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Cover of Childhood Obesity Prevention Programs: Comparative Effectiveness Review and Meta-Analysis

Childhood Obesity Prevention Programs: Comparative Effectiveness Review and Meta-Analysis

Comparative Effectiveness Reviews, No. 115

Investigators: , MD, PhD, , MS, , MS, , PhD, , MD, , PhD, , MD, MPH, , MD, MPH, , MPH, and , MD, MPH.

Johns Hopkins University Evidence-based Practice Center
Rockville (MD): Agency for Healthcare Research and Quality (US); .
Report No.: 13-EHC081-EF

Structured Abstract

Objectives:

Childhood obesity is a serious health problem in the United States and worldwide. More than 30 percent of American children and adolescents are overweight or obese. We assessed the effectiveness of childhood obesity prevention programs by reviewing all interventional studies that aimed to improve diet, physical activity, or both and that were conducted in schools, homes, primary care clinics, childcare settings, the community, or combinations of these settings in high-income countries. We also reviewed consumer health informatics interventions. We compared the effects of the interventions on weight-related outcomes (e.g., body mass index [BMI], waist circumference, percent body fat, skinfold thickness, prevalence of obesity and overweight); intermediate outcomes (e.g., diet, physical activity); and obesity-related clinical outcomes (e.g., blood pressure, blood lipids).

Data sources:

We searched MEDLINE®, Embase®, PsycInfo®, CINAHL®, clinicaltrials.gov, and the Cochrane Library through August 11, 2012.

Methods:

Two reviewers independently reviewed each article for eligibility. For each study, one reviewer extracted the data and a second reviewer verified the accuracy. Both reviewers assessed the risk of bias for each study. Together, the reviewers graded the strength of the evidence (SOE) supporting interventions—diet, physical activity, or both—in each setting for the outcomes of interest. We quantitatively pooled the results of studies that were sufficiently similar. Only experimental studies with followup of at least 1 year (6 months for studies in school settings) were included. We abstracted data on comparisons of intervention versus control.

Results:

We identified 34,545 unique citations and included 131 articles describing 124 interventional studies. The majority of the interventions (104 studies) were school based, although many of them included components delivered in other settings. Most were conducted in the United States and in the past decade. Results of four studies were pooled for BMI and four for BMI z-score in the school-only setting; results of five school-home studies were pooled for BMI. Other studies tested interventions delivered at home (n=6), in primary care (n=1), in childcare (n=4), and in the community (n=9). Six studies tested consumer health informatics interventions. For obesity prevention, the following settings and interventions showed benefit: school-based—diet or physical activity interventions (SOE moderate); school-based with a home component—physical activity interventions (SOE high) and both diet and physical activity (SOE moderate); school-based with home and community components—diet and physical activity interventions (SOE high); school-based with a community component—diet and physical activity interventions (SOE moderate); community with a school component—diet and physical activity interventions (SOE moderate). The strength of the evidence is either low or insufficient for the remainder of the interventions and settings.

Conclusions:

The evidence is moderate about the effectiveness of school-based interventions for childhood obesity prevention. Physical activity interventions in a school-based setting with a family component or diet and physical activity interventions in a school-based setting with home and community components have the most evidence for effectiveness. More research is needed to test interventions in other settings, such as those testing policy, environmental, and consumer health informatics strategies.

Contents

540 Gaither Road, Rockville, MD 20850; www​.ahrq.gov

Prepared for: Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services1, Contract No. 290-2007-10061-I. Prepared by: Johns Hopkins University Evidence-based Practice Center, Baltimore, MD

Suggested citation:

Wang Y, Wu Y, Wilson RF, Bleich S, Cheskin L, Weston C, Showell N, Fawole O, Lau B, Segal J. Childhood Obesity Prevention Programs: Comparative Effectiveness Review and Meta-Analysis. Comparative Effectiveness Review No. 115. (Prepared by the Johns Hopkins University Evidence-based Practice Center under Contract No. 290-2007-10061-I.) AHRQ Publication No. 13-EHC081-EF. Rockville, MD: Agency for Healthcare Research and Quality; June 2013. www.effectivehealthcare.ahrq.gov/reports/final.cfm.

This report is based on research conducted by the Johns Hopkins University Evidence-based Practice Center (EPC) under contract to the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD (Contract No. 290-2007-10061-I). The findings and conclusions in this document are those of the authors, who are responsible for its contents; the findings and conclusions do not necessarily represent the views of AHRQ. Therefore, no statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services.

The information in this report is intended to help health care decisionmakers—patients and clinicians, health system leaders, and policymakers, among others—make well-informed decisions and thereby improve the quality of health care services. This report is not intended to be a substitute for the application of clinical judgment. Anyone who makes decisions concerning the provision of clinical care should consider this report in the same way as any medical reference and in conjunction with all other pertinent information, i.e., in the context of available resources and circumstances presented by individual patients.

This report may be used, in whole or in part, as the basis for development of clinical practice guidelines and other quality enhancement tools, or as a basis for reimbursement and coverage policies. AHRQ or U.S. Department of Health and Human Services endorsement of such derivative products may not be stated or implied.

None of the investigators have any affiliations or financial involvement that conflicts with the material presented in this report.

1

540 Gaither Road, Rockville, MD 20850; www​.ahrq.gov

Bookshelf ID: NBK148737PMID: 23865092
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