Please use this identifier to cite or link to this item: http://hdl.handle.net/1893/32277
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dc.contributor.authorBrown, Tamaraen_UK
dc.contributor.authorMoore, Theresa HMen_UK
dc.contributor.authorHooper, Leeen_UK
dc.contributor.authorGao, Yangen_UK
dc.contributor.authorZayegh, Amiren_UK
dc.contributor.authorIjaz, Shareaen_UK
dc.contributor.authorElwenspoek, Marthaen_UK
dc.contributor.authorFoxen, Sophie Cen_UK
dc.contributor.authorMagee, Luciaen_UK
dc.contributor.authorO'Malley, Claireen_UK
dc.contributor.authorWaters, Elizabethen_UK
dc.contributor.authorSummerbell, Carolyn Den_UK
dc.date.accessioned2021-02-13T01:07:58Z-
dc.date.available2021-02-13T01:07:58Z-
dc.date.issued2019en_UK
dc.identifier.otherCD001871en_UK
dc.identifier.urihttp://hdl.handle.net/1893/32277-
dc.description.abstractBackground Prevention of childhood obesity is an international public health priority given the significant impact of obesity on acute and chronic diseases, general health, development and well‐being. The international evidence base for strategies to prevent obesity is very large and is accumulating rapidly. This is an update of a previous review. Objectives To determine the effectiveness of a range of interventions that include diet or physical activity components, or both, designed to prevent obesity in children. Search methods We searched CENTRAL, MEDLINE, Embase, PsychINFO and CINAHL in June 2015. We re‐ran the search from June 2015 to January 2018 and included a search of trial registers. Selection criteria Randomised controlled trials (RCTs) of diet or physical activity interventions, or combined diet and physical activity interventions, for preventing overweight or obesity in children (0‐17 years) that reported outcomes at a minimum of 12 weeks from baseline. Data collection and analysis Two authors independently extracted data, assessed risk‐of‐bias and evaluated overall certainty of the evidence using GRADE. We extracted data on adiposity outcomes, sociodemographic characteristics, adverse events, intervention process and costs. We meta‐analysed data as guided by the Cochrane Handbook for Systematic Reviews of Interventions and presented separate meta‐analyses by age group for child 0 to 5 years, 6 to 12 years, and 13 to 18 years for zBMI and BMI. Main results We included 153 RCTs, mostly from the USA or Europe. Thirteen studies were based in upper‐middle‐income countries (UMIC: Brazil, Ecuador, Lebanon, Mexico, Thailand, Turkey, US‐Mexico border), and one was based in a lower middle‐income country (LMIC: Egypt). The majority (85) targeted children aged 6 to 12 years. Children aged 0‐5 years: There is moderate‐certainty evidence from 16 RCTs (n = 6261) that diet combined with physical activity interventions, compared with control, reduced BMI (mean difference (MD) −0.07 kg/m2, 95% confidence interval (CI) −0.14 to −0.01), and had a similar effect (11 RCTs, n = 5536) on zBMI (MD −0.11, 95% CI −0.21 to 0.01). Neither diet (moderate‐certainty evidence) nor physical activity interventions alone (high‐certainty evidence) compared with control reduced BMI (physical activity alone: MD −0.22 kg/m2, 95% CI −0.44 to 0.01) or zBMI (diet alone: MD −0.14, 95% CI −0.32 to 0.04; physical activity alone: MD 0.01, 95% CI −0.10 to 0.13) in children aged 0‐5 years. Children aged 6 to 12 years: There is moderate‐certainty evidence from 14 RCTs (n = 16,410) that physical activity interventions, compared with control, reduced BMI (MD −0.10 kg/m2, 95% CI −0.14 to −0.05). However, there is moderate‐certainty evidence that they had little or no effect on zBMI (MD −0.02, 95% CI −0.06 to 0.02). There is low‐certainty evidence from 20 RCTs (n = 24,043) that diet combined with physical activity interventions, compared with control, reduced zBMI (MD −0.05 kg/m2, 95% CI −0.10 to −0.01). There is high‐certainty evidence that diet interventions, compared with control, had little impact on zBMI (MD −0.03, 95% CI −0.06 to 0.01) or BMI (−0.02 kg/m2, 95% CI −0.11 to 0.06). Children aged 13 to 18 years: There is very low‐certainty evidence that physical activity interventions, compared with control reduced BMI (MD −1.53 kg/m2, 95% CI −2.67 to −0.39; 4 RCTs; n = 720); and low‐certainty evidence for a reduction in zBMI (MD ‐0.2, 95% CI −0.3 to ‐0.1; 1 RCT; n = 100). There is low‐certainty evidence from eight RCTs (n = 16,583) that diet combined with physical activity interventions, compared with control, had no effect on BMI (MD −0.02 kg/m2, 95% CI −0.10 to 0.05); or zBMI (MD 0.01, 95% CI −0.05 to 0.07; 6 RCTs; n = 16,543). Evidence from two RCTs (low‐certainty evidence; n = 294) found no effect of diet interventions on BMI. Direct comparisons of interventions: Two RCTs reported data directly comparing diet with either physical activity or diet combined with physical activity interventions for children aged 6 to 12 years and reported no differences. Heterogeneity was apparent in the results from all three age groups, which could not be entirely explained by setting or duration of the interventions. Where reported, interventions did not appear to result in adverse effects (16 RCTs) or increase health inequalities (gender: 30 RCTs; socioeconomic status: 18 RCTs), although relatively few studies examined these factors. Re‐running the searches in January 2018 identified 315 records with potential relevance to this review, which will be synthesised in the next update. Authors' conclusions Interventions that include diet combined with physical activity interventions can reduce the risk of obesity (zBMI and BMI) in young children aged 0 to 5 years. There is weaker evidence from a single study that dietary interventions may be beneficial. However, interventions that focus only on physical activity do not appear to be effective in children of this age. In contrast, interventions that only focus on physical activity can reduce the risk of obesity (BMI) in children aged 6 to 12 years, and adolescents aged 13 to 18 years. In these age groups, there is no evidence that interventions that only focus on diet are effective, and some evidence that diet combined with physical activity interventions may be effective. Importantly, this updated review also suggests that interventions to prevent childhood obesity do not appear to result in adverse effects or health inequalities. The review will not be updated in its current form. To manage the growth in RCTs of child obesity prevention interventions, in future, this review will be split into three separate reviews based on child age.en_UK
dc.language.isoenen_UK
dc.publisherWileyen_UK
dc.relationBrown T, Moore TH, Hooper L, Gao Y, Zayegh A, Ijaz S, Elwenspoek M, Foxen SC, Magee L, O'Malley C, Waters E & Summerbell CD (2019) Interventions for preventing obesity in children. Cochrane Database of Systematic Reviews, 2019 (7), Art. No.: CD001871. https://doi.org/10.1002/14651858.CD001871.pub4en_UK
dc.rightsThis review is published as a Cochrane Review in the Cochrane Database of Systematic Reviews 2019, Issue 7. Cochrane Reviews are regularly updated as new evidence emerges and in response to comments and criticisms, and the Cochrane Database of Systematic Reviews should be consulted for the most recent version of the Review. Brown T, Moore THM, Hooper L, Gao Y, Zayegh A, Ijaz S, Elwenspoek M, Foxen SC, Magee L, O'Malley C, Waters E, Summerbell CD. Interventions for preventing obesity in children. Cochrane Database of Systematic Reviews 2019, Issue 7. Art. No.: CD001871. DOI: https://doi.org/10.1002/14651858.CD001871.pub4en_UK
dc.rights.urihttps://storre.stir.ac.uk/STORREEndUserLicence.pdfen_UK
dc.titleInterventions for preventing obesity in childrenen_UK
dc.typeJournal Articleen_UK
dc.identifier.doi10.1002/14651858.CD001871.pub4en_UK
dc.identifier.pmid31332776en_UK
dc.citation.jtitleCochrane Database of Systematic Reviewsen_UK
dc.citation.issn1469-493Xen_UK
dc.citation.volume2019en_UK
dc.citation.issue7en_UK
dc.citation.publicationstatusPublisheden_UK
dc.citation.peerreviewedRefereeden_UK
dc.type.statusVoR - Version of Recorden_UK
dc.contributor.funderWorld Health Organisationen_UK
dc.author.emailt.j.brown@stir.ac.uken_UK
dc.citation.date23/07/2019en_UK
dc.contributor.affiliationDurham Universityen_UK
dc.contributor.affiliationUniversity of Bristolen_UK
dc.contributor.affiliationUniversity of East Angliaen_UK
dc.contributor.affiliationHong Kong Baptist Universityen_UK
dc.contributor.affiliationThe Royal Children's Hospitalen_UK
dc.contributor.affiliationUniversity of Bristolen_UK
dc.contributor.affiliationUniversity of Bristolen_UK
dc.contributor.affiliationDefence Medical Servicesen_UK
dc.contributor.affiliationRoyal United Hospitals Bathen_UK
dc.contributor.affiliationDurham Universityen_UK
dc.contributor.affiliationUniversity of Melbourneen_UK
dc.contributor.affiliationDurham Universityen_UK
dc.identifier.isiWOS:000478017500032en_UK
dc.identifier.scopusid2-s2.0-85070287164en_UK
dc.identifier.wtid1704106en_UK
dc.contributor.orcid0000-0003-1285-7098en_UK
dc.date.accepted2019-06-28en_UK
dc.date.filedepositdate2021-02-11en_UK
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