Academic journal article Childhood Obesity

Effective Interventions in Overweight or Obese Young Children: Systematic Review and Meta-Analysis

Academic journal article Childhood Obesity

Effective Interventions in Overweight or Obese Young Children: Systematic Review and Meta-Analysis

Article excerpt

[Author Affiliation]

Esther van Hoek. 1 Department of Pediatrics, Gelderse Vallei Hospital, Ede, The Netherlands.

Edith J.M. Feskens. 2 Division of Human Nutrition, Wageningen University, Wageningen, The Netherlands.

Laura I. Bouwman. 3 Department of Social Sciences, Wageningen University, Wageningen, The Netherlands.

Arieke J. Janse. 4 Department of Pediatrics, Gelderse Vallei Hospital, Ede, The Netherlands.

Address correspondence to: Arieke J. Janse, MD, PhD, MSc, Pediatrician and Clinical Epidemiologist, Department of Pediatrics, Gelderse Vallei Hospital, PO Box 9025, 6710 HN Ede, The Netherlands, E-mail: JanseA1@zgv.nl

Introduction

The prevalence of overweight and obesity is on the rise worldwide.1 Obesity in childhood has severe somatic and psychosocial consequences in the short and long term.2-5 Successful treatment programs change behavior (diet and activity level) and therefore decrease overweight and its consequences.6 Often, behavioral therapy is included to help participants initiate and sustain behavioral change.6 A ≥0.5 reduction in BMI z-score is clinically relevant given that it is associated with a reduction in cardiovascular risk (CVR) factors and insulin resistance (IR) in children 4-15 years of age.7-9

Starting treatment at a young age appears to be more successful than treating older children.10-13 First, parents have more control over their children's daily environment at early age, potentially making lifestyle changes easier. Second, starting treatment at a young age possibly prevents early adiposity rebound, the time point when BMI rises after reaching a nadir, predicting later obesity.14-16 To change targeted children's lifestyle behavior, optimal strategies must take into account children's developmental stage, because developmental stage influences the child's liking or disliking healthy behavior and understanding of health.17

Clinical guidelines from the United States, UK, and The Netherlands summarize the recommendations for the treatment of children with obesity, but do not give age-specific recommendations for young children.18-22 The Cochrane review on interventions for treating obesity in children by Oude Luttikhuis and colleagues concluded that combined behavioral lifestyle interventions give favorable results, but interventions in young children were not reviewed separately.23 Two systematic reviews were performed describing interventions to prevent or treat obesity in preschool-age children (2-5 years of age).24,25 Both reviews concluded that it was advisable to address adults (e. g., parents and teachers) or families, rather than children alone, and to employ multicomponent interventions focusing on more than one strategy.24,25 Given that a meta-analysis was not performed, the overall effectiveness of treatment programs and the characteristics of effective treatment programs for overweight or obese young children are unknown. The aim of this article is therefore to summarize the effectiveness of treatment programs in overweight or obese children at an early age (mean age, 3-<8 years), as indicated in the literature up to April 15, 2012.

Methods

Search Strategy

The databases PubMed, Embase, Web of Science, and PsycINFO were searched. Database-specific keywords relating to overweight, obesity, children, treatment, and trial were used (Table 1). The search was limited by language (English, Spanish, German, and Dutch). The search included publications up to April 15, 2012.

[Table omitted; see PDF]

Literature Selection

Inclusion criteria were: body weight or another variable that contains body weight as the outcome of treatment (compared to no treatment, usual care, or baseline); population of overweight or obese young children, with a mean or median in the age of 3-<8 years; and English, Spanish, German, or Dutch language. …

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