Evaluation of Family-Based Interventions as a Therapeutic Tool in the Modulation of Childhood Obesity: A Systematic Review
Abstract
:1. Introduction
2. Materials and Methods
2.1. Search Strategy
2.2. Inclusion Criteria
2.3. Study Selection
2.4. Quality Assessment
2.5. Data Extraction
3. Results
3.1. Study Selection
3.2. Quality Assessment
3.3. Outcome Evaluation
3.4. Characteristics of the Participants and Interventions
3.5. Intervention Effects on Anthropometry and Body Composition
3.6. Intervention Effects on Diet and Physical Activity
4. Discussion
4.1. Characteristics of the Participants and Interventions
4.2. Intervention Effects on Anthropometry and Body Composition
4.3. Intervention Effects on Diet and Physical Activity
5. Limitations and Strengths
6. Practical Applications
7. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Appendix A. Search Strategy
Database | Keywords | Records Identified |
PubMed | ((childhood obesity [Title/Abstract] OR Obesity [Title/Abstract] OR children [Title/Abstract]) AND (‘physical activity [Title/Abstract] OR ‘exercise’ [Title/Abstract]) AND (Diet [Title/Abstract] OR exercise [Title/Abstract]) Filters: Randomized Controlled Trial, from 2014–2024, in the last 10 years. | 87 |
Scielo | (“childhood obesity” [Title/Abstract] OR “obesity” [Title/Abstract] OR “children” [Title/Abstract]) AND (“physical activity” [Title/Abstract] OR “exercise” [Title/Abstract]) AND (“intervention” [Title/Abstract] OR “family-based intervention” [Title/Abstract]). In Title Abstract Keyword in All Text—Publication Year from 2014 to 2024. Filters: Full text, Trial, in the last 10 years. | 44 |
Web of Science | Childhood obesity OR obesity OR children (Topic) and physical activity OR exercise (Topic) and intervention OR family-based intervention (Topic) and 2024 or 2023 or 2022 or 2021 or 2020 or 2019 or 2018 or 2017 or 2016 or 2015 or 2014 (Publication Years) and Article (Document Types) | 148 |
Cochrane | (Childhood obesity OR obesity OR children): ti,ab,kw AND (physical activity OR exercise): ti,ab,kw AND (intervention OR family-based intervention): ti,ab,kw’ with Cochrane Library publication date Between Jan 2014 and June 2024, in Trials (word variations have been searched) | 47 |
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Study | Items | Total | % | Quality Score | |||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 | 11 | 12 | 13 | 14 | 15 | 16 | ||||
Ahmad et al. [2], 2018 | 1 | 1 | 1 | 1 | 1 | 1 | 0 | 1 | 1 | 1 | 1 | 1 | 0 | 1 | 1 | 0 | 15 | 93.75 | E |
Cohen et al. [28], 2016 | 1 | 1 | 1 | 1 | 1 | 1 | 0 | 1 | 1 | 0 | 0 | 1 | 1 | 1 | 1 | 1 | 13 | 81.25 | VG |
Ek et al. [27], 2019 | 1 | 1 | 1 | 1 | 1 | 1 | 0 | 1 | 1 | 0 | 0 | 1 | 1 | 1 | 1 | 1 | 13 | 81.25 | VG |
Robertson et al. [24], 2017 | 1 | 1 | 1 | 1 | 1 | 1 | 0 | 1 | 1 | 0 | 0 | 1 | 1 | 1 | 1 | 1 | 13 | 81.25 | VG |
Stark et al. [26], 2018 | 1 | 1 | 1 | 1 | 1 | 1 | 0 | 0 | 1 | 0 | 0 | 1 | 1 | 1 | 1 | 1 | 12 | 75 | G |
Wilfley et al. [25], 2017 | 1 | 1 | 1 | 1 | 1 | 1 | 0 | 1 | 1 | 0 | 0 | 1 | 1 | 1 | 1 | 1 | 13 | 81.25 | VG |
Random Sequence Generation (Selection Bias) | Allocation Concealment (Selection Bias) | Blinding (Performance Bias and Detection Bias) Participant | Blinding (Performance Bias and Detection Bias) Personnel | Blinding (Performance Bias and Detection Bias) Outcome Assessor | Incomplete Outcome (Attrition Bias) | Selective Reporting (Reporting Bias) | Other Bias | |
---|---|---|---|---|---|---|---|---|
Ahmad et al. [2], 2018 | ||||||||
Cohen et al. [28], 2016 | ||||||||
Ek et al. [27], 2019 | ||||||||
Robertson et al. [24], 2017 | ||||||||
Stark et al. [26], 2018 | ||||||||
Wilfley et al. [25], 2017 |
First Author, Year of Publication, and Country | Study Design | Participants: Group Name, Number (Gender), Anthropometric Characteristics, and Withdrawals | Variable | Outcomes | Conclusions |
---|---|---|---|---|---|
Ahmad et al. [2], 2018 Malaysia | Randomized clinical trial | REDUCE: n = 67 (39 girls and 28 boys) Age (mean ± SD): 9.6 ± 1.2 years Height (mean ± SD): 136.1 ± 8.6 cm Weight (mean ± SD): 47.0 ± 10.5 kg BMIz (mean ± SD): 2.05 ± 0.40 BMI (mean ± SD): 25.2 ± 3.5 % BF (mean ± SD): 37.87 ± 4.20 Waist circumference (mean ± SD): 90.21 ± 7.98th CG: n = 67 (37 girls and 30 boys) Age (mean ± SD): 9.6 ± 1.2 years Height (mean ± SD): 135.6 ± 9.2 cm Weight (mean ± SD): 48.2 ± 12.0 kg BMIz (mean ± SD): 2.11 ± 0.4 BMI (mean ± SD): 25.7 ± 3.9 % BF (mean ± SD): 37.63 ± 4.09 Waist circumference (mean ± SD): 91.28 ± 7.04th Study withdrawals: 0 | BMI z-score % total body fat Waist circumference percentile | REDUCE vs. CG ↓* BMIz REDUCE vs. CG ↓* % total body fat REDUCE vs. CG ↓* Waist circumference percentile | The 4-month REDUCE intervention program was effective in reducing infant adiposity. |
Cohen et al. [28], 2016 Canada | Randomized clinical trial | StnTx: n = 25 (14 girls and 11 boys) Age (mean ± SD): 7.7 ± 0.8 years BMI (mean ± SD): 25.2 ± 8.4 %BF (mean ± SD): 38.5 ± 5.5 Waist circumference (cm) (mean ± SD): 81.3 ± 8.4 Study withdrawals: 2 ModTx: n = 25 (15 girls and 10 boys) Age (mean ± SD): 8.1 ± 0.7 years BMI (mean ± SD): 24.1 ± 2.8 %BF (mean ± SD): 36.8 ± 5.5 Waist circumference (cm) (mean ± SD): 81.6 ± 8.7 Study withdrawals: 1 Control: n = 28 (16 girls and 12 boys) Age (mean ± SD): 7.7 ± 0.8 years BMI (mean ± SD): 24.1 ± 3.2 %BF (mean ± SD):36.2 ± 15.5 Waist circumference (cm) (mean ± SD): 80.7 ± 9.1 Study withdrawals: 2 | ∆BAZ ∆%BF ∆FM LM Waist circumference Macronutrient intake Saturated fatty acids | ModTx vs. CG ↓* ∆BAZ ↓* ∆% BF ↓* ∆FM CG vs. ModTx ↑* ∆Waist circumference ↑* ∆FM of trunk ↑* LM in all groups FMI ModTx ≈ CG Macronutrient intake ≈ in all groups Saturated fatty acids ≈ in all groups (at 3 months) | The intervention based on the Canadian guidelines on diet and PA had effects on reducing adiposity in children with O/SP |
Ek et al. [27], 2019 Sweden | Randomized clinical trial | Booster: n = 44 (19 girls and 25 boys) Age (mean ± SD): 5.2 ± 0.8 years BMIz (mean ± SD): 3.0 ± 0.5 BMI (mean ± SD): 21.4 ± 1.5 Waist circumference (cm) (mean ± SD): 65.1 ± 4.3 Study withdrawals: 18 No Booster: n = 43 (23 girls and 20 boys) Age (mean ± SD): 5.2 ± 0–9 years BMIz (mean ± SD): 3.1 ± 0.7 BMI (mean ± SD): 21.9 ± 2.3 Waist circumference (cm) (mean ± SD): 67.6 ± 6.5 Study withdrawals: 13 CG: n = 87 (42 girls and 45 boys) Age (mean ± SD): 5.3 ± 0.7 years BMIz (mean ± SD): 2.9 ± 0.6 BMI (mean ± SD): 21.3 ± 1.7 Waist circumference (cm) (mean ± SD): 66.9 ± 6.2 Study withdrawals: 16 | BMIz Waist circumference | Booster + No booster vs. CG ↓ BMIz CG vs. Booster + No booster ↑* Waist circumference | A parent-only treatment with boosters exceeded standard care for the treatment of obesity in preschoolers. |
Robertson et al. [24], 2017 United Kingdom | Randomized clinical trial | FFH: n = 56 (32 girls and 24 boys) Age (mean ± SD): 9.44 ± 1.47 years BMIz (mean ± SD): 2.7 ± 0.63 BMI (mean ± SD): 25.92 ± 4.57 Study withdrawals: 12 CG: n = 59 (27 girls and 32 boys) Age (mean ± SD): 9.25 ± 1.61 years BMIz (mean ± SD): 2.68 ± 0.69 BMI (mean ± SD): 25.08 ± 3.57 Study withdrawals: 20 | BMIz Waist circumference | ↓ BMIz in all groups CG: ↓* BMIz, FFH: ↓ BMIz FFH ≈ CG waist circumference | FFH was neither effective nor cost-effective for the treatment of obesity compared to usual care. |
Stark et al. [26], 2018 United States | Randomized clinical trial | LAUNCH: n = 57 (25 girls and 32 boys) Age (mean ± SD): 55.10 ± 12.07 months BMIz (mean ± SD): 2.41 ± 0.53 Height (mean ± SD): 111.02 ± 8.71 cm Weight (mean ± SD): 26.15 ± 6.16 kg Study withdrawals: 14 MI: n = 56 (39 girls and 17 boys) Age (mean ± SD): 55.0 ± 10.67 months BMIz (mean ± SD): 2.41 ± 0.56 Height (mean ± SD): 111.62 ± 8.04 cm Weight (mean ± SD): 25.91 ± 5.02 kg Study withdrawals: 10 CG: n = 54 (32 girls and 22 boys) Age (mean ± SD): 55.30 ± 11.06 months BMIz (mean ± SD): 2.48 ± 0.70 Height (mean ± SD): 110.70 ± 7.92 cm Weight (mean ± SD): 25.97 ± 5.47 kg Study withdrawals: 4 | BMIz | LAUNCH vs. CG ↓* BMIz ↓ BMI in CG for 6 months. | A 6-month intensive (LAUNCH) behavioral skills-based intervention (LAUNCH) was needed to reduce obesity in preschool children. |
Wilfley et al. [25], 2017 United States | Randomized clinical trial | SFM + H: n = 59 (37 girls and 22 boys) Age (mean ± SD): 9.5 ± 1.3 years Study withdrawals: 4 SFM + L: n = 56 (36 girls and 20 boys) Age (mean ± SD): 9.4 ± 1.2 years Study withdrawals: 2 Control: n = 57 (33 girls and 24 boys) Age (mean ± SD): 9.5 ± 1.3 years Study withdrawals: 6 | BMIz % Overweight | SFM + H vs. CG ↓* BMIz SFM + H vs. CG ↓* % Overweight SFM + H vs. CG ↑* Proportion of children who decreased ≥9 units in the % of overweight | The content of the SFM + H specialized intervention improved weight outcomes in children. |
Reference | BMI z-Score Category | Value Range | International Organization/Institution (for BMI Reference) |
---|---|---|---|
Ahmad et al. [2], 2018 | Overweight | N/D | N/D |
With BMI z-score of more than 1 standard deviation | |||
Cohen et al. [28], 2016 | Overweight | 85–97 percentile | World Health Organization |
Obese | >97 percentile | ||
Ek et al. [27], 2019 | With obesity | N/D | International Obesity Task Force (IOTF) |
Robertson et al. [24], 2017 | Overweight | ≥91st percentile BMI | N/D |
Obese | ≥98th percentile BMI | ||
Stark et al. [26], 2018 | Overweight | BMI percentile for age and sex ≥95 | National Center for Health Statistics |
Obese | No more than 100% above the median BMI | ||
Wilfley et al. [25], 2017 | Overweight | ≥85th percentile | N/D |
Obese | BMI ≥ 25 |
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Fernández-Lázaro, D.; Celorrio San Miguel, A.M.; Garrosa, E.; Fernández-Araque, A.M.; Mielgo-Ayuso, J.; Roche, E.; Arribalzaga, S. Evaluation of Family-Based Interventions as a Therapeutic Tool in the Modulation of Childhood Obesity: A Systematic Review. Children 2024, 11, 930. https://doi.org/10.3390/children11080930
Fernández-Lázaro D, Celorrio San Miguel AM, Garrosa E, Fernández-Araque AM, Mielgo-Ayuso J, Roche E, Arribalzaga S. Evaluation of Family-Based Interventions as a Therapeutic Tool in the Modulation of Childhood Obesity: A Systematic Review. Children. 2024; 11(8):930. https://doi.org/10.3390/children11080930
Chicago/Turabian StyleFernández-Lázaro, Diego, Ana M. Celorrio San Miguel, Evelina Garrosa, Ana M. Fernández-Araque, Juan Mielgo-Ayuso, Enrique Roche, and Soledad Arribalzaga. 2024. "Evaluation of Family-Based Interventions as a Therapeutic Tool in the Modulation of Childhood Obesity: A Systematic Review" Children 11, no. 8: 930. https://doi.org/10.3390/children11080930