elizabeth:Teesside Univ, Hlth & Social Care Inst, Middlesbrough TS1 3BA, Cleveland, England
· AL-KHUDAIRY, Lena:Univ Warwick, Div Hlth Sci, Warwick Med Sch, Coventry, W Midlands, England
· BAUR, Louise:Univ Sydney, Dept Paediat & Child Hlth, Westmead, NSW, Australia
· METZENDORF, Maria-Inti:Heinrich Heine Univ Dusseldorf, Cochrane Metab & Endocrine Disorders Grp, Inst Gen Practice, Fac Med, Dusseldorf, Germany
· DEMAIO, Alessandro:World Hlth Org, Geneva, Switzerland
· ELLS, Louisa J.:Teesside Univ, Hlth & Social Care Inst, Middlesbrough TS1 3BA, Cleveland, England
hcfmusp.origem.id 2-s2.0-85021060353
hcfmusp.origem.id WOS:000408840400038
hcfmusp.publisher.city HOBOKEN
hcfmusp.publisher.country USA
dc.description.index MEDLINE
dc.identifier.eissn 1361-6137
hcfmusp.citation.scopus 74
hcfmusp.citation.wos 59
hcfmusp.affiliation.country Brasil
hcfmusp.affiliation.country Holanda
hcfmusp.affiliation.country Austrália
hcfmusp.affiliation.country Alemanha
hcfmusp.affiliation.country Suíça
hcfmusp.affiliation.country Inglaterra
hcfmusp.citation.toppaper Highly


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