Pediatric Weight Management

Child Nutrition and Physical Activity and Inactivity

Citation:

Brown T, Summerbell C. Systematic review of school-based interventions that focus on changing dietary intake and physical activity levels to prevent childhood obesity: An update to the obesity guidance produced by the National Institute for Health and Clinical Excellence. Obes Rev. 2009 Jan; 10(1): 110-141. Epub: 2008 Jul 30. Review.

PubMed ID: 18673306
 
Study Design:
Meta-analysis or Systematic Review
Class:
M - Click here for explanation of classification scheme.
Quality Rating:
Neutral NEUTRAL: See Quality Criteria Checklist below.
Research Purpose:
  • To determine the effectiveness of interventions on diet and physical activity (PA) behaviors in school children
  • To identify study characteristics affecting outcome (i.e., gender, age, socioeconomic status, setting, process indicators) .
Inclusion Criteria:
  • School-aged children, five to 18 years old
  • A randomized controlled trial or controlled clinical trial
  • School-based lifestyle interventions vs. usual care or other active interventions
  • At least 12 weeks of duration
  • Reported weight outcome
  • No recruitment of children on the basis of weight (or any other measure of weight).
Exclusion Criteria:

Studies in children with critical illness or eating disorders.

Description of Study Protocol:
  • Sources (databases) searched: MEDLINE and EMBASE
  • Search dates (beginning and end): January 2006 to September 2007
  • Key question(s): What is the effectiveness of interventions on diet and physical activity (PA) behaviors in school children?
  • Types of interventions: A lifestyle intervention (including healthy eating, increase in PA, reduction in sedentary behaviors, behavior therapy, social support and education for diet and activity behaviors)
  • Outcomes investigated: Weight, body mass index (BMI), BMI z-score, percentage of body fat, skin-fold thickness and percentage of overweight
  • Population included: School-aged children, age five to 18 years old.
Data Collection Summary:
  • Population: School-aged children, ages five to 18 years old
  • Intervention(s) or exposure: School-based lifestyle interventions
  • Comparator or control: Usual care or other active interventions
  • Outcomes: Weight
  • Setting: School
  • Method of analysis: Narrative summary.     
Description of Actual Data Sample:
  • Number of studies identified: 1,553
  • Number of studies reviewed: 70
  • Number of studies included: 38 studies (47 papers).
Summary of Results:
  • Quantity of studies: 38 studies
    • Diet studies: Three 
    • PA studies: 15 
    • Diet + PA studies: 20 
  • Quality ofstudies (rating or grading of the conclusion): No study quality assessment
  • Design(s) of studies included for this question: A randomized controlled trial or controlled clinical trial:
    • Question 1: What is the effectiveness of interventions on diet and physical activity (PA) behaviors in school children?
      • Insufficient evidence to assess the effectiveness of dietary interventions or diet vs. physical activity interventions.
      • Dietary interventions: Insufficient evidence to assess the effectiveness
      • Diet vs. PA interventions: Insufficient evidence to assess the effectiveness
      • School-based physical activity interventions may help children maintain a healthy weight but the results are inconsistent and short-term
      • Overall, the study suggests that combined diet and physical activity school-based interventions may help prevent children becoming overweight in the long term
    • Question 2: What are the study characteristics might be associated with outcome (e.g., gender, age, socioeconomic status, setting, process evaluation)?
      • Physical activity interventions may be more successful in younger children and in girls
      • Physical activity interventions, particularly in girls in primary schools, may help to prevent these children from becoming overweight in the short term.
Author Conclusion:
  • Dietary interventions: insufficient evidence to assess the effectiveness
  • Diet vs. PA interventions: insufficient evidence to assess the effectiveness
  • School-based physical activity interventions may help children maintain a healthy weight but the results are inconsistent and short-term.
  • Overall suggest that combined diet and physical activity school-based interventions may help prevent children becoming overweight in the long term.
  • Physical activity interventions may be more successful in younger children and in girls.
  • Physical activity interventions, particularly in girls in primary schools, may help to prevent these children from becoming overweight in the short term. 
Funding Source:
Other: not reported
Reviewer Comments:
  • Studies are heterogeneous; we cannot generalize about what interventions are more effective
  • Some studies had small number of subjects to determine significant differences between the intervention and control groups
  • Pilot studies are included. Studies may have insufficient duration or intensity to show the effectiveness of the program.
  • Some studies rely on authors’ reporting of significant or non-significant effects of the interventions. 
Quality Criteria Checklist: Review Articles
Relevance Questions
  1. Will the answer if true, have a direct bearing on the health of patients? Yes
  2. Is the outcome or topic something that patients/clients/population groups would care about? Yes
  3. Is the problem addressed in the review one that is relevant to dietetics practice? Yes
  4. Will the information, if true, require a change in practice? Yes
 
Validity Questions
  1. Was the question for the review clearly focused and appropriate? Yes
  2. Was the search strategy used to locate relevant studies comprehensive? Were the databases searched and the search termsused described? Yes
  3. Were explicit methods used to select studies to include in the review? Were inclusion/exclusion criteria specified andappropriate? Wereselectionmethods unbiased? Yes
  4. Was there an appraisal of the quality and validity of studies included in the review? Were appraisal methodsspecified,appropriate, andreproducible? No
  5. Were specific treatments/interventions/exposures described? Were treatments similar enough to be combined? Yes
  6. Was the outcome of interest clearly indicated? Were other potential harms and benefits considered? Yes
  7. Were processes for data abstraction, synthesis, and analysis described? Were they applied consistently acrossstudies and groups? Was thereappropriate use of qualitative and/or quantitative synthesis? Was variation in findings among studies analyzed? Were heterogeneity issued considered? If data from studies were aggregated for meta-analysis, was the procedure described? No
  8. Are the results clearly presented in narrative and/or quantitative terms? If summary statistics are used, are levels ofsignificance and/or confidence intervals included? Yes
  9. Are conclusions supported by results with biases and limitations taken into consideration? Are limitations ofthe review identified anddiscussed? Yes
  10. Was bias due to the review's funding or sponsorship unlikely? Yes