Diet and Physical Activity Interventions to Prevent or Treat Obesity in South Asian Children and Adults: A Systematic Review and Meta-Analysis
Abstract
:1. Introduction
- Downstream interventions are those focused on change or support for individuals and include primary prevention. Examples include communication strategies, health information and behaviour change campaigns.
- Midstream interventions are those that focus on psychosocial levels and behaviours. Midstream interventions include social marketing and the provision of health education to individuals, communities and populations more broadly. Community action and community development interventions, which often encompass awareness raising, are also directed at social change, so they are sometimes considered to be more upstream than midstream.
- Upstream interventions take a population focus, and are also intended as change mechanisms, to support efforts to promote social change. Upstream interventions encompass institutional practices and systems change, organisational change and development, workforce development, policy, and legislation, to influence social (including ethnic) norms that create and reinforce social and health inequalities.
2. Methods
2.1. Search Strategy and Study Selection
2.2. Eligibility Criteria
2.3. Data Extraction and Quality Assessment
2.4. Data Analysis
3. Results
3.1. Methodological Characteristics and Quality of Included Studies
Study ID | No. | I % Male | C % Male | I Age (Years) | C Age (Years) | Ethnicity | Min BMI * | I Mean Baseline BMI | C Mean Baseline BMI | Target Behaviour Change | Country | Setting | Duration Months | ||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
RCTs (children) | |||||||||||||||||||||||||
Singhal 2010 [59] | 201 | 61 | 60 | 16 | 16 | Asian Indian | N | NR | NR | D&PA | India | School | 6 | ||||||||||||
Nidhi 2012 [53] | 90 | 0 | 0 | 16 | 16 | Asian Indian | N | 20.3 | 21.2 | PA | India | School | 3 | ||||||||||||
Johnston 2013 [46] | 835 | 62 | 54 | 8 | 8 | 25% Asian | N | 21.6 | 21.0 | D&PA | USA | School | 24 | ||||||||||||
CCTs | |||||||||||||||||||||||||
Almas 2013 [35] | 280 | 0 | 0 | 10 | 10 | Pakistani | N | 1.35 (z-score) | 1.92 (z-score) | PA | Pakistan | School | 5 | ||||||||||||
Adab 2014 [62] | 574 | 54 | 50 | 7 | 6 | 86% South Asian | N | −0.03 (z-score) | 0.08 (z-score) | D&PA | UK | School | 4 | ||||||||||||
BA (children) | |||||||||||||||||||||||||
Balagopal 2008 [38] ** | 118 | 48 | NA | 14 | NA | Asian Indian | N | 16.0 | NA | D&PA | India | Community | 7 | ||||||||||||
Kameswararao 2009 [47] a | 59 | 61 | NA | School age | School age | Asian Indian | Y | 59/610 BMI ≥ 95th percentile | NA | D&PA | India | School | 6 | ||||||||||||
Madsen 2009 [50] | 233 | 52 | NA | 10 | NA | 26% South Asian | N | 20.9 | NA | PA | USA | Community | 8 | ||||||||||||
RCTs (adults) | |||||||||||||||||||||||||
Ramachandran 2006 [54] b | 269 | 78 | 76 | 46 | 45 | Asian Indian | N | 25.7 | 26.3 | D&PA | India | Community | 30 | ||||||||||||
Bellary 2008 [40] | 1486 | 54 | 49 | 57 | 57 | South Asian | N | 28.5 | 28.6 | D | UK | General Practice | 24 | ||||||||||||
Admiraal 2013 [34] | 536 | 50 | 51 | 45 | 45 | Hindustani Surinamese | N | 28.1 | 27.2 | D&PA | Netherlands | General Practice | 12 | ||||||||||||
Andersen 2013 [36] | 150 | 100 | 100 | 36 | 40 | Born/parents born in Pakistan | N | 27.1 | 27.4 | PA | Norway | Community University | 5 | ||||||||||||
Ramachandran 2013 [55] | 537 | 100 | 100 | 46 | 46 | Asian Indian | Y | 25.8 | 25.8 | D&PA | India | Workplace | 20 | ||||||||||||
Telle-Hjellset 2013 [60] | 198 | 0 | 0 | 41 | 42 | Born/both parents born in Pakistan | N | 29.4 | 29.8 | D&PA | Norway | Mother & child health clinic | 7 | ||||||||||||
Bhopal 2014 [41] | 156 | 46 | 45 | 53 | 52 | Indian, Pakistani origin | Y | 30.6 | 30.5 | D&PA | UK | Home | 36 | ||||||||||||
BA (adults) | |||||||||||||||||||||||||
Ghosh 2006 [44] | 45 | 100 | NA | 60 | NA | Asian Indian | Y | 26.3 | NA | PA | India | University | 5 | ||||||||||||
Mathews 2007 [51] | 304 | 34 | NA | 44 | NA | Bangladeshi Indian Pakistani | N | 28.6 | NA | D&PA | UK | Clinic, community | 6–12 | ||||||||||||
Rush 2007 [56] | 41 | 53 | NA | M: 62; F: 59 | NA | Asian Indian | N | NR | NA | D&PA | New Zealand | Community, laboratory | 5 | ||||||||||||
Backes 2008 [37] | 23 | 0 | NA | 44 | NA | South Asian | Y | 30.2 | NA | D | USA | University | 3 | ||||||||||||
Balagopal 2008 [38] ** | 585 | 41 | NA | 40 | NA | Asian Indian | N | 20.6 | NA | D&PA | India | Community | 7 | ||||||||||||
Dixon 2008 [43] c | 22 | 53 | NA | >25 | NA | South Asian | Y | 27.3 | NA | D | UK | Hospital | 12 | ||||||||||||
Kousar 2008 [49] | 53 | 0 | NA | 38 | NA | Born in Pakistan | Y | 29.2 | NA | D&PA | Australia | University | 6 | ||||||||||||
Misra 2008 [52] | 30 | 73 | NA | 41 | NA | Asian Indian | N | 24.1 | NA | PA | India | Physiotherapy clinic | 3 | ||||||||||||
Prabhakaran 2009 [61] d | 2331 | 60 | 57 | 41 | 39 | Asian Indian | N | NR | NR | D&PA | India | Worksite | 44–48 | ||||||||||||
Sharma 2009 [58] e | 200 | 12 | 12 | 20–60 | 20–60 | Asian Indian | Y | Vatta 31.0 Pitta 32.0 Kapha 31.6 | NA | D | India | Clinic | 3 | ||||||||||||
Shailaja 2011 [57] d | 200 | UM:81 UF:19 RM:46 RF:17 | NA | 18–60 | 18–60 | Asian South Indian | Y | UM:28.1 UF:29.3 RM:27.1 RF:28.2 | NA | D&PA | India | Community | 3 | ||||||||||||
Balagopal 2012 [39] | 1681 | 46 | NA | 42 | NA | Asian Indian | N | 20.8 | NA | D&PA | India | Community | 6 | ||||||||||||
Chander 2013 [42] | 157 | 71 | NA | 60 | NA | Asian Indian | N | 30.6 | NA | D&PA | India | Hospital | 10 | ||||||||||||
Khaskheli 2013 [48] | 98 | 0 | NA | 31 | NA | Pakistani | Y | 36.2 | NA | D&PA | Pakistan | Private clinic | 12 | ||||||||||||
Gulati 2014 [45] c | 35 | 40 | NA | 43 | NA | Asian Indian | Y | 30.9 | NA | D | India | Hospital | 6 |
3.2. Effects of Interventions
Study ID | No. Quality Criteria Met (Max 6) | Effectiveness BMI/z-Score * ↓↑↔? | Effectiveness WC * ↓↑↔? | Effectiveness WT *↓↑↔? | Summary Effectiveness ↓↑↔↕? |
---|---|---|---|---|---|
RCTs (children) | |||||
Singhal 2010 [59] | 5 | ↔ | ↑ | ↔ | ↕ |
Nidhi 2012 [53] | 4 | ↔ | ↔ | NR | ↔ |
Johnston 2013 [46] | 5 | ↔ | NR | ↑ | ↕ |
CCTs (children) | |||||
Almas 2013 [35] | 3 | ↓ | NR | NR | ↓ |
Adab 2014 [62] | 4 | ↑ adjusted ↔unadjusted | ↔ | NR | ↕ |
BA (children) | |||||
Balagopal 2008 [38] | 4 | ↓ | ↑ | NR | ↕ |
Kameswararao 2009 [47] | 3 | ? | NR | NR | ? |
Madsen 2009 [50] | 1 | ↑ | NR | NR | ↑ |
RCTs (adults) | |||||
Ramachandran 2006 [54] | 6 | ↔ | ↔ | ↔ | ↔ |
Bellary 2008 [40] | 5 | ↓ | ↔ | ↓ | ↕ |
Admiraal 2013 [34] | 4 | ↔ | ↔ | ↔ | ↔ |
Andersen 2013 [36] | 6 | ↑ | ↑ | ↑ | ↑ |
Ramachandran 2013 [55] | 5 | ↔ | ↔ | NR | ↔ |
Telle-Hjellset 2013 [60] | 6 | ↔ | ↔ | ↔ | ↔ |
Bhopal 2014 [41] | 5 | ↑ adjusted ↔unadjusted | ↑adjusted ↔ unadjusted | ↑adjusted ↔ unadjusted | ↑adjusted ↔ unadjusted |
BA (adults) | |||||
Ghosh 2006 [44] | 3 | ↑ | NR | NR | ↑ |
Mathews 2007 [51] | 2 | ↑ | ↔ | ↑ | ↕ |
Rush 2007 [56] | 3 | NR | ↑M ↔F | ↑M ↔F | ↕ |
Backes 2008 [37] | 2 | ↑ | NR | ↑ | ↑ |
Balagopal 2008 [38] | 4 | ↓ | ↑ | NR | ↕ |
Dixon 2008 [43] | 5 | ↑ | ↔ | ↔ | ↕ |
Kousar 2008 [49] | 3 | ↑ | NR | NR | ↑ |
Misra 2008 [52] | 3 | ↔ | ↑ | NR | ↕ |
Prabhakaran 2009 [61] | 2 | NR | ↑ | ↑ | ↑ |
Sharma 2009 [58] | 0 | ↑ | ↑ | ↑ | ↑ |
Balagopal 2012 [39] | 4 | ↑ | ↑ | NR | ↑ |
Chander 2013 [42] | 0 | ↑ | NR | NR | ↑ |
Khaskheli 2013 [48] | 1 | ↑ | NR | NR | ↑ |
Shailaja 2011 [57] | 2 | ↑ | ↑ | ? | ↑ |
Gulati 2014 [45] | 4 | NR | ? | ? | ? |
3.3. Diet and Physical Activity Interventions in Children
Controlled Clinical Trials/Randomised Controlled Trials
Before-and-After Studies
3.4. Diet and Physical Activity Interventions in Adults
Randomised Controlled Trials
Before-and-After Studies
3.5. Analysis by Type of Intervention and Length of Follow-Up
3.6. Economic Outcomes
4. Discussion
4.1. Strengths and Limitations of this Review
4.2. Recommendations for Research
5. Conclusions
Supplementary Files
Supplementary File 1Acknowledgements
Author Contributions
Conflicts of Interest
References
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Brown, T.; Smith, S.; Bhopal, R.; Kasim, A.; Summerbell, C. Diet and Physical Activity Interventions to Prevent or Treat Obesity in South Asian Children and Adults: A Systematic Review and Meta-Analysis. Int. J. Environ. Res. Public Health 2015, 12, 566-594. https://doi.org/10.3390/ijerph120100566
Brown T, Smith S, Bhopal R, Kasim A, Summerbell C. Diet and Physical Activity Interventions to Prevent or Treat Obesity in South Asian Children and Adults: A Systematic Review and Meta-Analysis. International Journal of Environmental Research and Public Health. 2015; 12(1):566-594. https://doi.org/10.3390/ijerph120100566
Chicago/Turabian StyleBrown, Tamara, Sarah Smith, Raj Bhopal, Adetayo Kasim, and Carolyn Summerbell. 2015. "Diet and Physical Activity Interventions to Prevent or Treat Obesity in South Asian Children and Adults: A Systematic Review and Meta-Analysis" International Journal of Environmental Research and Public Health 12, no. 1: 566-594. https://doi.org/10.3390/ijerph120100566