Abstract
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.
Original language | English |
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Article number | CD001871 |
Number of pages | 623 |
Journal | Cochrane Database of Systematic Reviews |
Issue number | 7 |
DOIs | |
Publication status | Published - 23 Jul 2019 |
Scopus Subject Areas
- Pharmacology (medical)
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Interventions for preventing obesity in children. / Brown, Tamara; Moore, Theresa Hm; Hooper, Lee et al.
In: Cochrane Database of Systematic Reviews, No. 7, CD001871, 23.07.2019.Research output: Contribution to journal › Article › peer-review
TY - JOUR
T1 - Interventions for preventing obesity in children
AU - Brown, Tamara
AU - Moore, Theresa Hm
AU - Hooper, Lee
AU - Gao, Yang
AU - Zayegh, Amir
AU - Ijaz, Sharea
AU - Elwenspoek, Martha
AU - Foxen, Sophie C.
AU - Magee, Lucia
AU - O’Malley, Claire
AU - Waters, Elizabeth
AU - Summerbell, Carolyn D.
N1 - Funding Information: The majority of RCTs declared non-industry funding in their publications, that is, not-for-profit charitable organisations and government institutes (n = 28; 72%). See Table 5. No RCTs were funded wholly by industry. Five RCTs (13%) (Daniels 2012; De Vries 2015; Paul 2011; Puder 2011; Roth 2015), described mixed funding from both industry and not-for-profit organisations, of which three included sponsorship from baby food manufacturers (Daniels 2012; Paul 2011; Puder 2011). Another two declared that both research and writing of the trial reports had been done independently from the funders: Puder 2011 received industry funding from two organisations that make infant nutrition, Wyeth Nutrition ( https://www.wyethnutrition.com/), and Nestlé ( www.nestlefoundation.org/e/research.html), and Roth 2015 was partially funded by a grant from a health insurance organisation, Barmer Ersatzkasse ( www.barmer.de/en). Both RCTs had industry funding mediated through not-for-profit foundations, a grant from the Wyeth foundation, and an “unrestricted educational grant from Nestlé” (Puder 2011). Three RCTs that received some industry sponsorship did not report if the research and writing were independent of funding. Sponsorship for De Vries 2015 derived from a telecommunications firm, Hutchison-Whampoa ( www.ckh.com.hk), Daniels 2012 from an infant food manufacturer, HJ Heinz ( www.heinzbaby.co.uk/), and the third, Paul 2011, was given infant food for the research by Gerber, a subsidiary of Nestlé ( medical.gerber.com/). Funding Information: The majority of RCTs declared non-industry funding in their publications (69; 81%). See Table 5. One study reported being funded by industry (Damsgaard 2014). This funding came from food sponsors, who provided foods for the study (Danæg A/S, Naturmælk, Lantmännen A/S, Skærtoft Mølle A/S, Kartoffelpart-nerskabet, AkzoNobel Danmark, Gloria Mundi, and Rose Poultry A/S), and a charitable trust from a bank (Nordea Foundation). Sponsorship was independent of the research and writing. Seven RCTs described mixed funding from both industry and not-for-profit organisations, of which two reported that both research and writing of the trial reports had been done independently from the funders. James 2004 had sponsorship from the pharmaceutical industry: Glaxo Smith Klein ( www.gsk.com/en-gb/); Aventis ( www.sanofi.com/en/); and Pfizer ( www.pfizer.com/). Paineau 2008 received funding from CEDUS ( www.sucre-info.com/le-cedus/), the professional organisation for the sugar beet sector in France. Five RCTs did not report if research or writing were independent of funding: Grydeland 2014 (chocolate manufacture); Kain 2014 (food processing company); Muckelbauer 2010 (association of the German water and gas industries); Papadaki 2010 (food provided by numerous sponsors including Coca-Cola, Kel-loggs and Unilever); Rodearmel 2006 (W.K. Kellogs Institute for Food and Nutrition Research). Funding Information: The majority of RCTs declared non-industry funding in their publications (26; 90%). See Table 5. Two RCTs stated they received no funding at all for their research (Shin 2015; Weeks 2012). Two RCTs received funding from both non-industry and industry sources. Bonsergent 2013 received industry funding from The Wyeth foundation (owned by Nestlé), and research and writing were independent of this funding. Patrick 2006 reported that three study authors were co-owners and received income from The Centre for Health Interventions, San Diego, California, which was developing products related to the trial. Funding Information: Funding: study has been made possible by contributions from the Italian Association Amici di Raoul Follereau (AIFO), Commune of Naples and from the 2nd University of Naples Funding Information: NCT01004367 Funding: this work was supported by generous financial support from VLIR-UOS and Nutrition 3rd World and conducted within the cooperation between the Cuenca University (Ecuador) and the Ghent University (Belgium) Mestizo ethnicity - no further details reported Funding Information: Funding: this research was largely funded by a grant from the National Heart Lung and Blood Institute, U01 HL-65160. This work is also a publication of the United States Department of Agriculture (USDA/ARS) Children’s Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, and was funded, in part, by federal funds from the USDA/ARS under Cooperative Agreement No. 58-6250-6001 Funding Information: Theoretical basis: SCT, Self-determination and Persuasion theories Resources for intervention implementation: reported Who delivered the intervention: reported PROGRESS categories assessed at baseline: gender, race/ethnicity; parent: education (the sample had more 10-year-olds, men/boys, white people, and parents with a college degree or higher) PROGRESS categories analysed at outcome: NR Outcomes relating to harms/unintended effects: NR Intervention included strategies to address diversity or disadvantage: NR Economic evaluation: NR Funding: this research was primarily funded by a grant from the National Institute of Diabetes and Digestive and Kidney Diseases (5 U44 DK66724-01). This work is also a publication of the U.S. Department of Agriculture (USDA/ARS) Children’s Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston,Texas, and had been funded in part with federal funds from the USDA/ARS under Cooperative Agreement No.58-6250-6001. Sample size was set by the funding agency. there was 80% power to detect a small-to-moderate overall effect (Cohen’s d = 0.25 Children were required to have BMI percentile between 50 percentile and 95 percentile at baseline Reply from study author re duration of intervention: “The time from baseline to post was the time needed to play both games, which was roughly three months, but varied by participant. We called in a control participant to equal the times between pre and post in both groups.” Graduated incentives were provided for child participation in data collection: USD 25 for baseline assessment; USD 30 for between-game assessments; USD 35 for immediate postgame assessment; and USD 40 for 2-month follow-up Treatment group participants were loaned 24-inch iMac computers with the games and Microsoft Windows XP operating system preinstalled, but had no applications other than the video game interventions. Intervention co-ordinators monitored child use of the games by organising and reviewing email messages each time a child completed a session, answering call-in questions, guiding repair of minor hardware or software malfunctions, and arranging for speedy repair of larger malfunctions Post-game questionnaires with children and interviews with parents revealed that most children (80%-90%) enjoyed playing both Diab and Nano Funding Information: Theoretical basis: SCT and TTM of Change Resources for intervention implementation: reported Who delivered the intervention: reported PROGRESS categories assessed at baseline: child: gender, race/ethnicity (country of origin); parent: race/ethnicity (country of origin, acculturation), education PROGRESS categories analysed at outcome: NR Outcomes relating to harms/unintended effects: NR Intervention included strategies to address diversity or disadvantage: NR Economic evaluation: NR NCT00808431 Funding: supported by a Project Diabetes Implementation grant from the State of Tennessee (GR-09-25517-00) awarded to Dr Barkin and funds awarded to Dr Barkin from the Vanderbilt Clinical and Translational Science Award (National Center for Research Resources/NIH) (1 UL1 RR024975). Dr Gesell was supported by the American Heart Association Clinical Research grant Program (09CRP2230246). None of the funders contributed to the design and conduct of the study; collection, management, analysis, or interpretation of the data; or preparation, review, or approval of the manuscript 42% of participating preschool-aged children were overweight or obese at baseline Both transportation to and from study sessions and on-site child care services (for siblings) were provided free of charge to all study participants. Participants received small incentives after each wave of data collection (e.g. cutting board, kitchen timer, gift card to local supermarket), a total value of USD 60 per parent-child dyad over the study period Funding Information: Theoretical basis: NR Resources: NR Who delivered the intervention: reported PROGRESS categories assessed at baseline: gender, race/ethnicity PROGRESS categories analysed at outcome: NR Outcomes relating to harms/unintended effects: NR Intervention included strategies to address diversity or disadvantage: all participants were considered to have low SES because of their enrolment in Head Start Economic evaluation: NR NCT01937481 Funding: this project is supported by Agriculture and Food Research Initiative Competitive Grant no. 2010-85215-20648 from the USDA National Institute of Food and Funding Information: Agriculture. Additional support for this research was funded by a career development award from the NIH (K23DK087826) awarded to REB Funding Information: Theoretical basis: concepts of goal setting, positive reinforcement, monitoring, and cognitive restructuring Resources for intervention implementation: NR Who delivered the intervention: reported PROGRESS categories assessed at baseline: child: gender; parent: education, occupation, race/ethnicity (country of origin) PROGRESS categories analysed at outcome: NR Outcomes relating to harms/unintended effects: NR Intervention included strategies to address diversity or disadvantage: NR Economic evaluation: NR NCT00959309 Funding: supported in part by a Paediatric Consultants Research Grant, Hospital for Sick Children, Toronto. The Paediatric Outcomes Research Team is supported by a grant from the Hospital for Sick Children Foundation. The funding organisations were not involved in any of the following: design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript The intervention group had a clinically significantly higher zBMI at baseline, Funding Information: Funding: this research was supported by grant R40MC00241 from the Maternal and Child Health Research Program, US Department of Health and Human Services to Maureen Black, Ph.D., and the University of Maryland General Clinical Research Center grant M01 RR16500, General Clinical Research Centers Program, National Center for Research Resources (NCRR), NIH Mentors received approximately 40 h of training, including MI and had weekly supervision during the intervention Funding Information: Theoretical basis: SCT and Sociocultural theory Resources for intervention implementation: NR Who delivered the intervention: reported PROGRESS categories assessed at baseline: child: race/ethnicity; school: SES (low-income) PROGRESS categories analysed at outcome: NR Outcomes relating to harms/unintended effects: NR Intervention included strategies to address diversity or disadvantage: NR Economic evaluation: NR Funding: this trial was funded by a grant from the Chicago Consortium to Lower Obesity in Chicago Children (CLOCC:AU 508485) GIG staff and study personnel collected data on attendance, programme quality, curriculum implementation, and participant engagement from programme girls only Across all sites, on average, girls who participated in the programme throughout the year attended 73.6% of GIG sessions. Ratings of programme quality were high at all programme sites particularly for safe environment (M = 4.78, SD = 0.23), supportive environment (M = 3.84, SD = 0.24), and interaction (M = 3.93, SD = 0.36) domains, which were all above normative score distributions in validity studies. The 4th domain, engagement, was relatively lower (M = 2.64, SD = 0.28), but still at the higher end of the distribution for Youth Programme Quality Assessment Scales. Implementation data suggest that curriculum was implemented very well across the 5 school sites (M = 1.85, SD = 0.12) and participant engagement was high (M = 1.81, SD = 0.16) on average Funding Information: Funding: the study was funded by the Office of Public Health-Maternal and Child Health Department of Louisiana (New Orleans, LA) Training of staff and implementation carried out as part of the intervention Funding Information: NCT00814554 Funding: the PRALIMAP trial was funded by grants from public and private sectors. Special acknowledgements are addressed to ARH Lorraine, Conseil Régional de Lorraine, DRASS de Lorraine, GRSP de Lorraine, Fondation Coeurs et Artères, Fondation Wyeth, Ministère de l’enseignement supérieur et de la recherche, Inca, IRESP, Régime local d’assurance maladie d’Alsace Lorraine and Urcam de Lorraine. All trial steps, design, data collection, analysis, write-ups, and reports are and will be performed independently of any funding or sponsoring agency Staff resources: public health professionals of Nancy University (for screening and care strategy), health education professionals external to the high schools (PRALIMAP monitors), and supported and supervised high school professionals (the teachers) in the implementation of strategies. The teachers conducted the education strategy (no mention of training) The process evaluation showed that, of 11 planned hours of dietary and PA lectures, the 12 “education schools” performed 4.8+/-0.8 hours on average (range 3-6); menu offerings were considerably improved over the 2-year period of intervention in the 12 environment schools, with more fruits and vegetables and fewer sugary drinks and snacks. However, this trend also was noted, to a lesser extent, in the 12 “no-environment schools, ” probably because of the French nutritional policy which followed since 2001. Adapted care management (ie: the screening strategy), comprising 7 group sessions, was implemented in full in 8 high schools, partially implemented in 1, and not implemented at all in 3 Funding Information: Theoretical basis: NR Resources for intervention implementation: reported (downloadable) Who delivered the intervention: reported PROGRESS categories assessed at baseline: child: gender, race/ethnicity PROGRESS categories analysed at outcome: NR Outcomes relating to harms/unintended effects: NR Intervention included strategies to address diversity or disadvantage: NR Economic evaluation: NR NCT00756626. Funding: funded by the US Department of Agriculture, National Institute of Food and Agriculture (2007-04556 to K.B.) All participants low-income. Intervention delivered as part of routine care in an existing service. Culturally tailored -Spanish and English resources Funding Information: Theoretical basis: SCT Resources for intervention implementation: reported Who delivered the intervention: reported PROGRESS categories assessed at baseline: child: gender, race/ethnicity; parent: education PROGRESS categories analysed at outcome: NR Outcomes relating to harms/unintended effects: NR Intervention included strategies to address diversity or disadvantage: NR Economic evaluation: NR (cost reported) Funding: this study was funded by the Baden-Württemberg Stiftung (Stuttgart, Germany) It was implemented during regular class time by the classroom teacher within the existing curriculum (mainly social studies) in order to ensure programme implementation without additional personnel or materials in everyday teaching Costs/resources: teachers took part in 4 training sessions (2.5 h each). Teachers and schools had no direct costs to cover (for materials or for additional teaching time). However, in terms of indirect costs for the schools, the intervention required 29 regular teaching units mainly in social sciences during 1 school year (that corresponds to the weekly working time of teachers) and additionally 10 h of training sessions. From the perspective of the intervention provider costs were limited to personnel costs of the Funding Information: Funding: this work was supported by the UnitedHealth HEROES grant provided by Youth Service America and an internal faculty-mentoring grant, provided by the College of Education, Criminal Justice, and Human Services at the University of Cincinnati Separate paper on process evaluation. Implementation: most lessons recording 100% tasks completed, lessons implemented in both intended order and length. After-school staff members reported that the programme was well received by children. 70.4% children attended each lesson on the initial day of delivery. Sources of contamination identified Funding Information: Funding: supported by National Heart, Lung, and Blood Institute grants U01-HL-50869, -50867, -50905, -50885, and -50907 Funding Information: ISRCTN81847050 Funding: supported by the National Health and Medical Research Council (grant 425801). Additional funds were supplied by the Heart Foundation Victoria and Deakin University. Very young children of first-time mothers The total estimated cost of delivering the programme, based on the costs of the intervention adjusted for the fact that a trial setting sees an artificially small number of families included relative to the workforce employed, was approximately AUD 500 per family Funding Information: Funding: Shanghai Municipal Health Bureau: Award Number 12GWZX0301 Study authors reported that successful completion of intervention activities required administrative measures and expert resources as well as financial support Funding Information: Funding: this publication was made possible by grant number KL2 RR024130 to J. L.C. from the National Center for Research Resources, a component of the NIH and NIH Roadmap for Medical Research, Chinese Community Health Care Association community grants and in part by NIH grant DK060617 to M.B.H Funding Information: Funding: this publication was made possible by grant number KL2 RR024130 to J. L.C. from the National Center for Research Resources, a component of the NIH and NIH Road map for medical research, Hellman research grant, and in part by NIH grant DK060617 to M.B.H No details provided relating to costs of intervention and resources but authors reported it is relatively low cost intervention because it is internet-based Funding Information: Theoretical basis: Social Ecological framework Resources for intervention implementation: reported Who delivered the intervention: reported PROGRESS categories assessed at baseline: child: gender; parent: race/ethnicity, SES (household income) PROGRESS categories analysed at outcome: NR Outcomes relating to harms/unintended effects: NR Intervention included strategies to address diversity or disadvantage: NR Economic evaluation: reported ISRCTN79122411 Funding: the SPACE study is a part of the Center for Intervention Research in Health Promotion and Disease Prevention. The SPACE-study is funded by TrygFonden All intervention schools upgraded their outdoor areas (10 000-20 000 EURO) and established Playspots (EUR 65,000-250,000). They also implemented PA policy, kickstarters, mandatory outdoor recess, and school theme week. The school’s play patrol, school’s traffic patrol, and cyclist education were already implemented if feasible at most schools, and did not directly change apart from being included in the school’s PA policy. The improvement of cycling infrastructure was partly met in 2 schools, but lack of financial support made it impossible to implement in the remaining 5 schools. The organisation of the after-school fitness programme was implemented in 2 local areas, but lack of voluntary instructors made the component impossible in the other 5 areas. Interviews with school leaders after intervention revealed that all schools planned to continue the organisational components of the interventions, but with minor adjustments especially to the mandatory outdoor recess Funding Information: Funding: this work was funded by the Patient Care and Outcomes Research Grant program from the American Heart Association, Dallas, Tex (9970182N) Funding Information: Theoretical basis: Ecological and Developmental Systems Theories and BEM Resources for intervention implementation: reported Who delivered the intervention: reported PROGRESS categories assessed at baseline: child: gender, race/ethnicity PROGRESS categories analysed at outcome: NR Outcomes relating to harms/unintended effects: NR Intervention included strategies to address diversity or disadvantage: targeted low-income school district Economic evaluation: NR Funding: funding for this study was provided by the United States Department of Agriculture (USDA) National Research Initiative (NRI) award #2007-55215-05323 / (2007-55215-18241). Participants: 43% were overweight or obese and 25% were obese with an average zBMI of 0.77 ± 1.06 Healthy ONES provided a process for implementing environment and policy change with existing staff and required substitution rather than addition of activities; relatively low cost Funding Information: Outcome measures • Primary outcome: zBMI scores, BMI percentile, percentage overweight (≥ 85th, 95th percentile) percentage obesity (≥ 95th percentile weight for age) • Secondary outcomes: dietary intake, physical activity, sports participation, TV viewing Process evaluation: reported (implementation) Theoretical basis: SCT, HBM resources for intervention implementation: reported Who delivered the intervention: reported PROGRESS categories assessed at baseline: child: gender, race/ethnicity; parent: race/ ethnicity, education PROGRESS categories analysed at outcome: child, gender Outcomes relating to harms/unintended effects: NR Intervention included strategies to address diversity or disadvantage: culturally tailored, i.e. bilingual and bicultural evaluation assistants Economic evaluation: NR Funding: the Aventuras para Niños study was funded by the National Heart, Lung and Blood Institute (5R01HL073776). Additional support was provided to Dr. Elder and Dr. Ayala by the CDC (5U48DP000036), to Dr. Ayala by the American Cancer Society (RSGPB 113653), to Dr. Arredondo by the American Cancer Society (PFT-04-156-01), and to Dr. Crespo by the National Institute of Diabetes and Digestive and Kidney Diseases (F31DK079345) and the National Heart, Lung and Blood Institute (T32HL079891) Intervention groups differed in length and intensity Funding Information: Theoretical basis: TTM Resources for intervention implementation: reported Who delivered the intervention: reported PROGRESS categories assessed at baseline: child: race/ethnicity PROGRESS categories analysed at outcome: NR Outcomes relating to harms/unintended effects: NR Intervention included strategies to address diversity or disadvantage: NR (area selected is one of the poorest in Brazil) Economic evaluation: NR NCT01046474 Funding: this work was supported by Foundation of Support of Research of the State of Rio de Janeiro - FAPERJ (E261029422008); National Counsel of Technological and Scientific Development - CNPQ (474288/2009-9); Pan American Health and Education Foundation - PAHEF. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. 14% of final sample were participants who entered the study after random allocation; schools selected that were in low violence areas Funding Information: Theoretical basis: Attachment theory, Anticipatory Guidance and a Social Cognitive approach Resources for intervention implementation: reported Who delivered the intervention: reported PROGRESS categories assessed at baseline: parent: race/ethnicity, education, SES PROGRESS categories analysed at outcome: NR Outcomes relating to harms/unintended effects: NR Intervention included strategies to address diversity or disadvantage: NR Economic evaluation: NR ACTRN 12608000056392 Funding: nOURISH was funded from 2008-2010 by the Australian National Health and Medical Research Council (grant 426704). Additional funding was provided by HJ Heinz (postdoctoral fellowship, Dr Mallan), Meat & Livestock Australia, Department of Health South Australia, Food Standards Australia New Zealand, Queensland University of Technology, and National Health and Medical Research Council Career Development Award (390136, Dr Nicholson) Attendance At > 2 sessions for module 1 was N = 229 (65%) and module 2 was N = 130 (45% of those retained at module commencement) Study ongoing and details of results when infant aged 3.5 and 5 years also to be reported A separate paper (Daniels 2012) reports outcomes at 6 months post baseline, i.e. after the first of 2 intervention modules Funding Information: Theoretical basis: Social Learning theory and Exposure theory Resources for intervention implementation: NR Who delivered the intervention: reported PROGRESS categories assessed at baseline: child: gender, race/ethnicity; parent: education PROGRESS categories analysed at outcome: NR Outcomes relating to harms/unintended effects: NR Intervention included strategies to address diversity or disadvantage: NR Economic evaluation: NR Funding: this work was supported by a grant from the Baden-Württemberg Stiftung. F. D.B. is supported by the European Social Fund and by the Ministry of Science, Research and the Arts Baden-Württemberg This paper focuses on the nutritional intervention element but protocol reports that PA is a primary outcome On average, 23.1 (SD 12.1) children participated regularly in the lessons; 16.5 (SD 9. 5) parents present at the parents’-only and parent and children’s sessions. Reports that sustainability measurements not available from all participating preschools Funding Information: Theoretical basis: SEM Resources for intervention implementation: reported Who delivered the intervention: reported PROGRESS categories assessed at baseline: child: gender; parent: education PROGRESS categories analysed at outcome: SES (maternal education) Outcomes relating to harms/unintended effects: NR Intervention included strategies to address diversity or disadvantage: NR Economic evaluation: NR Funding: the study was commissioned, financed and steered by the Ministry of the Flemish Community (Department of Economics, Science and Innovation; Department of Welfare, Public Health and Family) Teachers received EUR 250 from the research project to buy materials or finance environmental changes. Regional Health Boards received EUR 500 for their input in the project All schools implemented the requested classroom hour. Regarding the snack and playground policy, it was clear that the requested adjustments asked for more time investment and at the time of observation, most schools had not yet met the standard Funding Information: Theoretical basis: ecological principles, SCT Resources: NR, but study authors state ‘resources were limited’ Who delivered the intervention: reported PROGRESS categories assessed at baseline: gender PROGRESS categories analysed at outcome: gender, SES Outcomes relating to harms/unintended effects: NR Intervention included strategies to address diversity or disadvantage: selected a bilingual health education curriculum, ’Bienestar’ (well-being), that is culturally targeted to Mexican Americans Economic evaluation: NR Funding: this project was supported by pilot research grants from the Center for Border Health Research through the Paso del Norte Health Foundation and by the NIH Hispanic Health Disparities Research Center (grant P20MD002287-01) Population was predominately Hispanic. Demographic variables such as age, gender, and self-reported ethnicity were collected at baseline. However, many students were apparently not aware of their ethnicity because more than half marked don’t know or other. Consequently, the study authors decided not to include self-reported ethnicity in any of the analyses Intervention exposure predicted lower BMI (P = 0.045), higher aerobic capacity (P = 0. 012), and greater intentions to eat healthily (P = 0.046) for the classroom at follow-up. Intervention effectiveness increased with increasing proportions of intervention participants in a classroom Funding Information: NCT00893529 Funding: supported by grants from the Netherlands Organization for Health Research and Development (120520010), the Netherlands Heart Foundation (2008B096), and the Royal Netherlands Academy of Arts and Sciences (ISK/741/PAH) It is customary for children in Dutch elementary schools to consume a beverage brought from home in class during a morning break around 10 am under supervision of the teacher Developed custom drinks for this study to ensure that the sugar-free and sugar-containing drinks tasted and looked essentially the same At 18 months, 26% of the children had stopped consuming the beverages Funding Information: Theoretical basis: NR Resources for intervention implementation: NR Who delivered the intervention: reported PROGRESS categories assessed at baseline: child: gender; parent: education, SES (income) PROGRESS categories analysed at outcome: gender Outcomes relating to harms/unintended effects: NR Intervention included strategies to address diversity or disadvantage: NR Economic evaluation: NR NCT01127412 Funding: this research was funded by an unrestricted grant from Hutchison Whampoa Ltd. and the University of Groningen GECKO also included a birth cohort study; only birthweight was reported at baseline Funding Information: Funding: this study was supported in part by grant 1-R01-HL65144 from the NIH, National Heart, Lung, and Blood Institute, Bethesda Funding Information: Theoretical basis: SCT Resources for intervention implementation: reported Who delivered the intervention: NR PROGRESS categories assessed at baseline: child: race/ethnicity, gender, SES PROGRESS categories analysed at outcome: NR Outcomes relating to harms/unintended effects: NR Intervention included strategies to address diversity or disadvantage: NR Economic evaluation: NR ACTRN1261000033004 Funding: this research project is funded by an Australian Research Council Discovery Project Grant (DP1092646). This sponsor had no involvement in the design or implementation of this study, in analyses of data, or in the drafting of this paper Process: a total of 148 girls received the intervention (83.1%). Students’ mean (SD) attendance at school sport sessions was 60.6% (26.0%). On average, girls attended 65.0% (25.1%) of the nutrition workshops, 24.6% (28.1%) of the optional lunch-time sessions, and completed 8.8% (25.7%) of the home PA and nutrition challenges Intervention delivery fidelity was found to be 74.0%. All 4 of the parental newsletters were sent to valid addresses for 74.5% of girls in the intervention group. A total of 58 text messages were sent to 91% of girls in the intervention group. Overall, girls were satisfied with the programme (mean (SD), 3.52 (1.24); rating scale, 1 = strongly disagree to 5 = strongly agree). The enhanced school sport sessions (41.7%) and the nutrition workshops (38.7%) were the 2 intervention components enjoyed most by girls Resources: the intervention was focused on promoting lifetime PAs, reducing sedentary behaviours, and encouraging low-cost healthy eating, and it was delivered during 4 school terms (i.e. 12 months) at no additional financial cost to the school or students. All intervention schools were provided with a standard equipment pack (value = USD 1300), which consisted of a range of equipment (e.g. elastic tubing RT devices, fitness balls, and yoga and Pilates resources) designed to support the promotion of lifetime PAs Funding Information: Outcomes relating to harms/unintended effects: NR Intervention included strategies to address diversity or disadvantage: NR Economic evaluation: NR Funding: this work was supported by grant NIH NIDDK R01 061489 from the National Institute of Diabetes and Digestive and Kidney Disease, Bethesda, MD. The authors would like to thank the International Life Sciences Institute for Health Promotion for educational materials Funding Information: Funding: this study was supported by grants R01 DK63554 and K01 DK62237 from the National Institute of Diabetes and Digestive Kidney Diseases, the Charles H. Hood Foundation, and grant M01 RR02172 awarded by the NIH to support the General Clinical Research Center at Children’s Hospital Boston Estimated that the cost involved in delivering their intervention was approximately 35 USD per student over 25 weeks Funding Information: Outcomes relating to harms/unintended effects: NR Intervention included strategies to address diversity or disadvantage: NR Economic evaluation: NR Funding: this study was supported by the NIH grant NIDDK R01DK072994. NCC was supported by grants T32HL079891 and F31KD079345. KC was supported by the Medical Research Council Epidemiology Unit (Unit Programme number U106179474) and the Centre for Diet and Activity Research (CEDAR), a UKCRC Public Health Research: Centre of Excellence. Funding from the British Heart Foundation, Economic and Social Research Council, Medical Research Council, the National Institute for Health Research, and the Wellcome Trust, under the auspices of the UK Clinical Research Collaboration, is gratefully acknowledged Context: recreation centres were affected by a municipal, then a statewide economic downturn resulting in increased responsibilities of recreational staff, and decreased staffing and reduced hours and programmes due to downsizing of municipal government. The overall dose was limited Funding Information: Funding: this study was funded in part by NIH Grant HD34284 (to L.H.E.) Funding Information: Theoretical basis: TPB, Precaution Adoption Process Model, Implementation intentions Resources for intervention implementation: reported Who delivered the intervention: reported PROGRESS categories assessed at baseline: child: gender, race/ethnicity, education (preuniversity vs vocational schools) PROGRESS categories analysed at outcome: NR Outcomes relating to harms/unintended effects: NR Intervention included strategies to address diversity or disadvantage: NR Economic evaluation: NR ISRCTN15743786 Funding: this study was funded by grant 62200020 from ZonMw, the Netherlands Organization for Health Care Research and Development More schools in the intervention group were vocational schools Process evaluation (see Ezendam 2012): 81% was exposed to all intervention modules and 73% reported to have put the advice into practise. Half and one-3rd of the students appreciated the tailored advice positively and neutrally, respectively Students attending vocational training appreciated FATaintPHAT better than students attending university preparation education. No associations were found between behavioural outcomes with appreciation and use Funding Information: Theoretical basis: NR Resources for intervention implementation: NR Who delivered the intervention: NR PROGRESS categories assessed at baseline: gender, SES PROGRESS categories analysed at outcome: NR Outcomes relating to harms/unintended effects: NR Funding: CNPq (Conselho Nacional de Desenvolvimento Científico eTecnológico) ---process n. 475959/2010-8 Funding Information: Theoretical basis: reported (SCT as the primary framework, and concepts from Self-determination theory) Resources for intervention implementation (e.g. funding needed or staff hours required) : reported Who delivered the intervention: reported PROGRESS categories assessed at baseline: reported (gender, race, education) PROGRESS categories analysed at outcome: NR Outcomes relating to harms/unintended effects: reported Intervention included strategies to address diversity or disadvantage: reported Economic evaluation: NR Funding: supported by a grant from the National Heart, Lung, and Blood Institute (Grant HL58871) Intervention design reported in secondary reference for Fitzgibbon 2005 (Fitzgibbon et al Preventive Medicine 2002;34:289-97). This study is linked with results reported for another 12 preschools servicing Latino communities in Fitzgibbon 2006. Funding Information: Theoretical basis: SCT Resources for intervention implementation (e.g. funding needed or staff hours required) : reported Who delivered the intervention: reported PROGRESS categories assessed at baseline: reported (gender, race, education) PROGRESS categories analysed at outcome: NR Outcomes relating to harms/unintended effects: reported Intervention included strategies to address diversity or disadvantage: reported Economic evaluation: NR Funding: supported by a grant from the National Heart, Lung, and Blood Institute (Grant HL58871) Intervention design reported in secondary reference for Fitzgibbon 2005 (Fitzgibbon et al Preventive Medicine 2002;34:289-97). This study is linked with results reported for another 12 preschools primarily servicing African-American children in Fitzgibbon 2005. Funding Information: Outcome measures • Primary outcome: BMI and zBMI • Secondary outcomes: dietary intake, PA, screen time Process evaluation: NR Theoretical basis: SCT, Self-Determination theory Resources for intervention implementation: reported Who delivered the intervention: reported PROGRESS categories assessed at baseline: gender, race/ethnicity; parent: gender, education, SES (income), occupation, social status (marital) PROGRESS categories analysed at outcome: NR Outcomes relating to harms/unintended effects: NR Intervention included strategies to address diversity or disadvantage: no, but study targeted at low-income, black minority children. Also cultural modifications such as addressing environmental considerations (social support, unsafe neighbourhoods, economic restrictions, conflicting responsibilities) Economic evaluation: NR Funding: the Hip-hop to health obesity prevention effectiveness trial was supported by the National Heart, Lung and Blood Institute (HL081645) Teacher training: for intervention and control groups the initial training sessions were 3 h. Following the 1st formal session, the intervention co-ordinator conducted 3 in-school training sessions for the intervention teachers and 1 in-school session for the control Funding Information: Funding: this study was supported by grants from the CDC (R06/CCR321534-01) and the US Department of Agriculture/Food and Nutrition Service through the Pennsylvania Nutrition Education Program as part of Food Stamp Nutrition Education Funding Information: Theoretical basis: NR Resources for intervention implementation: reported Who delivered the intervention: reported PROGRESS categories assessed at baseline: household: gender, race/ethnicity, social status (marital), SES (income), education PROGRESS categories analysed at outcome: NR Outcomes relating to harms/unintended effects: NR Intervention included strategies to address diversity or disadvantage: NR Economic evaluation: NR Funding: this study was supported by grant #1U54CA116849 and #R21CA137240 from the NIH/National Cancer Institute Only cost mentioned was for the USD 25 gift card for local grocery store for those households who attended the group sessions. Various resources (i.e. scales, goal sheets, telephone call time/cost, incentives such as sports balls, had weights gift cards etc) Intervention participation. Over 73% of the 45 intervention households attended at least 4/6 face-to-face group sessions and completed ≥ 50% of the home activities. About 20% of households had perfect attendance and home activity completion rates. Within-household attendance, or the average percent of eligible household members who attended each session, was 59%. Two-3rds (68%) of households had ≥ 50% household members attending sessions, and one-3rd of households had ≥ 75% household members attending sessions. TV-limiting devices were placed in 93% of intervention households. The average duration the devices were kept attached to the TVs was 10.6 months. Monitors were programmed to a weekly mean of 29.8 h (range 11-70), a 44% reduction from baseline (52.8 h weekly). 28/42 households kept the TV monitors on the TV after the end of the study. Session evaluations were administered during the last face-to-face group session. 83% of the intervention participants rated overall sessions as satisfactory or very satisfactory (on a 5-point scale) Funding Information: Theoretical basis: SCT Resources for intervention implementation: reported Who delivered the intervention: reported PROGRESS categories assessed at baseline: child: gender, race/ethnicity; parent: gender, race/ethnicity, education, occupation PROGRESS categories analysed at outcome: NR Outcomes relating to harms/unintended effects: NR Intervention included strategies to address diversity or disadvantage: NR Economic evaluation: NR Funding: this study was funded by the NIH (NIDDK R21 DK72997). The funders played no role in the design, implementation or write-up of the study Funding Information: Theoretical basis: SEM Resources for intervention implementation (e.g. funding needed or staff hours required) : NR Who delivered the intervention: reported PROGRESS categories assessed at baseline: reported (race, gender) PROGRESS categories analysed at outcome: reported (gender) Outcomes relating to harms/unintended effects: NR Intervention included strategies to address diversity or disadvantage: NR Economic evaluation: NR NCT00685555 Funding: in Lakeville, Minnesota, Switch was sponsored by Medica Foundation, the Healthy and Active America Foundation, and Fairview Health Services. In Cedar Rapids, Iowa Switch was sponsored by Cargill, Inc. and the Healthy and Active America Foundation. The Switch program is a programme of the National Institute on Media and the Family, a non-profit organisation. Several of the study authors were employed by the Institute to create the programme or to conduct the research , or consulted with the Institute on the design or analysis Funding Information: Funding: supported in part by grant HD-30780 from the National Institutes of Child Health and Human Developement, Bethesda, Md and Prevention Research Centre Grant U48/CCU115807 from the CDC, Atlanta, Ga Funding Information: Theoretical basis: SEM Resources for intervention implementation: NR Who delivered the intervention: reported PROGRESS categories assessed at baseline: child: gender; parent: education PROGRESS categories analysed at outcome: child: gender; parent: education Outcomes relating to harms/unintended effects: NR Intervention included strategies to address diversity or disadvantage: NR Economic evaluation: NR Funding: the study Health in adolescents (HEIA) was funded by the Norwegian Research Council (grant number 175323/V50) with supplementary funds from the Throne Holst Nutrition Research Foundation, University of Oslo and also from the Norwegian School of Sport Sciences Student booklets for classroom activities, posters for the classroom, sports equipment given to each class, monthly fact sheets and brochures to parents, and training material for teachers As only 2% of the variance in BMI and waist circumference was explained by group, they did not adjust for clustering in the analysis. Interaction effects by gender, pubertal status and parental educational level were tested in separate analyses as a 2nd step using 2-way ANCOVA/logistic regressions with the interaction terms as covariates Funding Information: Who delivered the intervention: reported PROGRESS categories assessed at baseline: reported (race, gender, education, SES) PROGRESS categories analysed at outcome: NR Outcomes relating to harms/unintended effects: NR Intervention included strategies to address diversity or disadvantage: reported Economic evaluation: NR Funding: this project was funded by the NIH (RO1DK93361) Data extracted from 4 publications (see secondary references for Gutin 2008): Yin et al. Eval Health Prof 2005;28:67 (intervention rationale, design, process and implementation factors) Yin et al. Obes Res 2005;13:2153 (1 year outcomes) Yin et al. Int J Obes 2005;29:S40 (1 year outcomes: post-hoc analysis of dose response relationship between outcomes and level of programme attendance) Gutin et al. Int J Ped Obes 2008 (3 year outcomes) Funding Information: Funding: this research was funded by an Eastern Mediterranean Regional Office Special Grant for Research in Priority Areas of Public Health (EMRO/WHO) Failure to succeed in modifying the school’s food environment due to lobbying and lack of support of some of the school authorities. Lebanon is a politically unstable context, with security threats and social unrests Funding Information: Funding: this study was supported by the Policy Research Centre Sport, PA and Health funded by the Flemish Government Funding Information: Theoretical basis: NR Resources for intervention implementation: reported Who delivered the intervention: reported PROGRESS categories assessed at baseline: child: gender, race/ethnicity; parent: education, SES (household income), marital status PROGRESS categories analysed at outcome: NR Outcomes relating to harms/unintended effects: NR Intervention included strategies to address diversity or disadvantage: targeted low-income, and racial/ethnic minority families Economic evaluation: NR NCT01565161 Funding: this work was supported by the CDC and the National Center for Chronic Disease Prevention and Health Promotion (Prevention Research Centers grant 1U48DP00194) Role of the Sponsors: the sponsors had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication Participants received USD 40 for completing the baseline visit and USD 50 for completing the 6-month follow-up visit Among the 62 families randomised to intervention, 48 (77%) completed all 4 home visits. Fewer families completed the phone calls; 23 (37%) completed all 4 phone calls Parents’ satisfaction was assessed using a survey to rate how satisfied they were with the programme components and how helpful each component was in guiding their approach to their child’s behaviours. Among the 55 intervention families who completed the process survey at follow-up, 89% reported being “satisfied” or “very satisfied” with the programme as a whole; 98% were “satisfied” or “very satisfied” with the counselling received during home visits; and 98% were “satisfied” or “very satisfied” with the counselling received during coaching calls. Nearly all parents (98%) reported they would recommend the programme to friends and family Funding Information: Funding: this work was supported by NIH Grant R03 DK56290 Funding Information: Hispanic children of lower SES were oversampled Economic evaluation: NR NCT00458029 Funding: supported by grants (U01-DK61230, U01-DK61249, U01-DK61231, and U01-DK61223) from the National Institute of Diabetes and Digestive and Kidney Diseases of the NIH to the Studies to Treat or Prevent Pediatric Type 2 Diabetes (STOPP-T2D) collaborative group, with additional support from the American Diabetes Association The intervention was facilitated by staff and funds provided by the study. Such an efficacy study cannot assess the feasibility, effectiveness, or sustainability of an intervention programme outside a study setting. Overall, the observed fidelity of implementing nutrition strategies improved from baseline to the end of the study. By the last semester, all but 2 nutrition process evaluation goals were met. The most challenging goal to implement was serving high fibre foods, including grain-based foods and legumes. The easiest goals to implement were lowering the fat content of foods offered and offering healthier beverages. The most challenging barriers experienced by research dietitians and food service staff were costs, availability of foods and student acceptance. Forming strong relationships between the research dietitians and food service staff was identified as a key strategy to meet HEALTHY nutrition goals. Barriers included teacher frustration that intervention activities detracted from tested subjects, student resistance and misbehaviour, classroom-management problems, communication-equipment problems, lack of teacher/staff engagement, high cost and limited availability of nutritious products, inadequate facility space, and large class sizes. Facilitators included teacher/staff engagement, effective classroom management, student engagement, schools with direct control over food service, support from school leaders, and adequate facilities and equipment. Schools received annual compensation for participation that could be used at the discretion of the school administration for programme enhancement. Schools assigned to intervention received USD 2000 in year 1, USD 3000 in year 2 and USD 4000 in year 3, and those assigned to control USD 2000 in year 1, USD 4000 in year 2 and USD 6000 in year 3. The control school amounts became higher because the intervention schools received additional compensation in terms of PE equipment and food service costs. The amounts escalated each year as a retention strategy Funding Information: Funding: this work was supported by the International Life Sciences Institute (ILSI) Research Foundation (Washington, D.C., USA, and ILSI Argentina, Buenos Aires, Argentina) Parents’ and/or caregivers’ attendance was 53% and was not considered exclusion criteria Funding Information: Theoretical basis: NR Resources for intervention implementation (e.g. funding needed or staff hours required) : NR Who delivered the intervention: reported PROGRESS categories assessed at baseline: reported (gender) PROGRESS categories analysed at outcome: reported (gender) Outcomes relating to harms/unintended effects: NR Intervention included strategies to address diversity or disadvantage: NR Economic evaluation: NR Funding: this project was funded from unrestricted educational grants from Glaxo-SmithKline, Aventis, and Pfizer and from internal resources within Bournemouth Diabetes and Endocrine Centre. The external funding bodies had no input into protocol development, data collection, or analysis or interpretation. 2 of the study authors had one child each in one of the schools, NR whether intervention or control Funding Information: Theoretical basis: NR Resources for intervention implementation: reported Who delivered the intervention: reported PROGRESS categories assessed at baseline: gender PROGRESS categories analysed at outcome: gender Outcomes relating to harms/unintended effects: NR Intervention included strategies to address diversity or disadvantage: NR Economic evaluation: NR Funding: this study was supported by the Chilean Ministry of Education, Chile De-portes (Government Sports Promotion Agency) and an unrestricted grant from Corpora Tresmontes This multicomponent intervention included a set of activities related to healthy eating and PA as part of a wider programme. It is important to point out that specifically these activities (and not others) were implemented because school principals and teachers only accepted the implementation and evaluation of the ones we report here. The only curricular initiative consisted in extending PE class time, while the others included training classroom teachers to deliver contents on healthy eating and PE teachers to improve the quality of their classes. % class time in MVPA declined (24.5-16.2) while remaining unchanged (24.8-23.7%) in classes conducted by untrained and trained teachers, respectively We were not able to implement two activities that were programmed: greater parental involvement and the transformation of the school kiosk into one that offers 80% of healthy foods Funding Information: Theoretical basis: NR Resources for intervention implementation: reported Who delivered the intervention: reported PROGRESS categories assessed at baseline: gender, race/ethnicity, SES PROGRESS categories analysed at outcome: gender Outcomes relating to harms/unintended effects: NR Intervention included strategies to address diversity or disadvantage: NR Economic evaluation: NR NCT01334359 Funding: all phases of this study were supported by NIH grant HD055352. Funded by the NIH A USD 100 incentive was provided at pretest and follow-up. No monetary incentive was provided for participation in the after-school intervention, which was provided at no cost Actual setting is unclear, presume schools/community setting, participants visited the University laboratory for measurement Fidelity: attendance for the 150-day programme ranged from 37%-99%, with 85% of the participants attending > 70% of the intervention sessions Funding Information: Funding: received from the Department of Health via the South West Public Health Group, South Gloucestershire Council, and DAL was funded by a Department of Health Career Scientist Award, which also funded data entry Funding Information: PROGRESS categories analysed at outcome: NR Outcomes relating to harms/unintended effects: NR Intervention included strategies to address diversity or disadvantage: NR Economic evaluation: NR ISRCTN50133740 Funding: the AFLY5 RCT is funded by the UK National Institute for Health Research (NIHR) Public Health Research Programme (09/3005/04), which also paid the salary of SW. DAL and LDH work in a unit that receives funds from the UK Medical Research Council (MRC) (MC UU 12013/5). RRK and RC work in Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement (DECIPHer) , which receives funding from the British Heart Foundation, Cancer Research UK, the Economic and Social Research Council (RES-590-28-0005), the MRC, the Welsh Assembly Government, and the Wellcome Trust WT087640MA), under the auspices of the UK Clinical Research Collaboration. LDH is supported by a UK MRC population health scientist fellowship (G1002375). None of the funders had involvement in the Trial Steering Committee, data analysis, data interpretation, data collection, or writing of the paper The process evaluation in the pilot study found that the teachers thought the intervention should be extended to include parents if it was to be maximally effective Training and all materials provided. schools were financially compensated for the cost of replacement teachers while their staff attended training Funding Information: Theoretical basis: NR Resources for intervention implementation: NR Who delivered the intervention: NR PROGRESS categories assessed at baseline: NR PROGRESS categories analysed at outcome: NR Outcomes relating to harms/unintended effects: NR Intervention included strategies to address diversity or disadvantage: targeted African-American girls Economic evaluation: NR NCT00000615 Funding: research was supported by co-operative agreements HL62662 and HL62663 from the National Heart, Lung, and Blood Institute, NIH Included children with BMI ≥ 25th age-sex specific percentile or have at least 1 parent with BMI ≥ 25 kg/m2. Girls were excluded if they had BMI > 35 kg/m2 Of the 10% randomly videotaped sessions, the Project Director determined whether the objectives were consistently implemented. The range of sessions judged acceptable was 92%-100% (reflects ratings based on 1 = strongly agree or 2 = agree). Session attendance over the 2 years averaged 27.8 (SD = 8.05) for the obesity prevention intervention and 27.9 (SD = 8.10) for the alternative intervention, including make-up sessions, which comprised about 50% of all attendance (P = 0.94). The pilot for this study is Beech 2003 Funding Information: Theoretical basis: SEM Resources for intervention implementation: reported Who delivered the intervention: reported PROGRESS categories assessed at baseline: child: gender; parent: race/ethnicity, education PROGRESS categories analysed at outcome: NR Outcomes relating to harms/unintended effects: NR Intervention included strategies to address diversity or disadvantage: NR Economic evaluation: NR ISRCTN15360785 Funding: this study was funded by the Swiss Federal Office of Sports (grant number SWI05-013), the Swiss National Science Foundation (grant number PMPDB-114401) , and the Diabetes Foundation of the Region of Basel. The funding sources had no role in the design and conduct of the study or in the collection, management, analysis, and interpretation of the data All assessors were trained in a pilot study 2 months before the main study The level of adherence to the intervention outside school (PA homework) was insufficient, which is a limitation of this study Funding Information: Theoretical basis: ASE, TTM Resources for intervention implementation: reported Who delivered the intervention: reported PROGRESS categories assessed at baseline: child: gender; parent: education, SES (income) PROGRESS categories analysed at outcome: NR Outcomes relating to harms/unintended effects: NR Intervention included strategies to address diversity or disadvantage: NR Economic evaluation: NR Baseline characteristics presented for both experimental groups lumped together Funding: this study was funded by the Spanish Ministry of Health. The financial backer had no role in the study design or in the collection, analysis and interpretation of data. Both the writing of the manuscript and the decision to submit it for publication belong to the study authors, who acted independently of the financial backer. All contributors had access to data Funding Information: Funding: this study was supported by grants from French National Plan for Nutrition and health (PNNS), the Comité Régional Exécutif des Actions de Santé d’Auvergne (CREAS),the Caisse Régionale d’Assurance Maladie d’Auvergne (CRAMA), the Appert Institutes, the town of Clermont-Ferrand and schools’ governing bodies of Clermont-Ferrand Funding Information: Theoretical basis: NR Resources for intervention implementation: reported Who delivered the intervention: NR PROGRESS categories assessed at baseline: gender, SES PROGRESS categories analysed at outcome: gender, SES Outcomes relating to harms/unintended effects: NR Intervention included strategies to address diversity or disadvantage: NR; intervention targeted children receiving school breakfasts Economic evaluation: NR ChiCTR-TRC-00000053 Funding: this research was supported by Nutricia Research Foundation. This is the pilot to Meng 2013 Funding Information: Theoretical basis: Investigation, Vision, Action and Change (IVAC) Methodology Resources for intervention implementation: reported Who delivered the intervention: reported PROGRESS categories assessed at baseline: gender, race/ethnicity PROGRESS categories analysed at outcome: gender, parental education and race/ethnicity Outcomes relating to harms/unintended effects: NR Intervention included strategies to address diversity or disadvantage: NR Economic evaluation: reported (Mora 2015 - direct medical costs) NCT01156805 Funding: study was supported by the Department of Education and Health of the Catalonian Government and the principals of all the schools concerned. Full costs of implementing the AVall project are reported in secondary reference for Llargues 2012, Mora et al 2015 - average cost per treated child was EUR 245.8; an annual cost of 41s per treated child 4 years after the intervention, the average BMI was reduced by 1.13 kg/m2 and implies 1.6 kg for treated children with average height. Thus, we compute the ratio of net intervention costs and net intervention effects: EUR 41/1.13 kg/m2 or EUR 25.6/kg Funding Information: Intervention included strategies to address diversity or disadvantage: NR, but teachers selected low-active boys and disadvantaged schools targeted Economic evaluation: NR ACTRN12610000330044 Funding: this study is funded by grant DP1092646 from the Australian Research Council Intervention delivered over 2 school terms at no cost to the school or students (in Australian secondary schools, extra-curricular/co-curricular school sport programmes are often delivered off campus and may involve weekly fees). RT is rarely offered in Australian schools. On average, participants in the intervention group attended 7/10 school sport sessions, 6/8 lunch-time sessions, 4/6 physical activity leadership sessions and 29/50 participants submitted their completed PA and nutrition handbooks. Approximately 50% (23 participants) of the intervention group satisfied the requirements for PALs accreditation. Overall, participants were satisfied with the programme (4.0 ± 0.9) Funding Information: Funding: non-industry/unclear “This study was supported in part by grant number FOMIX GTO-2006-C01-31929.” Funding Information: Funding: the study was primarily funded by the Icelandic Centre for Research (RANNIS) , but also supported by the city of Reykjavik, the Ministry of Education, Science and Culture and BRIM Seafood At baseline the intervention school children had on average 0.43 lower zBMIs than the children in the control schools (95% CI−0.94 to 0.08), adjusted for school clustering Gifts were given to all children in the intervention and control schools in the form of backpacks in the fall of 2007 and athletic T-shirts at the end of the intervention The goal of 60 min of PA/day was not achieved at the end of the study; high teacher turnover possibly affected decrease in PA When the study ended, Iceland was in a state of financial crisis Funding Information: Funding: the study was supported by grants from Stockholm County Council, Swedish Council for working life and social research, Swedish Research Council, Freemason’s in Stockholm Foundation for Children’s Welfare and Signhild Engkvist Foundation Funding Information: Theoretical basis: SEM Resources for intervention implementation: reported Who delivered the intervention: reported PROGRESS categories assessed at baseline: gender, race/ethnicity (born abroad); parent: education, occupation PROGRESS categories analysed at outcome: gender (parental employment status also used as potential confounder) Outcomes relating to harms/unintended effects: reported Intervention included strategies to address diversity or disadvantage: NR Economic evaluation: reported NCT01277224 Funding: this study was funded by the Ministry of Education and Science-Junta de Comunidades de Castilla-La Mancha (PII1I09-0259-9898 and POII10-0208-5325), and Ministry of Health (FIS PI081297). Additional funding was obtained from the Research Network on Preventative Activities and Health Promotion (Ref. - RD06/0018/ 0038) The cost of our intervention was EUR 28/month/child (wholly subsidised by research grant) Funding Information: Theoretical basis: TTM of Behaviour Change Resources for intervention implementation: reported Who delivered the intervention: reported PROGRESS categories assessed at baseline: gender, race/ethnicity PROGRESS categories analysed at outcome: NR Outcomes relating to harms/unintended effects: NR Intervention included strategies to address diversity or disadvantage: NR Economic evaluation: NR Funding: funding for this research was provided by the National Heart, Lung, and Blood Institute (Grant # R43 HL074482) Most treatment participants (90.2%) received at least 3 intervention sessions. Due to a programming error discovered in the 1st week of the trial, some treatment group participants (21.5%) received an extra dose of the intervention. Overall, the average number of intervention sessions was 3.09 Funding Information: NCT01704768 Funding: this study was funded by the NIH/ National Institute of Nursing Research 1R01NR012171 The study team observed incidents of decreased fidelity to the intervention that occurred at least once, in approximately half of the classrooms Funding Information: PROGRESS categories assessed at baseline: child, gender; parent: income PROGRESS categories analysed at outcome: NR Outcomes relating to harms/unintended effects: NR Intervention included strategies to address diversity or disadvantage: NR Economic evaluation: reported, cost-effectiveness analysis ChiCTR-PRC-09000402 Funding: this project has been funded by China Ministry of Science & Technology as “Key Projects in the National Science & Technology Pillar Program during the Eleventh Five-Year Plan Period”, grant number 2008BAI58B05. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript Inclusion criteria: the schools having pupils with an overweight/obesity rate in excess of 10% There are 5 different groups including 2 control groups: • Nutrition intervention (Beijing) • PA intervention (Beijing) • Control (Beijing) • Combined nutrition and PA intervention (other 5 cities) • Control (other 5 cities) The cost-effectiveness ratio was USD 120.3 for BMI and USD 249.3 for zBMI in combined intervention, respectively Pilot study is also included in the review: Li 2010a Funding Information: Funding: the raw material for health promotion activities covering the thematic areas of ‘Nutrition-dietary habits’ and ‘PA and health’ was funded by the Ministry of Education and the National Foundation for the Youth Funding Information: Who delivered the intervention: Reported PROGRESS categories assessed at baseline: Reported (Gender, SES) PROGRESS categories analysed at outcome: Reported (Gender) Outcomes relating to harms/unintended effects: Not Reported Intervention included strategies to address diversity or disadvantage: Not Reported Economic evaluation: Not Reported Funding: the project was financially supported by the Research Fund from the Songkhlanagarind Hospital Foundation. Trial supported by a grant from the National Research Council of Thailand Funding Information: Theoretical basis: SCT Resources for intervention implementation: reported Who delivered the intervention: reported PROGRESS categories assessed at baseline: child: gender; father: SES PROGRESS categories analysed at outcome: NR Outcomes relating to harms/unintended effects: NR Intervention included strategies to address diversity or disadvantage: NR Economic evaluation: NR Funding: this study was funded by the Hunter Medical Research Institute and the Gastronomic Lunch. Children in the control group were more likely to be overweight/ obese Funding Information: Theoretical basis: TPB Resources for intervention implementation: reported Who delivered the intervention: reported PROGRESS categories assessed at baseline: gender PROGRESS categories analysed at outcome: NR Outcomes relating to harms/unintended effects: reported Intervention included strategies to address diversity or disadvantage: NR, intervention only included deprived schools Economic evaluation: reported: costs NCT00554294 Funding: this study was supported by grant no. 05HS026 of the German Federal Ministry of Food, Agriculture, and Consumer Protection. Intervention material (water fountains, bottles, print of the lesson booklet) was provided by the Association of the German Gas and Water Industries The initial costs per water fountain were EUR 2500 and the long-term costs per enrolled child were EUR 13/year. The educational intervention was presented by the teachers; therefore, no additive costs emerged Funding Information: Theoretical basis: SEM Resources for intervention implementation: reported Who delivered the intervention: reported PROGRESS categories assessed at baseline: gender, race/ethnicity PROGRESS categories analysed at outcome: NR Outcomes relating to harms/unintended effects: NR Intervention included strategies to address diversity or disadvantage: intervention targeted low-income minority centres, cultural/ethnic modifications, nutritionist ensured that the modifications made to the centres’ daily menus were of equal cost as prior food purchases; designed to address health disparities through an innovative community-based model Economic evaluation: reported - some costs Funding: this research was funded by the Miami-Dade County Children’s Trust (grant number 764-287). Also assesses relationship between BMI and parent/home intervention activities. All centre menu changes were ‘revenue neutral’ Funding Information: Funding: the study was supported by a grant from The Rosalinde and Arthur Gilbert Foundation, and the Israel Heart Fund Funding Information: Funding: this study was supported by Grant AHA NATL/ 9970064N from the American Heart Association (D. Neumark-Sztainer, principal investigator) Funding Information: NCT00250497 Funding: supported by Grant R01 DK063107 (D. Neumark-Sztainer, principal investigator) from the National Institute of Diabetes and Digestive and Kidney Diseases, NIH. Research was supported in part by grant M01-RR00400 from the National Center for Research Resources, the NIH The pilot study Neumark-Sztainer 2003 is also included in this Cochrane Review No girls were excluded due to eating disorder behaviours Over 75% of the girls were racial/ethnic minorities and 46% were overweight or obese At follow-up, the percentage of intervention girls engaging in unhealthy weight control behaviours decreased by 13.7% (P = 0.021) as compared to control girls. Additionally, intervention girls showed significant improvements in body satisfaction (P = 0.045), perceived athletic competence (P = 0.044), and self-worth (P = 0.031) as compared to control girls A secondary reference to Neumark-Sztainer 2010, Friend et al 2014 (Sch Health. 2014;84: 326-333) evaluates sustainability of the programme in 10 of the schools Results: all schools continued all-girls PE classes using New moves components following the study period. Fewer schools continued the nutrition and social support classroom modules and individual coaching sessions while no schools continued lunch get-togethers. Programme components were sustained in both New moves intervention schools and control schools Conclusions: programmes are most likely to be sustained if they (1) fit into the current school structure, (2) receive buy-in by teachers, and (3) require minimal additional funds or staff time. Providing control schools with minimal training and intervention resources was sufficient to continue programme components if staff perceived the programme was important for students’ health and compatible within the school’s existing infrastructure Funding Information: Theoretical basis: ‘behavioural weight control principles’ Resources for intervention implementation: reported Who delivered the intervention: reported PROGRESS categories assessed at baseline: gender, race/ethnicity, SES (neighbourhood economic disadvantage) PROGRESS categories analysed at outcome: NR Outcomes relating to harms/unintended effects: NR Intervention included strategies to address diversity or disadvantage: NR, but intervention targeted disadvantaged neighbourhoods, and racial and ethnic minority girls Economic evaluation: NR Funding: Dr. Nollen was supported by an award that was co-funded by the Office of Research on Women’s Health (ORWH), the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institute of Allergy and Infectious Diseases (NIAID), and National Institutes of Mental Health (NIMH) (K12 HD052027) and the National Heart Lung and Blood Institute at the NIH (K23 HL090496) The average rating of programme enjoyment was 4.5 (SD 0.9). Favorite parts of the programme were obtaining songs (68.2%) and setting goals (36.4%). The least favourite part of the programme was the reminder prompts (31.8%). Girls used the programme on 63% of days, responded to 42% of prompts, and earned an average of 23.9 songs. Study reports that weight loss was not addressed Funding Information: Theoretical basis: SCT Resources for intervention implementation: reported Who delivered the intervention: reported PROGRESS categories assessed at baseline: child: gender; parent: education; race/ethnicity PROGRESS categories analysed at outcome: NR (for anthropometric) Outcomes relating to harms/unintended effects: reported (change prevalence of underweight) Intervention included strategies to address diversity or disadvantage: NR Economic evaluation: NR ISRCTN32750699 Funding: ES and LSE received funding for this study from the Public Health Fund, Stockholm County Council. GN received funding from the Signhild Engkvist Foundation, the Martin Rind Foundation and the Lars Hierta Memorial Foundation Funding Information: Theoretical basis: SCT Resources for intervention implementation: reported Who delivered the intervention: reported PROGRESS categories assessed at baseline: gender; parent: race/ethnicity, SES (household income), education, marital status PROGRESS categories analysed at outcome: NR Outcomes relating to harms/unintended effects: NR Intervention included strategies to address diversity or disadvantage: NR (except that intervention targeted overweight mothers) Economic evaluation: NR NCT00563264 Funding: this study was funded by a grant from the NIH, National Institute of Diabetes, Digestive and Kidney Diseases (R01-DK-07549). Dr. Zucker was supported by grant 1-K23-MH-070-418-01 Run-in period prior to randomisation All participants received monetary incentives (totaling USD 100) to complete assessments Study is ongoing - this paper only reports 8-month outcomes (22-month outcomes to follow) Funding Information: PROGRESS categories analysed at outcome: NR in this paper Outcomes relating to harms/unintended effects: NR in this paper Intervention included strategies to address diversity or disadvantage: NR Economic evaluation: NR NCT00390637 Funding: the DiOGenes study was partially funded by the European Community (contract FOOD-CT-2005-513946). Financial contributions from local sponsors were provided to the supermarket centres, which also received a number of foods free of charge from food manufacturers. A full list of these sponsors is available at www.diogenes-eu.org/sponsors/. Funding Information: Funding: this study was funded by a grant from the National Heart, Lung and Blood Institute (R01HL057775) Funding Information: Who delivered the intervention: reported PROGRESS categories assessed at baseline: reported (race, gender. education) PROGRESS categories analysed at outcome: reported (gender) Outcomes relating to harms/unintended effects: NR Intervention included strategies to address diversity or disadvantage: NR Economic evaluation: NR Funding: this project was supported by grants R01CA081495 and R01CA098861-03S1 from the NIH National Cancer Institute, Bethesda, Md. Drs Patrick, Calfas, and Sallis are co-owners of, and receive income from, the Center for Health Interventions, LLC (San Diego, Ca), which is developing products related to the research described in this paper. The terms of this arrangement have been reviewed and approved by San Diego State University and the University of California, San Diego, in accordance with their respective conflict-of-interest policies Funding Information: Theoretical basis: NR Resources for intervention implementation: reported Who delivered the intervention: reported PROGRESS categories assessed at baseline: gender; mother: race/ethnicity; SES (household income), education, marital status PROGRESS categories analysed at outcome: NR Outcomes relating to harms/unintended effects: reported (gaining insufficient weight) Intervention included strategies to address diversity or disadvantage: NR Economic evaluation: NR NCT00359242 Funding: this work was supported by grant DK72996 from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and in part by a General Clinical Research Center grant from NIH (M01RR10732) and GCRC Construction Grant (C06RR016499) awarded to the Pennsylvania State University College of Medicine. Infant food jars were generously donated by Gerber. Additional support was received from the Penn State Children, Youth and Families Consortium and The Children’s Miracle Network The mean birth weight for these participants was 3.33 kg, equivalent to the 45th percentile for birth weight for gestational age “... We do not have adequate data to assess the extent to which parents’ implementation of the “Soothe/Sleep” intervention may have affected its impact.” Funding Information: Theoretical basis: SEM Resources for intervention implementation: reported Who delivered the intervention: reported PROGRESS categories assessed at baseline: child, gender; parent: education, race/ethnicity (migrant status) PROGRESS categories analysed at outcome: parent: education, race/ethnicity (migrant status) Outcomes relating to harms/unintended effects: reported Intervention included strategies to address diversity or disadvantage: culturally tailored Economic evaluation: NR NCT00674544 Funding: the study was mainly supported by the Swiss National Science Foundation (grant No 3200B0-116837) and Health Promotion Switzerland (project No 2104). Additional funding was obtained from a research award for interdisciplinary research from the University of Lausanne, a Takeda research award, the Wyeth Foundation for the Health of Children and Adolescents, the Freie Akademische Gesellschaft, and an unrestricted educational grant from Nestlé. The funding sources had no role in the study design, data collection, analysis, interpretation of data, in the writing of the report, and in the decision to submit the article for publication Main paper (Puder 2011) reports main results; see secondary references: Burgi 2012 for outcome effects by (parental) migrant status and educational level; Niederer 2013 for outcome effects by child weight status and fitness level Funding Information: Theoretical basis: NR Resources for intervention implementation (e.g. funding needed or staff hours required) : reported Who delivered the intervention: reported PROGRESS categories assessed at baseline: reported (gender) PROGRESS categories analysed at outcome: reported (gender) Outcomes relating to harms/unintended effects: NR Intervention included strategies to address diversity or disadvantage: NR Economic evaluation: no formal evaluation, however costs of materials provided ISRCTN36363490 Funding: British Heart Foundation, Glasgow City Council, and the Caledonian Research Foundation. The pilot study was funded by Sport Aiding Medical Research for Kids (SPARKS) Funding Information: Theoretical basis: Social Cognitive Model Resources for intervention implementation: reported Who delivered the intervention: reported PROGRESS categories assessed at baseline: parent: SES (household income), household education, marital status PROGRESS categories analysed at outcome: baseline parent/guardian marital status as moderator of BMI Outcomes relating to harms/unintended effects: weight concerns, depressive symptoms, injuries/illness, height-growth velocity, BMI loss Intervention included strategies to address diversity or disadvantage: targeted African-American families with low SES; intervention culturally tailored Economic evaluation: NR NCT00000615 Funding: this research was funded by a co-operative agreement UO1 HL62663 from the National Heart, Lung, and Blood Institute, NIH. An NHLBI Program Officer (EO) was a member of the co-operative agreement Steering Committee and as a co-author on the manuscript, participated in interpretation of the data and preparation of the manuscript. The NHLBI Program Officer and other NHLBI scientific staff provided input on design and conduct of the study, but were not involved in collection, management or analysis of the data Pilot study is included in this Cochrane Review (Robinson 2003); girls were required to have a BMI ≥ 25th percentile for age and/or at least 1 overweight parent/guardian Funding Information: Funding: this work was supported by NIH Grants DK042549 and DK048520 and by the W.K. Kellogg Institute Deciding if this RCT is cluster-randomised or not depends upon which outcome data are looked at. The unit of allocation is the family. So technically a cluster-RCT. However the study authors specified a single ’target child’ per family. Therefore for data for the target child it is an RCT. However if data from ’other children’ in the family are assessed it is a cluster-RCT with the family as the cluster. However, we did not extract any numerical data from this study as they do not present change in BMI or zBMI Funding Information: NCT01397123 Funding: this work was supported by the Fundação para a Ciência e Tecnologia (FCT), Projeto PEst-OE/SAU/UI0617/2011 Included the programme in the progression of teaching career Funding Information: Theoretical basis: SCT Resources for intervention implementation: reported Who delivered the intervention: reported PROGRESS categories assessed at baseline: child, race/ethnicity; parent: education, SES (free/reduced or not) PROGRESS categories analysed at outcome: NR Outcomes relating to harms/unintended effects: NR Intervention included strategies to address diversity or disadvantage: NR Economic evaluation: NR NCT00949637 Funding: Funding for this project was provided, in part, by the Sunflower Foundation: Health Care for Kansans, a Topeka-based philanthropic organisation with the mission to serve as a catalyst for improving the health of Kansans 3 troop leader self-rating averages over the 8 modules ranged from 1.52-1.86 (zero = no implementation to 2.0 = full implementation). Troops differed (F2, 18 = 21.5, P < .001) in overall implementation with averages of 1.43, 1.86, and 1.84 (mean = 1.71) Funding Information: PROGRESS categories assessed at baseline: gender, SES, race/ethnicity (migrant status) PROGRESS categories analysed at outcome: NR Outcomes relating to harms/unintended effects: reported (accidents and infections) Intervention included strategies to address diversity or disadvantage: NR Economic evaluation: NR Funding: the authors declare that the institution of household, KCR and KR had financial support from the German Federal Ministry of Education and Research (BMBF) (Grant Nr. 01EL0606, BMBF) and from the BARMER GEK (formerly Gmuender Ersatz-Kasse GEK) for the submitted project. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript Implemented by preschool teachers without further costs Funding Information: Theoretical basis: ecological principles, TPB, HBM, SCT Resources for intervention implementation: reported Who delivered the intervention: reported PROGRESS categories assessed at baseline: gender PROGRESS categories analysed at outcome: NR Outcomes relating to harms/unintended effects: NR Intervention included strategies to address diversity or disadvantage: NR but intervention targeted schools classified by the Ministry of Education as having students of low SES and receiving benefits from the Federal School Breakfast Program Economic evaluation: NR Funding: the project was supported by the Pan American Health Organization (PAHO) , the HLHP program of the International Life Science Institute (ILSI), the Mexican Council for Science and Technology (Conacyt), and the Mexican Ministry of Health (SSa). This work was carried out with support from the Global Health Research Initiative (GHRI), a collaborative research funding partnership of the Canadian Institute of Health Research, the Canadian International Development Agency, Health Canada, the International Development Research Centre, and the Public Health Agency of Canada One of the plus schools changed during year 2 to become a full-time school, and data from this school was therefore excluded from the analysis Funding Information: Funding: the research was funded by a grant from the Northern and Yorkshire Region Research and Development Unit Funding Information: Funding: NIH Grant HL 44467 Funding Information: Funding: this study was funded by the Victorian Health Promotion Foundation. Jo Salmon is supported by a National Heart Foundation of Australia and Sanofi-Aventis Career Development Award. Kylie Ball is supported by a National Health and Medical Research Council/National Heart Foundation of Australia Career Development Award. David Crawford is supported by a Victorian Health Promotion Foundation Senior Research Fellowship Funding Information: Funding: the study was supported by the Brazilian National Research Council - CNPq. Grant number: 500404/2003-8 - CNPq Funding Information: NCT00988754 Funding: this work has been funded by a grant from the Bavarian State Ministry of the Environment and Public Health (Gesund.Leben.Bayern) (LP 00001-FA 08) Baseline waist circumference was less in the control group (P = 0.035), adjusted for in analyses; no significant change was observed for children below the 10th percentile Funding Information: PROGRESS categories assessed at baseline: reported (gender, SES) PROGRESS categories analysed at outcome: reported (gender, SES) Outcomes relating to harms/unintended effects: NR Intervention included strategies to address diversity or disadvantage: NR Economic evaluation: NR NCT00498459 Funding: this study was supported by grants from The Regional Health Insurance of Alsace-Moselle; National Program of Research in Human Nutrition (INSERM and INRA); French Public Authorities within the National Nutritional Health Program and through the Youth and Sports Department; Conseil General du Bas-Rhin; Municipalities of Drusenheim, Illkirch-Graffenstaden, Obernai and Schiltigheim and The International Longevity Centre. The funding sponsors had no role in the design and protocol development of the study, in data collection, analysis and interpretation or in manuscript preparation Funding Information: Outcome measures • Primary outcome ◦ Changes in body composition (i.e. waist circumference, skinfold thickness and BMI) • Secondary outcomes ◦ Changes in dietary and PA behaviour (EBRBs) ◦ Consumption of SSBs (i.e. consumption of soft drinks and fruit juices) ◦ Consumption of high-energy snacks (i.e. consumption of savoury snacks and sweet snacks) ◦ Screen-viewing behaviour (i.e. time spent on TV viewing and computer use) ◦ Active commuting to school Process evaluation: reported Theoretical basis: reported (Intervention mapping protocol, Behaviour Change and Environmental frameworks) Resources for intervention implementation (e.g. funding needed or staff hours required) : reported Who delivered the intervention: reported PROGRESS categories assessed at baseline: reported (gender, race) PROGRESS categories analysed at outcome: reported (gender, race) Outcomes relating to harms/unintended effects: NR Intervention included strategies to address diversity or disadvantage: reported Economic evaluation: NR Funding: this study is part of the Netherlands Research Programme for Weight Gain Prevention and is funded by grant 2000Z002 from the Netherlands Heart Foundation, the Dutch Ministry of Health, Welfare, and Sports, and the Royal Association of Teachers of PE (KVLO). None of the funders had input into protocol development, data collection, or analyses or interpretation Protocol published separately. Refer to secondary references for Singh 2009: Singh et al. BMC Public Health 2006, 6:304 doi:10.1186/1471-2458-6-304 and Singh et al. Arch Pediatr Adolesc Med 2007;161:565-571 for 8-month outcome data Funding Information: ACTRN12610000200088 Funding: this study was funded by an Australian Research Council Linkage Grant (ARC LP100100049) A voucher draw (supermarket vouchers worth AUD 50-250) encouraged participant retention Funding Information: Funding: study was funded by the generous gifts of: Joseph Drown Foundation, Simms/ Mann Family Foundation, and Venice Family Clinic Study analyses focuses on subset of children with a BMI > 50th percentile at baseline Funding Information: Theoretical basis: Self-determination theory and SCT Resources for intervention implementation: reported Who delivered the intervention: reported PROGRESS categories assessed at baseline: race/ethnicity, SES PROGRESS categories analysed at outcome: NR Outcomes relating to harms/unintended effects: reported Intervention included strategies to address diversity or disadvantage: targeted boys at risk of obesity: failing to meet international PA or screen-time guidelines Economic evaluation: NR ACTRN 12612000978864 Funding: this study was funded by an Australian Research Council Discovery Project grant (DP120100611). The sponsor had no involvement in the design or implementation of the study, in analyses of data, or in the drafting of the manuscript An equipment pack valued at approximately AUD 1000 (including pedometers, elastic tubing devices, boxing gloves, focus pads and hanging gym handles) was provided to each school if needed On average, schools conducted 79% of intended school sports sessions and 64% of intended lunchtime sessions. Sixty-five percent of boys attended $70% of the sport sessions but only 44% of boys attended at least two-3rds of lunchtime sessions Participant satisfaction with the ATLAS intervention was high, but satisfaction with the lunchtime sessions was somewhat lower. Smartphone (or similar device) ownership was reported by 70% of boys, and 63% reported using either the iPhone or Android version of the ATLAS app. Almost one-half of the group agreed or strongly agreed that the “push prompt” messages reminded them to be more active, reduce their screen-time, and drink fewer sugary drinks, and 44% of participants agreed or strongly agreed that the ATLAS Funding Information: Intervention included strategies to address diversity or disadvantage: reported Economic evaluation: NR Funding: non-industry. This project was supported by grants from the American Heart Association of Metropolitan Chicago Funding Information: Funding: this research was supported by Grant # 1 R01 HL078846 from the NIH, Bethesda, MD, USA Based on parent report and school records, 99.3% of children were of Native American Indian heritage, with almost all children from what is commonly known as the Oglala Sioux Tribe, but more correctly the Lakota people Motivational phone calls had to be stopped due to logistics of using cell phones as means of communication. There are drop spot areas on the reservation with no phone signal and many phones had no voice mail Funding Information: Funding: this research received financial support from the Commonwealth Education Trust (London, UK) Sustainability and economic viability of the intervention programme was enhanced by an ongoing course of professional development for the classroom teachers provided by the visiting specialists Funding Information: Funding: this study was funded by grants from the French National Plan for Nutrition and Health (PNNS), the Comite Regional Executif des Actions de Sante d’Auvergne (CREAS), the Caisse Régionale d’Assurance Maladie d’Auvergne (CRAMA), the Appert Institutes, the town of Clermont-Ferrand, and the governing bodies of the Clermont-Ferrand school system Funding Information: Theoretical basis: NR Resources for intervention implementation: reported Who delivered the intervention: reported PROGRESS categories assessed at baseline: gender PROGRESS categories analysed at outcome: NR Outcomes relating to harms/unintended effects: NR Intervention included strategies to address diversity or disadvantage: NR Economic evaluation: NR Funding: non-industry. The funding for this study was provided by LifeFitness Academy and the Youth Sports Research Council Funding Information: Theoretical basis: (i) theories of information processing; (ii) the Elaboration Likelihood Model; and (iii) the Precaution-Adoption Process Model Resources for intervention implementation: reported Who delivered the intervention: reported PROGRESS categories assessed at baseline: gender, SES (mother’s education) PROGRESS categories analysed at outcome: NR Outcomes relating to harms/unintended effects: NR Intervention included strategies to address diversity or disadvantage: NR Economic evaluation: NR Funding: the work was supported by the Ministry of the Flemish Community (Department of Economics, Science and Innovation; Department of Welfare, Public Health and Family). The work was performed by the Centre of Expertise for Welfare, Public Health and Family, which is a consortium of researchers from the Catholic University of Leuven, Ghent University, Vrije Universiteit Brussel and KH Kempen Funding Information: Theoretical basis: NR Resources for intervention implementation (e.g. funding needed or staff hours required) : reported Who delivered the intervention: reported PROGRESS categories assessed at baseline: reported (gender) PROGRESS categories analysed at outcome: reported (gender) Outcomes relating to harms/unintended effects: NR Intervention included strategies to address diversity or disadvantage: reported Economic evaluation: no formal evaluation, however average cost per child was provided (EUR 28 /child/month) Funding: this study was funded mainly by La Consejeria de Sanidad de Castilla-La Mancha (grant GC03060-00). Additional funding was obtained from the Ministerio de Sanidad y Consumo, Instituto de Salud Carlos III, Red de Investigacion en Actividades Preventivas y de Promocion de Salud (grant RD06/0018/ 0038) Funding Information: Funding: non-industry. The project was funded by the UK Food Standards Agency Funding Information: Theoretical basis: NR Resources for intervention implementation: reported Who delivered the intervention: reported PROGRESS categories assessed at baseline: mothers: race/ethnicity, education, SES (income), employment status, marital status PROGRESS categories analysed at outcome: NR Outcomes relating to harms/unintended effects: NR Intervention included strategies to address diversity or disadvantage: intervention targeted most socially and economically disadvantaged areas of Sydney Economic evaluation: reported (Hayes 2014 (Wen 2012 secondary reference)) Australian Clinical Trial Registry No 12607000168459 This study was funded by the Australian National Health and Medical Research Council (ID No 393112) Methods: economic evaluation of a RCT, the ’Healthy beginnings’ (HB) trial, from the perspective of the health funder. Intervention resources were determined from local health district records in 2012 AUD. Health-care resource utilisation was determined through patient-level data linkage. Results: the cost of HB intervention in the clinical trial over 2 years was AUD 1309 per child (2012 AUD) The incremental cost-effectiveness ratio was AUD 4230 per unit BMI avoided and AUD 631 per 0.1 reduction in zBMI. It was estimated that the programme could be delivered in practice for AUD 709 per child; with incremental cost-effectiveness ratios of AUD 2697 per unit BMI avoided and AUD 376 per 0.1 reduction in BMI z-score Conclusions: “We present the first economic evaluation of an effective obesity prevention initiative in early childhood. HB is a moderately priced intervention with demonstrated effectiveness that offers similar or better value for money than existing obesity prevention or treatment interventions targeted at older children.” Funding Information: Theoretical basis: NR Resources for intervention implementation: reported Who delivered the intervention: reported PROGRESS categories assessed at baseline: gender, SES (Index of Community SocioEducational Advantage (ICSEA)) PROGRESS categories analysed at outcome: gender Outcomes relating to harms/unintended effects: reported (risk of eating disorders) Intervention included strategies to address diversity or disadvantage: NR Economic evaluation: NR Funding: this research was funded by a Butterfly Research Institute Grant. S.M.W. held a research fellowship funded by the South Australian Centre for Intergenerational Health and now holds a research fellowship funded by the National Health and Medical Research Council. S.B.A. is supported by the Ellen Feldberg Gordon Fund for Eating Disorders Research and the Programs to prevent eating disorders and obesity 1821 www. cambridge.org/core/terms. doi.org/10.1017/S003329171400289X Downloaded from www.cambridge.org/core. University of Bristol Library, on 14 Mar 2018 at 15:47:04, subject to the Cambridge Core terms of use, available at US Maternal and Child Health Bureau, Health Resources and Services Administration, training grants MC00001 and the Leadership Education in Adolescent Health Project 6T71-MC00009 (Index of Community SocioEducational Advantage (ICSEA)) The mean ICSEA rating was 1104 (range = 972-1183), indicating above average socio-economic advantage, consistent with anecdotal reports from program presenters suggesting a predominantly white sample as reflecting Australian society Media smart girls (mean = 19.78, SD = 3.42) had a significantly lower BMI than HELPP girls (mean = 21.01, SD = 3.76, Effect size = 0.33) Funding Information: Outcome measures • Primary outcome: zBMI, % body fat • Secondary outcomes: PA, energy intake Process evaluation: reported (integrity) Theoretical basis: Social Learning theory Resources for intervention implementation: reported Who delivered the intervention: reported PROGRESS categories assessed at baseline: gender, race/ethnicity, SES (enrolment in the free or reduced-cost lunch programme) PROGRESS categories analysed at outcome: gender, race/ethnicity Outcomes relating to harms/unintended effects: NR Intervention included strategies to address diversity or disadvantage: NR however 81. 7% of participants described as being low SES at baseline Economic evaluation: NR NCT00289315 Funding: this project was supported by the National Institute for Child Health and Human Development of the NIH (R01 HD048483) and the U.S. Department of Agriculture (58-6435-4-90). In addition, this work was partially supported by the NORC Funding Information: Center Grant #1P30 DK072476 entitled “Nutritional Programming: Environmental and Molecular Interactions” sponsored by NIDDK, and C. Martin was supported by NIH grant K23 DK068052 (PI: C. Martin)
PY - 2019/7/23
Y1 - 2019/7/23
N2 - Background: 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.
AB - Background: 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.
UR - http://www.scopus.com/inward/record.url?scp=85070287164&partnerID=8YFLogxK
U2 - 10.1002/14651858.CD001871.pub4
DO - 10.1002/14651858.CD001871.pub4
M3 - Article
C2 - 31332776
AN - SCOPUS:85070287164
JO - Cochrane Database of Systematic Reviews
JF - Cochrane Database of Systematic Reviews
SN - 1469-493X
IS - 7
M1 - CD001871
ER -