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JBI Database of Systematic Reviews & Implementation Reports 2013;11(9) 180- 257

Collins et al. Effectiveness of parent-centred interventions for the prevention and treatment of childhood overweight and obesity in community settings: a systematic review© the authors 2013 doi: 10.11124/jbisrir-2013-709 Page 180

Effectiveness of parent-centred interventions for the prevention and treatment of childhood overweight and obesity in community settings: a systematic review

Clare E Collins PhD, BSc, Dip Nutr&Diet, Dip Clin Epi 1,2

Tracy L Burrows PhD, BHSc (Nutr&Diet) 1,2

James Bray BHSc (Nutr&Diet) 1

Roberta Asher BHSc (Nutr&Diet) 1

Myles Young BPsyc 2,3

Philip J Morgan B.Educ, PhD 2,3

1. University of Newcastle Evidence Based Health Care Group: a JBI Evidence Synthesis Group, School of

Health Sciences, Faculty of Health, University of Newcastle, NSW, Australia

2. Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, NSW, Australia

3. School of Education, Faculty of Education and Arts, University of Newcastle, NSW, Australia

Corresponding author

Clare E Collins

[email protected]

Executive summary

Background

Worldwide in 2000, 10% of children aged five to 17 years were reported as being overweight with an

additional 2-3% being obese. Overweight and obesity in childhood can adversely impact on both

physical and psychological health. The rise in the prevalence of childhood obesity is a complex issue

but widely recognised contributors include increased energy intake, decreased levels of physical

activity and greater time spent in sedentary pursuits. A large number of environmental and cultural

factors have also been identified as contributing to the problem.

Evidence to support an optimal approach to treating childhood obesity is limited with many studies

showing only modest results at best in the long-term. However, the importance of family-based

treatment that combines diet, physical activity and behavioral components has been acknowledged

in a recent Cochrane Systematic Review. It has also been suggested that interventions offered in the

community setting may help overcome barriers to participation, by making programs more accessible

and allowing the targeting of specific sub-groups of the population.

mailto:[email protected]

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Objectives

The objective of this review was to identify the effectiveness of parent-centred interventions

implemented in the community setting in modifying eating and physical activity behaviors or weight-

related outcomes of children.

Inclusion criteria

Types of participants

This review considered studies that included free-living children of pre-school, primary and

secondary school age and/or their parents/guardians aged >18 years.

Types of intervention(s)/phenomena of interest

Intervention programs were required to have a parental component, to target eating and/or exercise

behaviors for the prevention or treatment of obesity, and child weight status reported.

Types of studies

All intervention studies were included in the review including: randomized controlled trials (RCTs);

non-randomized controlled trials, longitudinal studies, cohort (both retrospective and prospective),

case control and time series studies which had been conducted in a community setting.

Types of outcomes

This review considered studies that included overweight/obesity related outcomes, eating behavior

outcomes, physical activity behaviour outcomes, and sedentary behavior outcomes and constructs.

Search strategy

A literature search of community-based parent-centred intervention studies to promote nutrition and

physical activity for the prevention and treatment and of childhood overweight and obesity was

performed in eight electronic databases dating from 1975 to April 2009.

Methodological quality

Studies were critically appraised for methodological quality using standardized tools.

Data collection

Data was extracted by one reviewer using a standardized data extraction form developed by the

researchers and checked for accuracy and consistency by a second reviewer.

Data synthesis

Data in relation to setting, methodology, intervention components and effect on weight, dietary intake

and physical activity was extracted, and described in a narrative synthesis. Where possible a meta-

analysis was undertaken.

Results

Of the home-based interventions, five of nine studies reported statistically significant changes in

anthropometric outcomes post intervention. Of the 10 studies in the before and after school care

setting, seven reported a significant decrease in a weight-related outcome post intervention, with only

one reporting an increase.

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Conclusions

Results from the review support the after-school setting as the most promising for community

intervention setting for targeting parents as agents of change within child obesity prevention and

treatment programs.

Implications for practice

At this stage, interventions to support parents should target the after-school environment as opposed

to being conducted in the home, summer camps, leisure centers or churches. Targeting a decrease

in energy intake and sweetened beverages in parallel with increasing number of daily steps and

decreasing screen time use.

Implications for research

Future studies of high quality are needed across the full range of community settings. Given that

currently most of the higher quality RCTs and the studies showing positive impacts of weight change

are in the after-school setting, further studies in this area using similar methodologies to those

already published will facilitate future meta-analyses in this area.

Keywords

systematic review; obesity; prevention; intervention; pediatric; diet; nutrition; physical activity; parent;

community setting

Introduction

Background

In Australia, at a population level, 25% of adults are considered obese with 67% of men and 52% of women

overweight or obese. 1,2

This is a substantial health concern, as overweight and obesity can lead to a range of

chronic diseases such as heart disease, Type 2 diabetes, musculoskeletal and respiratory problems. 1 Being

overweight may also lead to a reduced quality of life and also places a large financial burden on

governments for health care. 3 Obesity is now seen as a major epidemic and is common in all age and

population groups across Australia. 3

The Australian Bureau of Statistics 2007/08 National Health survey in Australia reported a quarter of children

aged five to 17 years as overweight or obese. 4 Worldwide in 2000, 10% of children aged five to 17 years

were reported as being overweight with an additional 2-3% being obese and we can expect that these rates

have increased further since. 5 Obesity in childhood is seen as an independent risk factor for adult obesity

and can have an impact on physical and psychological health. 6,7

Medical conditions such as sleep apnea,

asthma, early growth and maturity and poor pulmonary function are all associated with childhood obesity. 8

The rise in the prevalence of childhood obesity is a result of increases in energy in the diet, decreased

levels of physical activity and greater time spent in sedentary lifestyles. 9 A large number of environmental

and cultural factors have also been identified as contributing to the problem. 9

Children who are overweight are twice the risk of being overweight adults compared to children of healthy

weight. 6 Guo and Chumlea have reported children in the obese range (body mass index [BMI] >95

percentile) at age nine were 80% more likely of having a BMI greater than 28 in adulthood at age 35. 10

Overweight and obesity prevalence among children exists in a socioeconomic gradient with the most

disadvantaged quintiles predictive of higher BMI compared to those in the highest quintiles in developed

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nations. 11

In addition, there is an increased risk for a child becoming overweight or obese if one parent is

overweight and this risk is further increased if both parents are overweight. 12

Children of overweight parents

have twice the risk of being overweight than those with healthy weight parents. 3 There is emerging research

to suggest that having an overweight father may be more likely to increase the odds of child obesity. 13

Evidence to support the optimal approach to treating childhood obesity are limited with many studies

showing only modest results at best in the long term; 14,15

however several reviews have highlighted the

importance of family–based, combined dietary and physical activity and behavioral components. 16

Obesity

treatment interventions that include parental involvement have been shown to be an important feature of

behavioral programs, particularly children who are pre-adolescent. 16

It has been suggested that interventions

in the community setting may help overcome barriers to participation by making programs more accessible

and allowing targeting of specific groups. 16

Family-centred interventions can be those in which the children

are initially targeted within settings such as school and after-school care but the intervention focuses on the

home environment and changes with the assistance of family members. Alternatively, parents may be

recruited by schools or after-school care to participate, with the same intent of focusing on the home

environment and the family approach, specifically to change the health behavior of the child.

Many interventions for preventing childhood obesity have been implemented in the school setting 16

with a

modest effect in bringing about environmental and behavioral changes 9,17

and health benefits; however a

meta-analysis of these studies shows no consistent changes in body composition. 18

As children spend less

than 50% of their awake time within school hours, studies are needed to address all of the daily influences

on energy balance and improvement in living environments that support healthy eating and physical activity

outside of school hours. 19

This includes the after-school setting in which many children spend their time.

Efficacy trials in family-centred nutrition and physical activity interventions have shown a reduction in BMI Z-

scores (measure of relative weight [as in adults] but adjusted for the child’s age and sex) 20

over one and two

years follow up and improvements in dietary intakes; 21-24

however there is little literature showing the

effectiveness of these types of family-centred interventions in the community setting.

Objectives

The aim of this review was to identify the effectiveness of parent-centred interventions implemented in the

community setting in modifying weight-related outcomes, and eating and physical activity behaviors of

children.

Inclusion criteria

Types of participants

This review considered studies that included children of pre-school, primary and secondary school age

and/or their parents/guardians aged >18 years.

Types of intervention(s)

Interventions of interest were implemented in a community setting including, but not limited to: pre-schools

(outside of curriculum), schools (non-curricular, before- and after-school), home-based community centres

and community camps, with the aim of improving eating and physical activity behaviors and/or

overweight/obesity outcome measures. Interventions conducted at pre-schools and schools were conducted

outside of those school curriculums and were resourced separately. No intervention controls and active

intervention controls were considered as comparators.

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Types of studies

All intervention studies were included in the review, including: RCTs, non-randomised controlled trials, and

longitudinal, cohort (both retrospective and prospective), case control and time series studies which had

been conducted in a community setting. These were used to evaluate effectiveness of the interventions in

modifying nutrition or diet and physical activity behaviors of children. Studies were required to be published

in the English language.

Types of outcomes

This review considered studies that included the following outcome measures for children and/or their

parents:

i) Overweight/obesity related outcomes: weight (kg), % body weight lost, BMI, waist circumference (cm).

ii) Eating behavior outcomes: fruit and vegetable intake, macronutrient composition (e.g. fat intake per day),

core food groups, diet quality.

iii) Physical activity behavior outcomes: steps per day, time spent in activity, energy expenditure.

iv) Sedentary behavior outcomes and constructs: time spent in non-educational, small screen recreation

(e.g. TV, computer, hand held electronic games).

Two reviewers independently assessed study inclusion based on the title, abstract and/or full paper (JB and

CC). If disagreement occurred a third independent reviewer (TB) was used followed by discussion until

consensus was reached.

Search strategy

A literature search was performed of community-based parent-centred intervention studies to promote

nutrition and physical activity for the prevention and treatment of childhood overweight and obesity dating

from 1975 to April 2009. It was considered likely that few relevant studies would have been published before

1975. The search was conducted in and performed until 2009. The original primary author has since

withdrawn from his role and due to limited resources, this review has only recently been completed. This

review provides a thorough appraisal of the literature until 2009 and provides a platform for researchers to

build on and undertake an update on this topic. Eight electronic databases were searched: Cochrane Library,

MEDLINE/ PREMEDLINE, EMBASE (Excerpta Medica Database, CINAHL (Cumulative index to Nursing and

Allied Health Literature), Web of Science, Scopus and PsycINFO. Reference lists from included studies and

relevant review articles were manually searched to identify papers not already retrieved. The MeSH (Medical

Subject Headings of the national Library of Medicine) keyword search terms focussed on the intervention

type (e.g. parent-centred, family focussed), setting (e.g. community) and behaviors (e.g. nutrition, physical

activity). Keywords included ‘parent’, ‘parents’, ‘foster parents’, ‘single parents’, ‘adoptive parents’, ‘family’,

‘single- parent family’, ‘community’, ‘school’, ‘home’, ‘home visiting programs’, ‘home care’, ‘home care

services’, home environment’, ‘overweight’, ‘obesity’, ‘body weight’, ‘physical activity’, ‘nutrition’, ‘healthy

eating’, ‘food habits’, ‘feeding behavior’, ‘diets’, ‘child’, ‘child, preschool’, ‘intervention’, ‘family intervention’,

‘family therapy’ ‘early intervention (education)’, ‘intervention studies’. The full search strategy and list of terms

are reported in Appendix 1.

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Assessment of methodological quality

The study methodological quality was evaluated using the Joanna Briggs Institute Critical Appraisal Checklist

for Experimental studies (JBI-MAstARI) 25

or the JBI Critical Appraisal Checklist for Descriptive/Case Series

studies (See Appendix 2). 26

Two independent reviewers evaluated whether each item was present as ‘Yes’,

absent ‘No’ or ‘Unclear’ for each included study and then recoded each response as +1, 0 and -1

respectively. High quality studies were deemed to have a score of 8 or above. If disagreement between the

reviewers occurred, a third reviewer repeated the procedure to achieve consensus. No study was removed

from the review based on study quality. One reviewer then extracted study descriptive characteristics,

methods used and impact on outcomes of interest. A second reviewer then checked all extracted data for

each study.

Data collection and synthesis

Data was extracted by one reviewer using a standardized data extraction form from JBI data extraction tools

(see Appendix 3) and checked for accuracy and consistency by a second reviewer. Data in relation to

setting, methodology, intervention components and effect on weight, dietary intake and physical activity was

extracted, and described in a narrative synthesis. Where possible, a meta-analysis was undertaken using

RevMan 5.1.2 27

as an author was trained in this software. Two included studies compared two different

home-based interventions to a single minimal control. To avoid double counting of participants in these

instances, the shared control was split. 28

When standard deviations for within group change scores were not

reported this was calculated using the methods outlined in the Cochrane Handbook. 28

Results

A total of 1181 studies were identified using the search strategy outlined in Figure 1. Of these, 32 met the

inclusion criteria and were assessed for study quality and critical appraisal. The main reasons for exclusion

were: not the correct type of intervention (n=53) or not carried out in a community setting (n=46). All studies

assessed for quality were included in the review.

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Figure 1: Identification of studies included in the systematic review

Description of studies

The aim was to identify the effectiveness of parent-centred interventions implemented in the community

setting in modifying weight related outcomes. To address this, studies were categorized by the type of

setting (Home based, before and after school care, Community /leisure centres, community clinic, University

and Church) in which they were conducted (see Appendix 4 - Table 1). Of the 32 studies included in the

review, 22 were RCTs, three were pseudo-randomised controlled trials and seven were pre-test post-test

studies.

Descriptive characteristics of the 32 studies included in the systematic review are summarized in Table 2.

Eighteen studies were conducted in the USA, 19, 29-45

three in the UK, 46-48

three in Israel, 49-51

two in Finland, 52,

53 and one each in France,

54 Spain,

55 Russia,

56 Canada,

57 China

58 and Australia.

59 Six of the included studies

were conducted in ethnically diverse population samples including: four studies that targeted African

Americans and/or Hispanics 37-40

and one each targeting native Americans 31

and Canadian aboriginals. 57

A total of 7353 individuals participated across the 32 included studies. The age range of children was seven

months to 18 years, with the majority of studies conducted in children eight to 12 years (n=22 studies) and

11 conducted in children aged >14 years and only two studies in children less than one year. Sample sizes

ranged from 10 to 1696, with six studies having a sample size less than 20 and 16 studies having less than

60 participants.

Full text papers retrieved n= 229

Papers exclude (n =187)

Not a study (n=43)

Not an intervention (n=24)

Not intervention type (n=53)

Not target population (n=22)

Not a community setting (n=46)

No child weight outcome reported (n=4)

Reference excluded as duplicates n= 341

Included studies n = 32

N = 36

References identified from the literature search n =1181

References excluded based on title and/ or abstract n = 611

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The majority of studies (10/32 studies) were conducted in the before- or after-school care setting followed by

home-based interventions (9/32), community and leisure centres (6/32), and summer camp (2/32), with one

each in a University and Church setting.

Of the included studies, 22 of 32 interventions included both a diet and physical activity component while five

included physical activity only and two included diet only. The theoretical basis for the interventions was

described in 10/32 studies, with Social Cognitive Theory being the most commonly described in five

studies. 31, 34, 37-40

Intervention components included: goal setting (n= 7), home visits (n=4) and self-monitoring

(n=3). The intervention lengths ranged from nine weeks to two years, with an average of six months. Follow-

up ranged from 10 weeks to three years post intervention.

The parental components of the interventions varied across programs within the included studies. The most

common parental component was where parents either received the same intervention as the child (n=10

studies), 33-36, 39, 46, 54, 56-59

or parents attended some or all sessions with their children (n=5 studies). 30, 45, 48, 49,

53 In seven studies the interventions specifically targeted or focused on parents only,

29, 31, 32, 38, 41, 44, 50 with

parents and children attending separate sessions in three studies. 43, 51, 52

Other parental involvement

strategies included regular newsletters or information packs (n=5), 19, 30, 40, 52, 55

parental education or access

to study websites (n=1). 37

One study did not clearly describe the parental component of the program. 47

Methodological quality

Study quality characteristics of the included studies are described in Table 2a and 2b (see Appendix 4). Of

the ten pre-defined quality items (maximum score 10 points), 12 studies had a score of 8 or above while 12

had a score < 4. The lowest quality studies were descriptive/case studies while the highest quality studies

were RCTs. However, nine of 25 trials were assessed as inadequately describing the randomization process

related to assignment to groups. Four studies assessed that intervention groups were not comparable at

entry with an additional two rated as unclear, while all studies were rated as employing appropriate statistical

analyses Within 24 studies, participants were not blinded to treatment allocation; however this is likely to be

due to the nature of lifestyle interventions.

Findings of the review

Weight-related outcomes

Home-based

Of the home-based interventions, five of nine studies reported statistically significant changes in

anthropometric outcomes post intervention. 41, 58, 59

30, 36

However, in two of these studies there was a

significant increase in body weight 59

and percent body fat post intervention. 36

Of those reporting a significant

decrease in anthropometric variables post intervention, the range of reported outcome measures were varied

making comparison difficult. For two of three studies, in all intervention arms (including controls in one

study), 30

BMI Z-score decreased by a mean of ~0.1 units, after a one- 41

and two-year follow up. 30

The

remaining study reported scores between group differences, with the intervention group achieving greater

weight loss (-0.3 ± 4.3SD kg) from baseline to two years compared to the controls (5.5 ± 3.5kg). 58

Before and after school interventions

Of the 10 articles in the before- and after-school care setting, seven reported a significant decrease in a

weight-related outcome post intervention, with only one reporting an increase. 56

Of those studies which

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reported a decrease in a weight-related outcome, three reported a change in BMI z score or percentile, 19, 42,

44 two BMI,

29, 33 and one change in weight for height (based on weight for height charts).

Of the remaining settings, less than 50% of included studies reported significant changes in a weight variable

post intervention, with only a small number studies in each intervention category (Table 3) (see Appendix 4).

Meta-analysis

A number of meta-analyses were planned to address the research question, but this was limited by the

significant heterogeneity of the studies. Key areas of heterogeneity included the study design, setting, type of

control group, intervention content, outcomes and data reported.

A meta-analysis was conducted to summarize the effectiveness of home-based interventions compared to

minimal intervention controls. To reduce bias, the meta-analysis only compared intervention effects from

RCTs. As fewer than 10 interventions were included in this meta-analysis, a funnel plot was not generated to

assess publication bias. 28

Five comparisons from three studies were pooled in the meta analysis using

RevMan 5.1.2 27

(See Figure 2). Two included studies compared two different home-based interventions to a

single minimal control. To avoid double counting of participants in these instances, the shared control was

split. 28

Four studies reported BMI-z score; however as one reported waist-to-height z-score (WHZ), the

aggregate result was calculated as the standardized mean difference (SMD) between home-based

interventions and minimal intervention controls. For the study 41

not reporting standard deviation for within-

group change scores, this was calculated using the method outlined in the Cochrane Handbook and a

correlation coefficient from a similar study. 19

Included interventions were sufficiently homogenous (χ 2 = 3.76,

d.f. = 4 [P = 0.44], I 2 = 0%), so the fixed effects model was used. This meta-analysis revealed that there was

no significant difference in post-intervention weight outcomes between home-based intervention groups

compared to minimal intervention controls (SMD -0.09 (-0.20, 0.03), Z = 1.48 [P =0.14]).

Figure 2: Meta-analysis comparing the effects of weight loss interventions in a home based setting to

minimal intervention controls on children’s adiposity outcomes (change from baseline to post-test)

Secondary outcomes

Seventeen of the 32 included studies reported a dietary outcome (Table 4) (see Appendix 4) with total

energy intake the most commonly reported measure and described in 12 studies, 30, 31, 37-39, 43, 50, 51, 53, 54, 57, 59

followed by daily serves of fruit and vegetables (n= 8 studies), 37, 38, 40, 41, 46, 48, 49, 57

percent energy derived

from fat (n=9) 31, 37-40, 43, 54, 57, 59

and amount of sweetened drinks (n=6 studies). 37, 38, 40, 41, 49, 57

Four studies

reported significant changes in energy intakes ranging from -60 kcal /day at eight months post intervention 54

in one study to -320kcal / day at a two-year follow up. 30

Three studies reported changes in sweetened drinks

decreasing between one serve per day at 12 weeks 38

to -0.4 serves / day at six months 57

to -20 ounces per

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week at 12 months in another study. 41

The most common dietary assessment method was the 24-hour recall

and food diary/record assessed in seven and eight studies each. Across the included studies, there was

general lack of attention to detail in describing the dietary assessment methods including how many days

were assessed, if weekdays and weekends were used 43, 49, 59

or use of non-validated tools. 29, 47

Nineteen studies reported a physical activity or sedentary behavior measure (Table 4). The outcome

measures for physical activity were more varied than for diet, with 11 different measures across the studies.

The most common measure was the total amount of daily physical activity, commonly measured as time

spent in moderate/vigorous activity (n=8 studies), 31, 37-42, 57

total step counts/day assessed in two studies 35, 59

and total daily screen time measured in six studies. 57

30, 41, 42, 50, 51

Two studies reported increases in the

number of daily steps at 10 weeks 59

in one study and six months in another, 35

while two studies reported

changes in screen time ranging from -1.8 hours per day 51

to -17.5 hours per week. 30

The majority of studies

objectively measured physical activity through use of accelerometers (seven studies) all described as being

worn for at least three days. 30, 31, 37-40, 42

Discussion

Identifying effective parent-centred interventions in the community setting that modify diet and physical

activity behaviors of children is important if sustainable approaches to prevention and treatment of child

obesity are to be developed. The current review identified 32 studies that were conducted in community

settings and eligible for inclusion in the review. The majority were RCTs which were of moderate to high

quality. The main areas of methodological weakness were related to the description of randomization and

blinding of both subjects and assessors. However, of concern was that in six trials the participants were not

comparable at baseline or this was unclear, suggesting that randomization was inadequate and therefore the

results should be interpreted with caution.

While the majority of studies were conducted in the before- or after-school care setting, others included

home-based, community and leisure centre interventions with two conducted as part of a vacation summer

camp. It was not surprising that the after-school care setting was utilized in a number of studies given that

this setting usually has access to facilities needed for the promotion of healthy eating and physical activity

and that the after-school time period is ideal for accessing both parents and their children. It appears that this

setting was associated with the greatest proportion of effective intervention with seven of 10 reporting an

impact on weight change in the anticipated direction. However, of these most were only evaluated

immediately post intervention with only one study having any longer term follow up. 57

This study found

significant intervention effects after two years, but not after three years. 57

This is consistent with a meta-

analysis of after-school programs targeting physical activity and physical fitness that demonstrated

improvements in physical activity levels and other health-related aspects in the short term. 60

In a systematic

review, 61

interventions with a longer-term follow up, although not in an after-school setting, demonstrated

that programs targeting children in a kindergarten or pre-school setting can improve fruit and vegetable

intakes up to 18 months post intervention. 61

Interventions in the after-school setting with long-term follow-up

are clearly needed. The next most common setting was the home. While this is an ideal setting to test

effectiveness studies, it is associated with higher research costs due to the additional costs associated with

staff, travel and time to conduct the intervention, but it offers a much lower burden and is more accessible for

families.

The setting with the greatest proportion (70%) achieving successful weight-related outcomes was the before-

and after-school care setting, with the majority of these studies reporting a significant decrease in weight-

related outcomes post intervention and only one reporting an increase. 56

This compared to the home setting

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where only five of nine studies resulted in statistically significant post intervention changes in anthropometric

outcomes. 31, 41, 58, 59

In this setting intervention details tended to be less well reported making it difficult to

ascertain what the specific parental engagement components were. However, we were able to perform a

meta-analysis of the impact of home-based interventions versus a true no intervention control in a group of

sufficiently homogenous RCTs. This demonstrated that there was no significant difference in post-

intervention weight outcomes between home-based interventions groups compared to minimal intervention

controls. While this suggests that the home setting is not effective, it is hampered by the moderate to poor

study quality in many of the studies and therefore results should be interpreted with caution. High quality,

adequately powered studies with longer-term follow up in the home setting are needed that report age

adjusted growth such as BMI z-score or BMI percentiles, as opposed to BMI only.

The parent engagement components of the interventions varied across programs within the included studies.

The most common parental component was where parents received the same intervention as the child (n=8

studies), or parents attended some or all sessions with their children (n=4 studies). In six studies, the

interventions specifically targeted or focused exclusively on parents, with parents and children attending

separate sessions in five studies. Other parental involvement strategies included regular newsletters or

information packs (n=5), parental education or access to study websites (n=2). Future studies could include

study arms where parents are the exclusive focus with no child involvement versus parent plus child

involvement versus child only as the control group. While this approach has been used to target children and

parents differential for dietary change (parents) versus physical activity change (children), 21

studies that use

the same intervention components but only vary the family members to whom the program is targeted are

needed. This would help to ascertain directly the effectiveness of parental involvement necessary to optimize

outcomes in interventions in the community setting.

The majority of interventions included both diet and physical activity component, although five targeted

physical activity only and two targeted diet only. The average intervention length was six months with follow

up periods ranging from 10 weeks to three years. Approximately half of the included studies reported a

dietary outcome, and this was most commonly total energy intake. It was encouraging to note that some

reported dietary intake at the food group level including daily serves of fruit and vegetables, and sweetened

drinks as this has been previously identified as an omission in the evidence base. 62

This is important in

establishing food based guidelines. Almost two thirds of the included studies reported a physical activity or

sedentary behavior measure most commonly as the total amount of time spent in moderate/vigorous activity,

total daily step counts or total daily screen time.

A major weakness of the included studies was the poor description of methods/tools used to measure data

on dietary intake. This makes it difficult to ascertain the true changes in dietary intake, and future studies

should utilise existing tools/checklists to improve dietary reporting. 63,64

In contrast, the majority of studies

assessing physical activity utilized accepted objective measures of physical activity including

accelerometers, pedometers or standardised tests such as the one mile run.

Limitations of the review

The current systematic review had a number of limitations that need to be considered when interpreting the

results. It only included studies published in English and those which reported weight as a primary outcome.

Included studies spanned a wide age range, from toddlers to adolescents, and studies were heterogeneous

in terms of intervention components, meaning the results should be interpreted with caution. However,

strengths include a comprehensive search strategy across a number of databases and the use of

standardized data extraction and critical appraisal tools. A considerable amount of studies identified were

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carried out in ethnically diverse populations making results more generalizable over a broader population.

This is a strength within this field of research as often it is a limitation due to homogenous samples. In

addition, a substantial number of studies were effectiveness studies carried out in real world settings rather

than efficacy trials conducted under highly controlled conditions. Findings were therefore more relevant and

less challenging when attempting to translate into practice.

Conclusion

Numerous studies aiming to prevent or treat child obesity, and which include a parental component have

been conducted across a range of community settings. Most of the studies included in the systematic review

were of a short duration and which had methodological weaknesses. However at this stage the evidence

supports the after-school setting as the most promising, with home-based interventions deemed not effective

based on meta-analysis. Future studies need to be of high methodological quality and designed to have the

potential to be included in a meta-analysis. This review informs the areas of weakness that need to be

addressed and program components that are associated with improved weight outcomes. High quality

RCTs, with adequate sample sizes, study designs and follow up periods that extend beyond the intervention

phase are needed. A strategic approach to research in this area could strengthen the evidence on

effectiveness of community-based studies aimed at preventing or treatment of child obesity in a timely

manner.

Implications for practice

At this stage, interventions to support parents should target the after-school environment as opposed to

being conducted in the home, summer camps, leisure centers or churches. Targeting a decrease in energy

intake and sweetened beverages should be done in parallel with increasing the number of daily steps and

decreasing screen time use. To improve program reach, they must be implemented and evaluated for

effectiveness in preventing or treating child overweight and obesity outside of the optimized conditions of

hospital clinics or university research centres and in community settings. They must meet the unique needs

of each community and continually evolve in order to be sustainable and of interest to the population in the

long term, particularly in the use of newer technology.

Implications for future research

Future studies of high quality are needed across the full range of community settings. Given that currently

most of the higher quality RCTs and the studies showing positive impacts of weight change are in the after-

school setting, further studies in this area using similar methodologies to those already published will

facilitate future meta-analyses in this area.

Conflict of Interest

The authors have no conflicts of interest to declare.

Acknowledgements

The authors would like to acknowledge Hannah Lucas for her assistance with the review process.

JBI Database of Systematic Reviews & Implementation Reports 2013;11(9) 180- 257

References

1. Dunstan D. Diabesity and associated disorders in Australia 2000: The Australian Diabetes, Obesity and Lifestyle Study (AusDiab).2001.

2. AIHW. Australias Health 2012, Australias Health Series no13 cat no AUS156. Canberra: Australian Institute Health and Welfare2012.

3. Australian Health Ministers Advisory Council. Healthy Weight 2008, Australia’s Future: Commonwealth of Australia2008.

4. Australian Bureau of Statistics. Feature Article 1: Children who are Overweight or Obese. Canberra2009-10 [cited 2013]; Available from: http://www.abs.gov.au/AUSSTATS/[email protected]/Lookup/1301.0Chapter11062009%E2%80%9310.

5. International Obesity Taskforce. Obesity in children and young people: A crisis in public health. Obesity Reviews. 2004(May).

6. Singh AS MC, Twist JW, van Mechelen, Chinapaw MJ. Tracking of childhood overweight into adulthood: a systematic review of literature. Obesity Reviews. 2008;9(5):474-88.

7. Australian Bureau of Statistics. Information Paper: An Introduction to Socio-Economic Indexes for Areas (SEIFA). 2006.

8. Lobstein T BL, Uauy R. Obesity in children and young people: a crisis in public health. Obesity Review

2004;5(Supple 1):4-104.

9. Summerbell CD WE, Edmunds LD, Kerr D. Interventions for preventing obesity in children. Cochrane Database of Systematic Reviews. 2005.

10. Guo SS CW. Tracking of body mass index in relation to overweight in adulthood American Journal of Clinical Nutrition. 1999;70:145S-8S

11. Shrewsbury V WJ. Socioeconmic status and adiposity in childhood: a systematic review of cross sectional studies 1990-2005. Obesity. 2008;16(2):275-84.

12. Whitaker R ea. Predicting obesity in young. adulthood from childhood and parental obesity. New Engl J Med. 1997;337(13).

13. Freeman E, Fletcher R, Collins CE, Morgan PJ, Burrows T, Callister R. Preventing and treating childhood obesity: time to target fathers. International Journal of Obesity. 2011:1-3.

14. Epstein Lea. Treatment of Paediatric Obesity. Paediatrics. 1998;13(101).

15. Golan M CSL-trOR, 2004. 12: p. 357-361. Targeting parents exclusively in the treatment of childhood obesity. Obesity Research. 2004;12:357-61.

16. Oude Luttikhus H BL, Shrewsbury VA, O'Malley C, Stolk RP, Summerbell CD. Interventions for treating obesity in children (Review). The Cochrane Library. 2009.

17. Doak CM VT, Renders CM Seidel JC. The prevention of overweight and obesity in children and adolescents: a review of interventions and programs. Obesity Reviews. 2006;7:111-36.

18. Harris KCKL, Schulzer M, Retallack J. Effect of school-based physical activity interventions on body mass index in children: a meta analysis. CMAJ. 2009;180(7).

19. Economos CD HR, Goldberg J, Must A, Naumova E, Collins J, Nelson M. A community Intervention Reduces BMI z-score in Children: Shape Up Sommerville First Year Results. Obesity. 2007;15(5).

20. Must A, Anderson SE. Body mass index in children and adolescents: considerations for population- based applications. Int J Obes. 0000;30(4):590-4.

http://www.abs.gov.au/AUSSTATS/[email protected]/Lookup/1301.0Chapter11062009%E2%80%9310

JBI Database of Systematic Reviews & Implementation Reports 2013;11(9) 180- 257

21. Collins C, Okely A, Morgan P, Jones R, . BT, Cliff D, et al. Long-term outcomes of the HIKCUPS multi-site randomized trial: Efficacy of a parent-centred dietary-modification program, child-centred physical activity program or both in overweight children. Pediatrics. 2011;127:619-27.

22. Okely A, Collins C, Morgan P, Jones R, Warren J, Cliff D, et al. Multi-site randomized controlled trial of a child-centred physical activity program, a parent-centred dietary modification program, or both in obese children: The HIKCUPS study. . Journal of Paediatrics. 2010;157:388-94.

23. Burrows TWJ, Baur LA, Collins CE. Impact of a child obesity intervention on dietary intake and behaviors. International Journal of Obesity. 2008;32:1481-8.

24. Burrows T, C C, Warren J. Long term changes in food consumption trends in overweight children enrolled in the HIKCUPS intervention. Journal of Pediatric Gastroentrology and Nutrition. 2011;53(5):543-7.

25. Joanna Briggs Institute. Assessment and Review Instrument (JBI_MAStARI) Critical Appraisal Checklist for Experimental Studies. 2010.

26. Joanna Briggs Institue. JBI Critical Appraisal Checklist for Descriptive/ Case Series. 2010.

27. Review Manager (RevMan). Version 5.1.2. Version 5.1 ed. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration; 2011.

28. Higgins J, Green Se. Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration; 2011; Available from: www.cochrane-handbook.org.

29. Melnyk BM, Small L, Morrison-Beedy D, Strasser A, Spath L, Kreipe R, et al. The COPE Healthy Lifestyles TEEN Program: Feasibility, preliminary efficacy, & lessons learned from an after school group intervention with overweight adolescents: Journal of Pediatric Health Care Vol 21(5) Sep-Oct 2007, 315-322; 2007.

30. Epstein L, Roemmich J, Robinson J, Paluch R, Winiewicz D, Fuerch J, et al. A randomized trial of the effects of reducing television viewing and computer use on body mass index in young children. Arch Pediatr Adolesc Med. 2008;162:239-45.

31. Harvey-Berino J, Rourke J. Obesity prevention in preschool Native-American children: A pilot study using home visiting. Obesity Research. 2003;11(5):606-11.

32. Gately PJ CC, Butterly RJ, Mackreth P, Carroll S. The effects of a children's summer camp programme on weight loss, with a 10 month follow-up. Int J Obesity. 2000;24:1445-53.

33. Joosse L, Stearns M, Anderson H, Hartlaub P, Euclide J. Fit kids/fit families: A report on a countywide effort to promote healthy behaviors. Wisconsin Medical Journal. 2008;107(5):231-6.

34. Ransdell LB, Dratt J, Kennedy C, O'Neill S, De Voe D. Daughters and mothers exercising together (DAMET): A 12-week pilot project designed to improve physical self-perception and increase recreational physical activity. Women and Health. 2001;33(3-4):101-16.

35. Ransdell LB, Robertson LA, Ornes L, Moyer-Mileur L. Generations exercising together to improve fitness (GET FIT): A pilot study designed to increase physical activity and improve health-related fitness in three generations of women. Women and Health. 2004;40(3):77-94.

36. Ransdell LB, Taylor A, Oakland D, Schmidt J, Moyer-Mileur L, Shultz B. Daughters and mothers exercising together: Effects of home- and community-based programs. Medicine and Science in Sports and Exercise. 2003;35(2):286-96.

37. Baranowski T, Baranowski JC, Cullen KW, Thompson DI, Nicklas T, Zakeri IF, et al. The Fun, Food, and Fitness Project (FFFP): The Baylor GEMS pilot study. Ethnicity and Disease. 2003;13(1 SUPPL. 1):S1- 30-S1-9.

38. Beech BM, Klesges RC, Kumanyika SK, Murray DM, Klesges L, McClanahan B, et al. Child- and parent-targeted interventions: The Memphis GEMS pilot study. Ethnicity and Disease. 2003;13(1 SUPPL. 1):S1-40-S1-53.

http://www.cochrane-handbook.org/

JBI Database of Systematic Reviews & Implementation Reports 2013;11(9) 180- 257

39. Robinson TN, Killen JD, Kraemer HC, Wilson DM, Matheson DM, Haskell WL, et al. Dance and reducing television viewing to prevent weight gain in African-American girls: the Stanford GEMS pilot study. Ethnicity & disease. 2003;13(1 Suppl 1):S65-77.

40. Story M, Sherwood NE, Himes JH, Davis M, Jacobs Jr DR, Cartwright Y, et al. An after-school obesity prevention program for African-American girls: the Minnesota GEMS pilot study. Ethnicity & disease. 2003;13(1 Suppl 1):S54-64.

41. Estabrooks PA, Shoup JA, Gattshall M, Dandamudi P, Shetterly S, Xu S. Automated Telephone Counseling for Parents of Overweight Children. A Randomized Controlled Trial. American Journal of Preventive Medicine. 2009;36(1):35-42.e2.

42. Weintraub DL TE, Haydel KF, Fujimoto Mm Fulton JE, Robinson TN. Team sports for overweight children. Arch Pediatri Adolesc Med. 2009;162(3):232-7.

43. Johnson CC, Nicklas TA, Arbeit ML, Harsha DW, Mott DS, Hunter SM, et al. Cardiovascular intervention for high-risk families: The Heart Smart Program. Southern Medical Journal. 1991;84(11):1305- 12.

44. Perman JA, Young TL, Stines E, Hamon J, Turner LM, Rowe MG. A community-driven obesity prevention and intervention in an elementary school. The Journal of the Kentucky Medical Association. 2008;106(3):104-8.

45. Resnicow K< Taylor R BM, McCarty F. Results of Go Girls: A weight control program for overweight african-american adolescent females. Obesity Research. 2005(13):1739-48.

46. Lake K. Family intervention and therapy for overweight and obese kids. Community Practitioner. 2007 06;80(6):10-2.

47. Peerbhoy D, Majumdar AJ, Wightman NA, Brand VL. Success and challenges of a community healthy lifestyles intervention in Merseyside (UK) to target families at risk from coronary heart disease [corrected] [published erratum appears in HEALTH EDUC J 2008 Sep;67(3):240]. Health Education Journal. 2008 06;67(2):134-47.

48. Tyers M. Healthy lifestyle project for overweight and obese children: A pilot study. Nutrition and Food Science. 2005;35(5):298-302.

49. Gillis D, Brauner M, Granot E. A community-based behavior modification intervention for childhood obesity. Journal of Pediatric Endocrinology and Metabolism. 2007;20(2):197-203.

50. Golan M, Fainaru M, Weizman A. Role of behaviour modification in the treatment of childhood obesity with the parents as the exclusive agents of change. International Journal of Obesity. 1998;22(12):1217-24.

51. Nemet D, Barzilay-Teeni N, Eliakim A. Treatment of childhood obesity in obese families. Journal of Pediatric Endocrinology and Metabolism. 2008;21(5):461-7.

52. Kalavainen MP, Korppi MO, Nuutinen OM. Clinical efficacy of group-based treatment for childhood obesity compared with routinely given individual counseling. International Journal of Obesity. 2007;31(10):1500-8.

53. Niinikoski H, LagstrÃ¶m H, Jokinen E, Siltala M, RÃ¶nnemaa T, Viikari J, et al. Impact of repeated dietary counseling between infancy and 14 years of age on dietary intakes and serum lipids and lipoproteins: the STRIP study. Circulation. 2007 08/28/2007 Aug 28;116(9):1032-40.

54. Paineau DL, Beaufils F, Boulier A, Cassuto DA, Chwalow J, Combris P, et al. Family dietary coaching to improve nutritional intakes and body weight control: A randomized controlled trial. Archives of Pediatrics and Adolescent Medicine. 2008;162(1):34-43.

55. Vizcaino VM AF, Gutierrez RF, Martinez MS, Lopez MS, Martinez SS, Garcia EL, Artalejo FR. Assessment of an after-school physical activity program to prevent obesity amoung 9- to 10-year-old children: a cluster randomised trial. Int J Obesity. 2008;32:12-22.

JBI Database of Systematic Reviews & Implementation Reports 2013;11(9) 180- 257

56. Alexandrov AA, Maslennikova GY, Kulikov SM, Propirnij GA, Perova NV. Primary prevention of cardiovascular disease: 3-Year intervention results in boys of 12 years of age. Preventive Medicine. 1992;21(1):53-62.

57. Anand SS, Davis AD, Ahmed R, Jacobs R, Xie C, Hill A, et al. A family-based intervention to promote healthy lifestyles in an Aboriginal community in Canada. Canadian Journal of Public Health. 2007 11;98(6):447-52.

58. Jiang JX, Xia XL, Greiner T, Lian GL, Rosenqvist U. A two year family based behaviour treatment for obese children. Archives of Disease in Childhood. 2005 12;90(12):1235-8.

59. Conwell LS TS, Brown WJ, Batch JA. The Feasibility of a Home-based Moderate-Intensity Physiacal Activity Intervention in Obese children and Adolescents. Br J Sports Med. 2008;Online doi: 10.1136/bjsm.2008.046359.

60. Beets MBA, Erwin HE, Huberty JL. After-school Program Impact on Physical Activity and Fitness. American Journal of Preventative Medicine-0nline. 2009;36(6):527-37.

61. Bayer OvKR, Strauss A, Mitschek C, Tosscke A M, Hose A, Koletzko BV. Sort- and mid-term effects of a setting based prevention program to reduce obesity risk factors in children: a cluster-randomised trial. Clinical Nutrition. 2009;28:122-8.

62. Collins C, Watson J, Burrows T. Measuring dietary intake in children and adolescents in the context of overweight and obesity. International Journal of Obesity. 2010;34(7):1103-15.

63. Nelson M, Margetts, BM., Black, AE. Checklist for the methods section of dietary investigations. Metabolism. 1993;42:258-9.

64. Burrows T, Golley R, C C, Magarey AM. Development of an online decision tool to guide dietary intake methdology selection. Nutrition and Dietetics. 2010;67(S1):3.

65. Joose L, Stearns M, Anderson H, Hartlaub P, Euclide J. Fit kids/fit families: A report on a countywide effort to promote healthy behaviors. Wisconsin Medical Journal. 2008;107(5):231-6.

66. Story M, Sherwood NE, Himes JH, Davis M, Jacobs Jr DR, Cartwright Y, et al. An after-school obesity prevention program for African-American girls: the Minnesota GEMS pilot study. Ethnicity and Disease. 2003;13(1 Suppl 1):S54-64.

67. Robinson TN, Killen JD, Kraemer HC, Wilson DM, Matheson DM, Haskell WL, et al. Dance and reducing television viewing to prevent weight gain in African-American girls: the Stanford GEMS pilot study. Ethnicity and Disease. 2003;13(1 Suppl 1):S65-77.

68. Gillis D, Brauner, M., Granot, E. A community-based behavior modification intervention for childhood obesity. J Pediatr Endocrinol Metab. 2007;20:197-203.

JBI Database of Systematic Reviews & Implementation Reports 2013;11(9) 180- 257

APPENDIX 1: Search strategy

Database Database procedure and search terms

Scopus (parent OR family) AND (school OR community OR home) AND (“healthy eating” OR

“physical activity” OR overweight) AND (intervention) AND (EXCLUDE DOCTYPE,

“re”)) AND (EXCLUDE (DOCTYPE, “cp”) OR EXCLUDE(DOCTYPE, “ed”)) AND (LIMIT-

TO (LANGUAGE, “English))

PsychINFO Search 1: exp Parents/ or exp Adoptive parents/ or parent.mp. or exp Foster Parents/ or

exp Single Parents/

Search 2: exp Family Intervention/ or exp Family/ or exp Family Therapy/

Search 3: community.mp.

Search 4: school.mp.

Search 5: exp Home Visiting Programs/ or exp Home Care/ or Home Environment/

Search 6: exp Physical Activity/

Search 7: exp Nutrition/

Search 8: exp Eating Behavior/ or exp Nutrition/ or exp Diets/

Search 9: exp Overweight/

Search 10: exp Obesity

Search 11: exp Family Intervention/ or exp Early Intervention/ or exp Intervention

Search 12: 1 or 2

Search 13: 4 or 3 or 5

Search 14: 8 or 6 or 7 or 10 or 9

ProQuest (parent or family) AND (community or home or school) AND (physical activity or

nutrition or healthy eating or overweight or obesity) AND (intervention)

Medline Search 1: parent.mp. or Parents/

Search 2: Family Therapy/ or Family/ or Family Health/ or Single-Parent Family/ or

family.mp.

Search 3: Schools/

Search 4: community.mp.

Search 5: home.mp. Or Home Care Services/

Search 6: Child, Preschool/

Search 7: Diet/ or Food Habits/ or healthy eating.mp. or Feeding Behavior/

JBI Database of Systematic Reviews & Implementation Reports 2013;11(9) 180- 257

Search 8: physical activity.mp.

Search 9: Obesity/ or Overweight/ or Body Weight/

Search 10: “Early Intervention (Education)”/ or Intervention Studies/

Search 11: 6 or 4 or 3 or 5

Search 12: 8 or 7 or 9

Search 13: 1 or 2

Search 14: 11 and 13 and 10 and 12

EMBASE Search 1: parent.mp. or Parents/

Search 2: Family Therapy/ or Family/ or Family Health/ or Single-Parent Family/ or

family.mp.

Search 3: Schools/

Search 4: community.mp.

Search 5: home.mp. Or Home Care Services/

Search 6: Child, Preschool/

Search 7: Diet/ or Food Habits/ or healthy eating.mp. or Feeding Behavior/

Search 8: physical activity.mp.

Search 9: Obesity/ or Overweight/ or Body Weight/

Search 10: “Early Intervention (Education)”/ or Intervention Studies/

Search 11: 6 or 4 or 3 or 5

Search 12: 8 or 7 or 9

Search 13: 1 or 2

Search 14: 11 and 13 and 10 and 12

ISI Web of

Knowledge

(parent or family) AND (community or home or school) AND (physical activity or

nutrition or healthy eating or overweight or obesity) AND (intervention)

CINAHL (parent or family) AND (community or home or school) AND (physical activity or

nutrition or healthy eating or overweight or obesity) AND (intervention)

The

Cochrane

Library

(parent or family) AND (community or home or school) AND (physical activity or

nutrition or healthy eating or overweight or obesity) AND (intervention)

JBI Database of Systematic Reviews & Implementation Reports 2013;11(9) 180- 257

Appendix 2: Critical appraisal tools

JBI Database of Systematic Reviews & Implementation Reports 2013;11(9) 180- 257

Appendix 3: Data extraction tools

JBI Database of Systematic Reviews & Implementation Reports 2013;11(9) 180- 257

Appendix 4

Table 1: Description of included studies

Setting

Author

Year

Country

Design

Intervention length

Follow up (f/u)

Sample

Children

Child age

Setting, Intervention mode, intensity, method, study arms

Ie Description

Parental Component Outcome Measures

Theoretical Framework

Home Based

Anand et al.

2007 57

Canada

RCT

6 mo

57 fam (n= 174)

Child (n= nr)

Aboriginal

5- 18 yr

(a) HV (frequency nr); family based intervention including diet and PA edu, ind and household GS. Water cooler provided to each household. Child PA program (1-2x/wk)

(b) Control- usual care

Same as for children without PA program

Wt, Diet, PA, Dietary knowledge

Protection motivation theory, social learning theory, theories of persuasion, normative influences.

Conwell et al.

2008 59

Australia

Pre-post test

10 wk

10 wk f/u

Child (n=18)

Obese (as defined by International Obesity task force)

8-18 yr

(a) Biweekly HV; ind PA GS and SM. Participants instructed to maintain habitual diet.

Non food based family rewards for child achieving PA goals

Wt, Diet, PA, biomarkers

Epstein et al.

2008 30

USA

RCT

2 yr

2 yr f/u

70 fam

Child (n= 70)

BMI ≥ 75 th percentile

4– 7 yr

(a) HB television viewing allowance using monitoring device, $ rewards for viewing under budget, advice for SB alternatives

(b) Control – no intervention

Monthly newsletters x 12 with parenting tips to reduce SB- commenced when child decreases TV viewing by 50%.

Wt, diet, PA, SB

Estabrooks et al.

2009 41

USA

RCT

Intervention length nr

6 mo and 12 mo f/u

220 fam

Child (n=220)

BMI ≥ 85 th percentile

8- 12 yr

(a) Parent-focussed PA and diet edu workbook plus 2x dietitian led grp edu session for parents

(b) Parent-focussed PA and diet edu workbook plus 2x dietitian led grp edu session for parents plus 10 automated telephone sessions with GS

Parent focussed intervention Wt, diet, PA, SB disordered eating

Social- ecological theory.

JBI Database of Systematic Reviews & Implementation Reports 2013;11(9) 180- 257

Setting

Author

Year

Country

Design

Intervention length

Follow up (f/u)

Sample

Children

Child age

Setting, Intervention mode, intensity, method, study arms

Ie Description

Parental Component Outcome Measures

Theoretical Framework

Harvey-Berino &

Rouke 2003 31

USA

RCT

16 wk

16 wk f/u

43 Mthr/Child pairs

Child (n=43)

BMI (Mthr) >25kg/m 2

Native American

9 mo -3 yr

(a) Weekly HV; Parenting skills development program focussed exclusively on diet and PA.

(b) Weekly HV; General parenting skills development program.

Parent focussed intervention Wt, diet, PA, Child feeding style.

Modelled on SCT but not explicitly stated.

Jiang et al.

2005 58

China

RCT

2 yr

2 yr f/u

75 fam

Child (n= 75)

School grade 7-9

(a) Monthly HV; family based dietary BM, ind PA edu and DA, GS and SM.

(b) Control- no intervention

Family based intervention Wt, biomarkers

Paineau et al.

2008 54

France

RCT

8 mo

8 mo f/u

1013 dyads

Child (n=1013)

7-9 yr

(a) IA and TC (~ 30 mins duration, frequency nr) for reduced fat and increased complex CHO diet. No specific PA recommendations. Monthly newsletters.

(b) IA and TC (~ 30 mins duration, frequency nr) for reduced fat and sugar and increased complex CHO diet. No specific PA recommendations. Monthly newsletters.

(c) Control- General nutrition information, no individualised information, dietary intake recorded as per (a) and (b). no specific PA recommendations.

Family based intervention, same as for children.

Wt, diet, PA, SB, biomarkers

Ransdell et al.

2003 36

USA

RCT

12 wk

12 wk f/u

20 Mthr/Dtr pairs

Child (n=20)

14 -17yrs

(a) Community based PA program, 3x/wk 60- 75 min grp PA sessions at designated facility. Incidental PA encouraged.

(b) HB PA program information pack. PA program to be done in and around participants home. Incidental PA encouraged.

(a) Same as for children

(b) Same as for children, parents encouraged to do PA with children

Wt, PA tolerance ND

Ransdell

2004 35

USA

RCT

6 mo

6 mo f/u

17 Triads- Gmthr/Mthr/Dtr

Child (n= 17)

8-13 yr

(a) 2x 2hr grp program introduction session. Take home written PA program. Monthly TC.

(b) Control- no intervention, wait-list.

Same as for children, encouraged to do PA together

Wt, PA ND

Before and after- school

JBI Database of Systematic Reviews & Implementation Reports 2013;11(9) 180- 257

Setting

Author

Year

Country

Design

Intervention length

Follow up (f/u)

Sample

Children

Child age

Setting, Intervention mode, intensity, method, study arms

Ie Description

Parental Component Outcome Measures

Theoretical Framework

Alexandrov et al.

1992 56

Russia

RCT

1- 3 yr f/u

1005 boys

11-12 yr

(a) 1x (duration nr) ind DA counselling for boys with obesity, increased BP or dyslipidaemia.1x (duration nr) grp DA session for remaining boys. Written information on DA and smoking provided. F/u interview after 1yr.

(b) Control- Reference population

Parents attended sessions with children

Wt, Biomarkers ND

Economous et al.

2007 19

USA

Non-R CT

8 mo

8 mo f/u

1696 children

School grade 1-3

(a) Multi-component community program to change before, during and after school environments. Included breakfast program, walk to school, cooking, PA, increased access to low energy density foods, new school policies. Parental newsletters, school, media and community engagement.

(b) Control grp 1- ND

(c ) Control grp 2 - ND

Bi- monthly newsletters, family events, parent nutrition forum, yearly child health report card

Wt ND

Johnson et al.

1991 43

USA

Non-R CT

12 wk

12 wk f/u

23 Parents

Child (n=19)

9- 13 yr

(a) 8x 90 min grp PA, diet, cooking and smoking edu and activity sessions. 3 x grp and ind family counselling. SM

(b) Control- ND

Child and parent segregated grp edu sessions. Fam counselling.

Wt, Diet, PA, Biomarkers

Joose et al.

2008 65

USA

Pre-Post

12 wk

12 wk f/u

68 fam

Child (n=68)

BMI ≥ 85 th percentile

5 -16 yr

(a) School and YMCA, 12x 60 min weekly grp sessions for diet and behavioural edu, PA session, GS and SM

Same as for children, some parent and child specific sessions (n=nr).

Wt, PA, self esteem, child habits

Kalevainen et al.

2007 52

Finland

RCT

6 mo

6 mo f/u

70 fam

Child (n=70)

Wt for ht 120-200%

7-9 yr

(a) School health care centre; 15x 90min grp healthy lifestyle (not wt management) program. Diet, PA edu, BM and actual PA for children. Written resources (child workbook, parents manual).

(b) Wt, diet and PA workbook. 2x 30min ind counselling for child for self knowledge and PA (parents allowed to participate if willing).

(a) Parents targeted as main agents of change. Parents and children attended separate sessions, 1 joint session only.

(b) Info booklets, attended ind sessions with children.

Wt Behavioural and solution orientated therapy

JBI Database of Systematic Reviews & Implementation Reports 2013;11(9) 180- 257

Setting

Author

Year

Country

Design

Intervention length

Follow up (f/u)

Sample

Children

Child age

Setting, Intervention mode, intensity, method, study arms

Ie Description

Parental Component Outcome Measures

Theoretical Framework

Melnyk et al.

2007 29

USA

RCT

9 wk

9 wk f/u

23 adolescents

BMI>25kg/m 2

15-18 yr

(a) After-school COPE healthy lifestyles TEEN program. 2x/wk 60- 90 min grp sessions for 6 wks plus 1x/wk for 3 wks. Sessions included behavioural skill building, PA (actual 20- 30 mins), diet edu, GS, SM.

(b) Control- Red Cross safety program.

4x(duration nr) grp parent only sessions on how to assist adolescents achieve goals.

Wt CBT

Cognitive- behaviour skills building (CBSB)

Perman et al.

2008 44

USA

Non-RCT

8 mo

8 mo f/u

166 children

BMI>85 th percentile

(targeted intervention group, n=40)

5-12 yr

(a) School wide diet edu and in class (PA) (intensity nr), removal of food rewards, school health advisory council and healthy breakfast and lunch provided in school.

Targeted after-school program for children BMI> 85 th

percentile with 2x/wk 90 min grp sessions for 6mo. Sessions on PA, diet edu and BM.

(b) Comparison school- no intervention

4x (duration nr) grp parent only sessions for cooking, budgeting lifestyle, diet, PA and BM edu. Childcare and fam meal provided when session attended.

Wt ND

Story et al.

2003 66

USA

RCT

12 wk

12 wk f/u

54 girls

BMI >25 th percentile

African American

8 -10 yr

(a) After-school, 2x/wk 60 min grp sessions for 12wk. Included PA (actual), PA and diet edu, GS. Healthy snack and water provided

(b) Control- 3 sessions not related to PA or diet

Weekly info pack, included healthy food ingredients every other week, 2 x family fun night, neighbourhood walking events, 1x TC with MI and GS, 1x ind letter

Wt, diet, PA, knowledge, psychosocial

SCT

Vizcaino et al.

2008 55

Spain

Cluster RCT

24 wk

24 wk f/u

1044 children

9-10 yr

(a) After-school, 3x/wk 90min group PA sessions

(b) nr

Edu on the intervention and heath risks associated with obesity and CVD. Rewards for adherence.

Wt, BP, biomarkers

Weintraub et al.

2009 42

USA

RCT

6 mo

6 mo f/u

21 Children

Overweight ≥ 85 th

percentile

9-13 yr

(a) After-school 3x/wk 75 min grp PA (soccer) sessions, increased to 4x/wk after 5 mo.

(b) Control- Weekly (duration of ind sessions nr), diet and PA edu program.

Attended quarterly matches with children and coaches.

Wt, PA, psychosocial

Community/ leisure centre

Beech et al.

2003 38

RCT

12 wk

60 Mthr/Dtr pairs

BMI ≥ 25 th percentile

(a) Community child focussed 1x/wk 90min grp sessions with PA (actual), diet edu and incentives for compliance.

1x Parent focussed intervention arm (b)

Wt, diet, PA, psychosocial

SCT

JBI Database of Systematic Reviews & Implementation Reports 2013;11(9) 180- 257

Setting

Author

Year

Country

Design

Intervention length

Follow up (f/u)

Sample

Children

Child age

Setting, Intervention mode, intensity, method, study arms

Ie Description

Parental Component Outcome Measures

Theoretical Framework

USA

12 wk f/u

African Americans

8 -10 yr

(b) Parent focussed 1x/wk 90 min parent targeted program with PA (actual), cooking and diet edu and take home resources. Childcare provided for children with non diet or PA focussed activities.

(b) Control- 1x/mo 90min self-esteem enhancement program. Non diet or PA based activities.

Lake

2007 46

Pre-Post

6 mo

6 mo f/u

17 children

4-16yr

(a): Gymnasium session (duration nr) 1-2x/wk. Diet and PA with trainer to motivate and support family weekly.

Same as for children. Family GS.

Wt, Diet, PA, self- esteem

Nemet et al.

2008 51

Israel

RCT

3 mo

3 mo f/u

22 overweight/obese fam

Child/ adolescent (n=22)

Child ≥95 th percentile

BMI (parents) >27kg/m

6 -16 yr

(a) 2x/wk (session duration nr) PA program at sports training centre, additional 30-45min/wk PA advised plus 1x/wk 45min movement therapy session. 1x/wk 60 min (1x 90min) ind diet and behaviour edu for 14wks. Hypocaloric diet (1200- 2000 kcal OR 30% caloric deficit from reported intake or <15% EER) PA

(b) Control- Referral to ambulatory care with ≥ 1x nutritional consultation and instructed to perform PA 3x/wk (duration nr)

8x ind diet edu sessions Parents and children attended separately. Whole fam approach to wt loss encouraged.

Wt, diet, PA, SB ND

Peerbhoy et al.

2008 47

Pre-Post

14 wk

6 mo f/u

34 fam (n= 90)

Child (n=42)

≥ 1 fam member with ≥ 1 CHD risk factor

5-17 yr

(a) Community centres, self-evaluation x 1, diet and PA action plan, fam grp activity x 1, fam pedometers, regeneration initiative participation.

Not adequately described Wt, diet, PA, ND

Robinson et al.

2003 67

USA

RCT

12 wk

12 wk f/u

61 girls

African American

BMI≥50 th percentile

and/or ≥ 1 parent/guardian BMI ≥25kg/m

8-10 yr

(a) Community centres and home; 5x/ wk (girls encouraged to attend as many as possible) grp sessions (2.5hrs) with homework time and PA (dance classes). 5- 6 fam HV for BM and GS to reduce SB (TV viewing).

(b) Control- community centre monthly grp (duration nr) health and diet edu. 11x health and diet edu newsletters.

(a) Fam based HV same as for children plus 5x newsletters to reinforce program

(b) 5x health and diet edu newsletters

Wt, diet, PA, psychosocial

SCT

JBI Database of Systematic Reviews & Implementation Reports 2013;11(9) 180- 257

Setting

Author

Year

Country

Design

Intervention length

Follow up (f/u)

Sample

Children

Child age

Setting, Intervention mode, intensity, method, study arms

Ie Description

Parental Component Outcome Measures

Theoretical Framework

Tyers

2005 48

Pre-Post

1 yr

1yr f/u

16 fam

Child (n=16)

Overweight and Obese (Within Int’l Obesity task force cut offs)

5-12 yr

(a) Leisure centre; 5 x Ind (duration nr) sessions for, DA,and PA edu and SM. 10 wk gym access and ind PA advice available. Written resources provided.

Attended sessions with children. All fam members encouraged to attend and participate in program

2 x fam walks

Wt, diet, PA, psychosocial

Community clinic

Gillis et al.

2007 68

Israël

RCT

6 mo

6 mo f/u

27 children

BMI>90 th Percentile

7- 16 yr

(a) 2 x 30min grp diet and PA edu, weekly TC.

(b) Control- 2 x 30min grp diet and PA edu.

Child focussed intervention .Parents attended grp sessions with children.

Wt, diet, PA, EB

Golan et al.

1998 50

Isreal

RCT

1 yr

1yr f/u

60 Fam

Child (n=60)

Obese (>20% expected wt for ht)

6 -11 yr

(a) Fam/ parent focussed intervention, no direct contact with children. Ind counselling available when required.

(b) 30x 60min grp sessions for children. Diet, PA and SM edu. Ind counselling available when required.

(a) 14x 60min grp sessions on diet, lifestyle and BM edu

(b) nr

Wt, diet, PA, SB, ES

Niinikoski et al.

2007 53

Finland

RCT

7 mo, 13 mo, 2 yr then annually until 14 yr

1062 fam

7mo – 14yr

(a) Well-baby clinics,at 1-3mo intervals until 2yr,

2x.yr until age 7, annual after. Ind diet edu focussed on heart disease risk factors

(b) Control- Basic health edu 2x/ year until 7 yr and annually after

Attended sessions with children

Wt, diet, biomarkers

Summer camp

JBI Database of Systematic Reviews & Implementation Reports 2013;11(9) 180- 257

Gately et al.

2000 32

USA

Pre-Post- delayed

post-test

8 wk

1 yr f/u

194 children

Mean age 12.6 yr

(a) 5 x 1.5hr group PA sessions/ wk, calorific

restriction (1400kcal), 2x/wk grp behaviour

modification and health, diet and PA edu program.

8 x grp parents program

involving diet, PA and wt

management edu.

Wt ND

Baranowski et al.

2003 37

USA

RCT

12 wk

12 wk f/u

35 girls and parents

Child (n=36)

≥ 50 th percentile BMI

African American

Mean age 8 yr

(a) Summer day camp and home; 4wk grp sessions

for diet, behaviour and PA edu plus PA (dance)

followed by 8wk HB internet program.

(b) Control; Usual camp activities and asked to visit

control website 1x/ mo

Access to intervention

website.

Wt, diet, PA,

website use

SCT

University

Ransdell et al.

2001 34

USA

Pre-Post

12 wk

6 mo f/u

10 Mthr/Dtr dyads

and 2 Mthr/Dtr triads

Child (n=12)

11-17 yr

(a) University ;2x/ wk 1.5-2hr sessions for PA and

PA edu, SM. Additional PA encouraged. 6 x mo

newsletters on program completion. Incentives for

program completion.

Same as for children. Mthrs

and Dtrs attend together,

some separation for age

appropriate activities

Wt, PA SCT

church

Resnicow et al.

2005 45

USA

RCT

6 mo

6 mo f/u

123 girls

BMI>90 th percentile

12-16 yr

(a) High Intensity, 24 - 26 weekly sessions with PA

(≥ 30min), behavioural activity (60min), diet edu1x

whole day session. 6x MI TC. GS.

(b) Mod intensity. 6x monthly sessions selected

from high intensity pool. No MI TC or whole day

session.

Parents invited to participate

in every 2nd session with

the children ie 12x sessions

in high intensity grp, 3x

sessions in mod intensity

grpfor PA and food tasting.

Parents met al.one during

60min behavioural activity

Wt, biomarkers ND

JBI Database of Systematic Reviews & Implementation Reports 2013;11(9) 180- 257

RCT- randomised control trial, mo- month, f/u- follow up, fam- families/households, nr- not reported, yr- year, Ind- individual, PA- physical activity, GS- goal setting, HV- home visits, Wt- weight, SM-

self monitoring, ND- not described, BMI- Body mass index, HB- home based, SB- sedentary behaviour, edu- education, grp- group, Mthr- mother, SCT- Social cognitive theory, BM- behaviour

modification, DA- Dietary Advice, IA- Internet access, TC- telephone counselling, min- minutes, CHO- carbohydrates, EER- estimated energy requirements, Gmthr- grandmother, Dtr- daughter, DA-

dietary advice, CVD- cardiovascular disease, EB- eating behaviours, MI- motivational interviewing, mod- moderate, Int’l- International, ES- eating style, HB- home based

JBI Database of Systematic Reviews & Implementation Reports 2013;11(9) 180- 257

Table 2a Critical Appraisal and Study Quality of included Randomised controlled trials studies

Reference Study type

Randomi sation

Groups treated

identically

Outcome measure

ment

Groups comparabl

e at baseline

Blinded to

treatment

Allocation concealme

Withdrawal s and ITT analysis

Blinding of outcome

assessors

Outcomes measured

reliably

Appropri ate

statistical analysis

Score Overall Quality

Melnyk (1)2007

RCT Y Y Y Y N UC Y Y Y Y 7 HIGH

Harvey- Berino (3)

2003

RCT Y Y Y Y N Y Y Y Y Y

8 HIGH

Ransdell (6) 2002

RCT Y Y Y Y N Y Y Y Y Y 8 HIGH

Ransdell (8) 2004

RCT Y Y Y Y N UC N UC Y Y 4

Niinikoski (9) 2007

RCT Y Y Y UC N UC UC UC Y Y 4

Baranowski (10) 2003

RCT Y Y Y N N Y Y Y Y Y 6 HIGH

Robinson (11) 2003

RCT N Y Y Y UC UC Y Y Y Y

6 HIGH

Beech (12) 2003

RCT Y Y Y Y N Y Y Y Y Y

8 HIGH

Story (13) 2003

RCT Y Y Y Y N Y UC Y Y Y 8 HIGH

Anand (15)2007

RCT Y Y Y Y N Y Y Y Y Y

8 HIGH

Table 2: Critical Appraisal

JBI Database of Systematic Reviews & Implementation Reports 2013;11(9) 180- 257

Economous (16) 2007

RCT N Y Y Y N UC Y UC Y Y

Johnson (17) 1991

RCT N Y Y Y N UC Y UC Y Y

Perman (19) 2008

RCT N Y Y Y N N N Y Y Y

Resnicow (21) 2005

RCT N Y Y Y N Y Y Y Y Y

6 HIGH

Paineau (23) 2008

RCT Y Y Y N N Y Y Y Y Y 6 HIGH

Vizcaino (24) 2008

RCT N Y Y Y N Y Y UC Y Y 5

Weintraub (25) 2009

RCT Y Y Y UC N Y Y N Y Y 5

Jiang (28) 2005

RCT Y Y Y Y N Y N UC Y Y 5

Epstein (29) 2008

RCT Y Y Y Y N N Y UC Y Y 5

Estabrooks (30) 2009

RCT Y Y Y N N N Y UC Y Y

Golan (31) 1998

RCT N Y Y Y N N UC UC Y Y

Alexandrov (32) 1992

RCT N Y Y N N UC UC UC Y Y

Kalevainen (33) 2007

RCT N Y Y Y N Y Y UC Y Y 5

JBI Database of Systematic Reviews & Implementation Reports 2013;11(9) 180- 257

Table 2b: Critical Appraisal and Study Quality of included descriptive studies

Reference Study Was the

study

based on

a random

sample?

Inclusion

criteria

clearly

defined

Confounding

factors

identified

Outcomes

assessed

using

objective

criteria

Sufficient

descriptions

of the

groups

Adequate

follow up

Withdrawals

described

Outcomes

measured

reliably

Appropriate

statistical

analysis

Score Overall

quality

Gately (4)

2000 Pre-Post

N N N Y N Y Y Y Y 1

Joose (5)

2008 Pre- Post

N N UC Y N Y UC Y Y 1

Tyers (7)

2005 Pre- Post

N Y N Y N Y N Y UC 0

Peerbhoy

(14) 2008 Pre- Post

N Y N Y N Y UC Y N 0

Gillis (34) 2007

RCT Y Y Y Y N Y Y UC Y Y 7 HIGH

Nemet (35) 2008

RCT Y Y Y Y N Y Y UC Y Y 7 HIGH

JBI Database of Systematic Reviews & Implementation Reports 2013;11(9) 180- 257

Lake (20)

2007 Pre- Post

N Y UC Y N Y UC N N -1

Ransdell

(27) 2001 Pre- Post

N N N Y N Y UC Y Y 0

Conwell

(36) 2008 Pre- Post

N Y N Y N Y Y Y Y 3

JBI Database of Systematic Reviews & Implementation Reports 2013;11(9) 180- 257

Table 3: Weight outcomes of included studies

Study and

Design

Measurement

Result (a) = intervention; (b) = control/usual care

Significance –

from baseline†; Between groups‡

HOME-BASED

Anand et al.

2007 (RCT) 57

(a) House-

hold dietary

and physical

activity

intervention

(b) Usual care

Mean wt change from

B(kg)

(a) n= 84/88, 6mo: -0.6 (?)

(b) n= 75/86, 6mo: 0.3 (?)

Mean wt gain (kg) from

baseline to post

intervention

(a) n=53/88, 6mo: 3.4±0.30SE

(b) n=44/86, 6mo: 3.4±0.32SE NS‡

Mean weight loss (kg)

from baseline to post

intervention

(a) n=19/88, 6mo: -4.1±0.60SE

(b) n=23/86, 6mo: -3.2±0.52SE NS‡

Mean weight stability

from baseline to post

intervention

(kg)

(a) n=12/88, 6mo: 0.1±0.09SE

(b) n=8/86, 6mo: 0.1±0.07

NS‡

JBI Database of Systematic Reviews & Implementation Reports 2013;11(9) 180- 257

Study and

Design

Measurement

Result (a) = intervention; (b) = control/usual care

Significance –

from baseline†; Between groups‡

Conwell et al.

2008 (Pre-

Post)

(a) Home-

based

physical

activity

intervention

Mean wt (kg) at

baseline, post-

intervention and

follow-up

(a) B (n=15) 81.1 (4.0SE), 10wk (n=15) 83.3 (4.1SE) (P<0.05),

20wk (n=15) 85.0 (3.9SE) (P<0.05)

Wk10; p<0.05†Wk20;p<0.05†

Mean BMI (Kg/m 2 )

B 34.5 (1.3), 10wk 34.9 (1.5), 20wk 35.0 (1.4)

NS†

Mean BMI-SDS

B 3.45 (0.11), 10wk 3.41 (0.11), 20wk 3.42 (0.11)

NS†

Mean WC (cm) B 106.7 (2.4), 10wk 106.2 (2.5) 20wk 107.2 (2.4) NS†

Epstein et al.

2009 (RCT)

(a) Reduced

t.v viewing (b)

Control

Mean change BMI z-

score from baseline to

24mo

(a) (n= 35) 24 mo -0.24±0.37SE

(b) (n= 32) 24 mo -0.13 ±0.32SE

p<0.05†

(I) > reduction in zBMI than (C): 6 mo; p= 0.02‡, 12 mo; p= 0.03‡

Estabrooks et Mean BMI z-score for

all 3 intervention

(a) B (n=49) 2.04 (0.02SE), 6mo (n=38) 1.99 (0.03SE), 12mo (n= 36) 1.98 (0.03SE) (a) 12mo p=<0.05†

JBI Database of Systematic Reviews & Implementation Reports 2013;11(9) 180- 257

Study and

Design

Measurement

Result (a) = intervention; (b) = control/usual care

Significance –

from baseline†; Between groups‡

al 2009 (RCT)

(a) Workbook

(b) Group

sessions (c)

Interactive

voice

response

groups at baseline, 6

and 12mo§

(b) B (n=85) 2.06 (0.04), 6mo (n=64) 2.03 (0.04), 12mo (n=56) 2.04 (0.04)

(b) 6mo p=<0.05†

Group (c) receiving 6-10 calls had > reduction BMI z score than (a) and (b)

at 6mo (p<0.05) and 12mo (p<0.01)‡

Harvey-Berino

& Rouke 2003

(RCT)

(a) obesity

prevention

program +

parenting

support (b)

parenting

support only

Mean WHZ score at

baseline, post-

intervention and

overall change (OC)

(a) n= 20: B 0.79±1.2SD, 16wk n= 20 0: 0.52±1.1SD, OC: -0.27±1.1SD

(b) n= 20: B 0.67±1.6, 16wk n= 20: 0.98 (1.4), OC: 0.31±1.1SD

NS†‡

Wt (kg) at baseline,

post-intervention and

overall change (OC)

(a) B: 12.2±2.4, 16wk: 13.1±2.4, OC: 0.9±2.4

(b) B 12.3 (2.9), 16wk 13.8 (3.6), OC: 1.5±3.2

NS†‡

>85th WHP (n %)

(a) B: 5 (25), 16wk: 3 (15)

(b) B: 3 (15), 16wk: 3 (15)

NS†‡

JBI Database of Systematic Reviews & Implementation Reports 2013;11(9) 180- 257

Study and

Design

Measurement

Result (a) = intervention; (b) = control/usual care

Significance –

from baseline†; Between groups‡

>95th WHP (n %)

(a) B:3 (15), 16wk: 1 (5)

(b) B: 5 (25), 16wk: 6 (30)

NS†‡

Jiang et al.

2005 (RCT)

(a) Family-

based

behavioural

treatment

program (b)

Control

Mean wt (kg) at

baseline, 2yrs and

overall change (∆)

(a) n= 33: B 70.1±5.7SD, 2yr: 69.7±4.4SD, Δ (B to 2 yr) -0.3±4.3SD

(b) n= 35: B 71.2±6.4, 2yr: 76.7±6.6, Δ (B to 2 yr) 5.5±3.5

(Δ B- 2yr) p= <0.001‡

Mean BMI (kg/m 2 )

(a) n= 33: B 26.6±1.7SD, 2yr: 24.0±0.9SD, Δ (B to 2 yr) -2.6±1.6SD

(b) n= 35: B 26.1±1.5, 2yr: 26.0±1.6, Δ (B to 2 yr) -0.1±1.1

(Δ B- 2yr) p= <0.001‡, (Δ B- 2yr) in (a) (p<0.001)†

Paineau et al.

2008 (RCT)

(a) ↓Fat,

↑CHO (b) ↓ fat

and sugar ↑

complex CHO

Mean wt (kg) change

from baseline to post-

intervention

(a) 8mo 1.6 (95% CI, 1.4 to 1.8)

(b) 8mo 1.7 (95% CI, 1.4 to 1.9)

NS‡

Mean BMI (kg/m 2 )

change from baseline

to post-intervention

(a) (n= 297) 0.05 (− 0.06 to 0.16)

(b) (n= 298) 0.10 (− 0.03 to 0.23)

NS‡

JBI Database of Systematic Reviews & Implementation Reports 2013;11(9) 180- 257

Study and

Design

Measurement

Result (a) = intervention; (b) = control/usual care

Significance –

from baseline†; Between groups‡

Mean BMI z-score

change from B

(a) -0.13 (−0.20 to -0.05)

(b) -0.09 (-0.18 to − 0.01)

NS‡

Ransdell et al.

2002 (RCT)

(a)

Community

based PA

program (b)

Home-based

PA program

Mean body fat (%) at

baseline and post-

intervention

(a) Dtr; Mthr (n= 10) B 30.50±6.25SD; 37.16±5.20SD, 12wk 30.82±5.70SD;

36.86±5.44SD

(b) Dtr; Mthr (n= 7) B 22.17±6.05; 35.77±4.68, 12wk 23.0±(5.53; 35.66±3.67

Dtr (Δ B-12wk) p= <0.01‡ (Mthr NS‡)

Dtr + Mthr: NS†

Ransdell*

2004 (RCT)

(a) Home-

nased PA

program (b)

Control

Mean wt (lbs) at

baseline and post-

intervention and

%change

(a) n= 27: B 132.95±43.21, 6mo: 132.91±40.09, %change: -0.03

(b) n= 9: B 122.09±41.74, 6mo: 122.55±39.38, %change: +0.38

NS†‡

BEFORE AND AFTER SCHOOL

JBI Database of Systematic Reviews & Implementation Reports 2013;11(9) 180- 257

Study and

Design

Measurement

Result (a) = intervention; (b) = control/usual care

Significance –

from baseline†; Between groups‡

Alexandrov et

al.1992 (RCT)

(a) Healthy

lifestyle

counseling (b)

Reference

group

Mean Quetelet Index

(kg/m 2 ) at baseline,

year 2 and 3

(a) n= 383 B 17.5(2.3SD); 2yr 18.0(2.2SD); 3yr 19.7(2.4SD)

(b) n= 383 B 17.7(2.6SD); 2yr 18.4(2.7SD); 3yr 19.7(2.6SD)

2y: P<0.05‡

3y: NS‡

Mean Quetelet Index

(kg/m 2 ) change

between years 1-2 and

3-4

(a) Δ after 1yr: +0.54, Δ after 3 yrs: +0.22

(b) Δ after 1yr: +0.72, Δ after 3 yrs: +0.21

1yr: p=0.0063‡ (3yr NS‡)

Economous et

al. 2007 (Non-

RCT)

(a)

Community-

based diet

and PA

program (b)

and (c)

reference

groups

BMI z score change for

females and males

from baseline to post-

intervention + Δ BMI z

score

(a) n= 190(F); n= 195(M) B 0.782±1.10SD; 0.918±1.021SD, 8mo 0.755±1.070SD;

0.882±1.022SD, Δ: -0.027±0.356, Δ: -0.036±0.284

(b) n= 298(F); n=263(M) B 0.617±1.060SD; 0.777±0.999SD, 8mo 0.615±1.065SD;

0.768±0.995SD, Δ: -0.002±0.265, -0.009±0.289

(c )n= 117(F); n=115(M) B 0.679±1.055SD; 1.132±0.903SD, 8mo 0.688±1.055SD;

1.113±0.926SD, Δ: 0.009±0.294, -0.018±0.253

Multiple regression of

Δ BMI z score pre- and

post-intervention

(a) vs (b)+(c): -0.1005 (95%CI, -0.1151 to – 0.0859) p=0.001

Johnson et al. Mean Ponderosity

(wt/ht 3 ) change for

(a) B (n=14) 18.1(3.5SD), 12wk (n=12) 17.7(4.0SD) NS†‡

JBI Database of Systematic Reviews & Implementation Reports 2013;11(9) 180- 257

Study and

Design

Measurement

Result (a) = intervention; (b) = control/usual care

Significance –

from baseline†; Between groups‡

1991 (Non

Random CT)

(a) School-

based healthy

lifestyle

program (b)

Control

adults from baseline to

post-intervention

(b) B (n=9) 18.4(2.7SD), 12wk (n=8) 18.6(2.7SD)

Mean Ponderosity

(wt/ht 3 ) change for

children from baseline

to post-intervention

Data NR. Stated NS difference over time or between groups. NS†‡

Joose et al.

2008 (Pre

Post)

(a) Healthy

lifestyle

program

Mean BMI (kg/m 2 ) at

baseline and post-

intervention

(a) n= 68 B 30.00(6.533SD), 12wk 29(6.193SD)

P<0.0001†

Mean BC (cm) (a) n= 68 B 370.06(64.43SD), 12wk 362.51(60.41SD)

P<0.0004†

Kalevainen et

al.

2007 (RCT)

(a) Family-

based healthy

Change in wt-for-ht (%)

from baseline to post-

intervention

(a) (n= 35) 6 mo - 6.8(6.2SD)

(b) 6 mo -1.8(6.2)

P= 0.001‡

JBI Database of Systematic Reviews & Implementation Reports 2013;11(9) 180- 257

Study and

Design

Measurement

Result (a) = intervention; (b) = control/usual care

Significance –

from baseline†; Between groups‡

lifestyle

treatment (b)

Routine

counseling (2

sessions)

≥5 % reduction (n)

post-intervention

(a) 22(63 %)

(b) 9(26 %)

P= 0.004‡

≥10 % reduction (n)

post-intervention

(a) 5(14%)

(b) 13(37 %)

P= 0.054‡

Change in BMI (kg/m 2 )

from baseline to post-

intervention

(a) 0.0(1.1)

(b) -0.8(1.0)

P=0.003‡

Change in BMI-SDS

from baseline to post-

intervention

(a) -0.2(0.3)

(b) -0.3 (0.3)

P= 0.022‡

JBI Database of Systematic Reviews & Implementation Reports 2013;11(9) 180- 257

Study and

Design

Measurement

Result (a) = intervention; (b) = control/usual care

Significance –

from baseline†; Between groups‡

Melnyk et al.

2007 (RCT)

(a) Healthy

lifestyle

program (b)

Control

Mean BMI (kg/m 2 ) at

baseline and post-

intervention

(a) B (n= 7) 33.1(10.30SD), 9wk (n=6) 29.34 (4.92SD)

(b) B (n=5) 30.72 (3.23), 9wk (n=5) 33.07(3.41)

Diff Δ BMI between groups p=0.03‡

Mean Weight (lb) at

baseline and post-

intervention

(a) B 212.36 (83.71), 9wk 180.67(43.14)

(b) B 189.90 (25.99), 9wk 200.60 (20.90)

Diff Δ weight between groups =p0.03‡

Perman et al.

2008(Non-

RCT)

(a) Project

school (b)

Comparison

school

Mean BMI percentile

change from baseline

to post-intervention

(a) (n= 166) B 72.14(27.33SD), 8mo 68.57(31.62SD)

(b) (n= 184) B 76.88(25.5), 8mo 75.49(26.11)

P=0.027‡

Targeted group NS results (data NR)

Story et al.

2003 (RCT)

(a) After-

school obesity

prevention

Mean BMI (kg/m2)

change from baseline to

post-intervention

(a) B (n=26) 21.9 (5.9SD), 12wk (n=26) 21.7 (0.2SE)

(b) B (n=28) 19.5 (3.3SD), 12wk (n=27) 21.5 (0.2SE)

Adjusted Mean Difference 0.2 (0.2)

NS‡

JBI Database of Systematic Reviews & Implementation Reports 2013;11(9) 180- 257

Study and

Design

Measurement

Result (a) = intervention; (b) = control/usual care

Significance –

from baseline†; Between groups‡

program (b)

Control

Mean Waist (cm)

change from baseline to

post-intervention

(a) B 72.0 (14.4), 12wk (n=26) 72.0 (0.5)

(b) B 65.7 (9.8), 12wk (n=27) 70.7 (0.5)

Adjusted Mean Difference 1.4 (0.8)

NS‡

Vizcaino et al.

2008 (Cluster

RCT) (a)

School-based

PA program

(b) Control

Mean BMI (kg/m 2 )

change from baseline

to post-intervention

(a) boys (n=260); girls (n=253), B18.4 (3.6); 18.7 (3.7), 24wk 18.8 (3.7); 18.9 (3.4)

(b) boys (n=296); girls (n=310), B 18.6 (3.4); 18.5 (3.6), 24wk 19.0 (3.4); 18.8 (3.6)

Adjusted mean difference between intervention and control: boys;girls, 0.07(-0.12;

0.27);-0.12 (-0.32; 0.07) (95%CI)

Adjusted mean diff NS‡

Mean BMI >75th

Percentile change from

baseline to post-

intervention

(a) B 23.6 (2.8), 24wk 23.5 (2.6) }

(b) B 23.6 (2.8), 24wk 23.5 (2.6)

n=264 reported for intervention and control group combined

Adjusted difference of intervention vs control -0.13 (-0.41; 0.16) (95%CI)

Adjusted mean diff NS‡

Weintraub et

al. 2009

(RCT)

(a) After-

BMI z score

(a) n= 9 B 2.15 (0.44SD), 3mo 2.08 (0.49SD), 6mo 2.06 (0.50SD)

(b) n= 12 B 2.22 (0.33SD), 3m 2.22 (0.30SD), 6mo 2.06 (0.50SD)

Adjusted differences between intervention and control 3mo: -0.07 (95% CI, -0.13 to -

Adjusted diff 3mo and 6mo: p=0.04‡

JBI Database of Systematic Reviews & Implementation Reports 2013;11(9) 180- 257

Study and

Design

Measurement

Result (a) = intervention; (b) = control/usual care

Significance –

from baseline†; Between groups‡

school team

sports

program (b)

Control

0.003)

Adjusted differences between intervention and control 6mo: -0.08 (-0.16 to -0.003)

BMI (kg/m 2 ) (a) B 27.17 (4.96), 3mo 27.12 (5.20), 6mo 27.39 (5.44)

(b) B 29.01 (4.77), 3m0 29.3 (4.52), 6mo 29.80 (4.90)

Adjusted differences between intervention and control 3mo: -0.43 (95% CI, -1.15 to

0.30)

Adjusted differences between intervention and control 6mo: -0.48 (-1.46, 0.49)

Adjusted diff 3mo and 6mo: NS‡

COMMUNITY/ LEISURE CENTRE

Beech et al.

2003 (RCT)

Mean BMI (kg/m 2 )

Mean WC (cm)

(a) n= 21 B 25.5 (7.4SD), 12wk 24.3 (0.2SE)

(b) n= 21 B 23.0 (5.6), 12wk 24.3 (0.2)

(a) n= 21 B nr, 12wk 74.0 (0.6SE)

(b) n= 21 B nr, 12wk 74.7 (0.6)

JBI Database of Systematic Reviews & Implementation Reports 2013;11(9) 180- 257

Study and

Design

Measurement

Result (a) = intervention; (b) = control/usual care

Significance –

from baseline†; Between groups‡

Lake

2007

(Pre- Post)

BMI z-score

(a) n=15; 60% decreased, 40% increased

(a) 53% decreased (average 2.4cm), 56% increased (average 3.5cm)

Nemet et al.

2008 (RCT)

Mean Wt (kg)

Mean BMI (kg/m 2 )

Mean BMI Percentile

(%)

(a) n= 11 B 56.2(4.8 SEM), 3mo 55.9(4.8 SEM)

(b) n= 11 B 55.9(4.8SEM), 3mo 57.6 (5.2SEM)

(a) B 26.6(1.8), 3mo 25.9 (1.9)

(b) B 26.5(1.3), 3mo 26.4(1.4)

(a) B 97.2(0.5), 3mo 95.8(1.0)

(b) B 97.3 (0.5), 3mo 97.3(0.5)

P=<0.05

Peerbhoy et

al. 2008 (Pre-

Post

Mean BMI (kg/m 2 ) Reported as no change (Data not provided) NS

Robinson et

al.

2003 (RCT)

Mean BMI (kg/m 2 )

(a) n= 28 B 20.95 (5.39SD), 12wk 21.45 (5.49SD)

(b) n= 33 B 21.57 (5.26), 12wk 22.28 (5.65)

JBI Database of Systematic Reviews & Implementation Reports 2013;11(9) 180- 257

Study and

Design

Measurement

Result (a) = intervention; (b) = control/usual care

Significance –

from baseline†; Between groups‡

Mean WC (cm) (a) B 71.00 (13.99), 12wk 71.62 (14.43)

(b) B 71.04 (3.15), 12wk 72.12 (13.38)

Tyers

2005 (Pre-

Post)

BMI (kg/m 2 ) Centile

Status

(a) n=16, 83% of children improved (data nr) 1yr

COMMUNITY CLINIC

Gillis et al.

2007 (RCT)

Mean Change BMI SDS

from B

(a) n= 11 B 1.98 (0.21), 6mo 1.93 (0.37), Δ (B to 6mo) -0.045 (0.19)

(b) n= 7 B 2.16 (0.34), 6m 2.23 (0.29), Δ (B to 6mo) 0.075 (0.08)

NS for any parameter

Golan et al.

1998 (RCT)

Degree of over wt (t)

Mean wt change (%)

from B

(a) (n=30) 1 yr 7.35

(b) (n= 30) 1 yr 3.74

(a) -14.6%

(b) - 8.1%

(P<0.001)

(P<0.01)

Significantly greater (P<0.05) wt loss (a) vs (b)

Niinikoski et

al.

Mean Wt (kg) Boys

JBI Database of Systematic Reviews & Implementation Reports 2013;11(9) 180- 257

Study and

Design

Measurement

Result (a) = intervention; (b) = control/usual care

Significance –

from baseline†; Between groups‡

2007 (RCT)

(a) (n= 267) 13mo 10.5, 4yr 17.2, 7yr 24.3, 10yr 34.1, 11yr 37.8, 12yr 41.5, 13yr 47.6, 14yr (n= 135) 53.9

(b) (n= 243) 13mo 10.6, 4yr 17.3, 7yr 24.4, 10yr 34.211yr 38, 12yr 42.6, 13yr48.5, 14yr (n= 141) 55.6

Girls

(a) (n= 241) 13mo 10, 4yr 17, 7yr 24.6, 10yr 34.9, 11yr 39.2, 12yr 44.3, 13yr 49.2, 14yr (n= 119) 54.1

(b) (n=239) 13mo 9.8, 4yr16.8, 7yr 24.6, 10yr 35, 11yr 39.7, 12yr 44.7, 13yr 49.6, 14yr (n= 137) 53.9

By grp NS (P=0.27)

SUMMER CAMP

Gately et al.

2000 (Pre-

Post)

Mean BMI (kg/m 2 )

Mean Wt (kg)

B (n=102) 32.7(7.2), 8wk (n=102) 28.3(6.4), 1yr (n=102) 30.1(7.0)

B (n= 102) 83.5 (26.6), 8wk (n= 102) 72.3(23.6) 1yr (n=102) 82.2(25.9)

Group x time P=<0.01

Baranowski et

al. 2003

(RCT)

Mean BMI (kg/m 2 )

Mean WC (cm)

(a) B (n=19) 21.1 (4.4SD), 12wk (n=17) 24.6 (1.0SD)

(b) B (n=14) 26.3 (7.9SD), 12wk (n=14) 24.1 (1.1SD)

(a) B (n=19) nr, 12wk (n=17) 74.1 (0.9SD)

(b) B (n=14) nr, 12wk (n=14) 71.7 (1.0SD)

By grp

UNIVERSITY

JBI Database of Systematic Reviews & Implementation Reports 2013;11(9) 180- 257

Study and

Design

Measurement

Result (a) = intervention; (b) = control/usual care

Significance –

from baseline†; Between groups‡

Ransdell et

al.

2001 (Pre-

Post)

Mean Wt (kg)

n= 26 B 60.8 (5.2SE), 12 wk 61.9 (5.1SE) P= 0.03

CHURCH

Resnicow et

al 2005 (RCT)

Mean BMI (kg/m 2 )

Mean Wt (lbs)

Mean WC (cm)

(a) n= 53 B 32.0 (5.8SD), 6mo 31.9 (5.5SD)

(b) n= 70 B 33.2 (7.3), 6mo 33.6 (7.8)

(a) B 185.4 (39.4), 6mo 186.9 (38.6)

(b) B 193.8 (46.3), 6mo 197.1 (48.1)

(a) B 87.1 (11.4), 6mo 87.0 (11.7)

(b) B 88.2 (12.4), 6mo 90.1 (15.3)

RCT- randomized control trial, * Indicates child and adult data combined child only data not reported, wt- weight, B- baseline, mo- month, nr- not reported, BMI- body mass index, WC- waist

circumference, wk- week, SE- standard error, NS- not statistically significant, grp- group, diff- difference, SD- standard deviation, dtr- daughter, mthr- mother, ht- height, CI-confidence interval, BC-

body circumference

†Significant difference from baseline

‡Significant difference between groups

JBI Database of Systematic Reviews & Implementation Reports 2013;11(9) 180- 257

Table 4: Secondary outcomes (diet and physical activity) of included studies

Source Diet

assessment

tool

Dietary

Outcome

Measure

Result

Significance Physical

Activity

Assessment

tool

Physical

Activity

Outcome

Measure

Result Significance

Home Based

Anand et al.

2007 (RCT)

24 hour recall Mean

kcals/day

Mean fat

intake (%

kcals)

Mean F&V

intake

(serve/d)

Mean fats,

oils, sweets

(serve/d)

Mean soda

(a) B 1948

(845SD),

6m:1696 (541SD)

(b) B 2102 (802),

6m: 1874 (617)

(a) B 35.7 (8.8),

6m 35.6 (8.5)

(b)

33.4(7.9),33.2(9.0

)

(a) B 2.4 (SD nr),

6m 2.5 (SD nr)

by group

P=0.006

P= 0.02

24 hour PA

recall

(children)

Questionnair

(Adolescents

)

Low activity1

participants)

Moderate

Activity (%

participants)

High Activity

(%)

Screen hours

(hrs/day)

(a) B 26.7, 6m 24.0

(b) B 21.9, 6m 23.4

(a) B 52.0, 6m 51.0

(b) B 50.0, 6m 54.7

(a) B 21.7, 6m 25.3

(b) B 28.1, 6m 21.8

(a) B 3.7 (2.9), 6m 3.1

(3.7)

(b) B 3.5 (3.0), 6m 3.4

(4.0)

by group

JBI Database of Systematic Reviews & Implementation Reports 2013;11(9) 180- 257

Source Diet

assessment

tool

Dietary

Outcome

Measure

Result

Significance Physical

Activity

Assessment

tool

Physical

Activity

Outcome

Measure

Result Significance

pop/juice

(serve/d)

(b) B 2.4, 6m 2.1

(a) B 17.5, 6m

12.5

(b) B 21.8, 6m

18.8 0.006

(a) B 1.3 (1.1SD),

6m 0.9 (0.9SD)

(b) B 1.5 (1.1), 6m

1.4 (1.0)

Conwell et al.

2008 (Pre-

Post)

3 day food diary Mean Total

E(kJ/d):

Mean % total

E from fat

(%)

B 1713.6.6

(115.5SE), 10wk

1673.0 (15.9SE),

20wk(f/u) 1779.3

(172.3SE)

B 29.7 (1.8), 10wk

29.8 (1.3), 20wk

f(/u)32.1 (2.21)

group by

time

7 day

Pedometer

Mean Daily

Step Counts

(Steps/d)

B: 10800 (919SE), 6wk

14120 (1191SE), 10wk

13667 (1117SE)

group by time

P<0.05 (6wk)

P<0.05

(10wk)

JBI Database of Systematic Reviews & Implementation Reports 2013;11(9) 180- 257

Source Diet

assessment

tool

Dietary

Outcome

Measure

Result

Significance Physical

Activity

Assessment

tool

Physical

Activity

Outcome

Measure

Result Significance

Epstein et al.

2008

85 item FFQ

(parent

complete)

Energy

(kcal/d)

(a) 18mo: -400,

24mo -320

(b) 18mo: -200,

24mo -180

by group

P<0.05 B to

18mo and

24mo

Acceleromet

er (3 random

weekdays +1

weekend

day)

allowance

Mean

change PA

(counts/min)

Mean

change TV/

Computer

Use (hrs/wk)

(a) B 757.0(256.4SD),

6mo 36.2(381.3), 12m

63.7(288.8), 18m

111.8(603.0), 24m

31.4(275.4)

(b) B 783.5(249.1SD),

6mo 43.7(302.2), 12m

7.8(316), 18m -

23.5(265.4), 24m –

62.7(189.7)

(a)B 24.2(10.8SD)

6mo−17.5 (7.0), 24m

−17.5 (7.0)

(b) B 26.1(10.1SD),

by group

By group P=

<0.001

JBI Database of Systematic Reviews & Implementation Reports 2013;11(9) 180- 257

Source Diet

assessment

tool

Dietary

Outcome

Measure

Result

Significance Physical

Activity

Assessment

tool

Physical

Activity

Outcome

Measure

Result Significance

24mo -5.2 (11.1)

Estabrooks et

al.

2009

Food frequency

questionnaire

Mean intake

sugared

drinks

(ounces/wk):

Mean intake

fruit

(serve/d):

Mean intake

vegetables

(serve/d):

(a) B: 92.46

(116.5SE), 6mo:

63.93 (56.86SE),

12mo: 71.81

(89.97SE)

(b) B: 83.25

(98.9), 6mo:

59.10 (58.29),

12mo: 59.63

(62.74)

(c )B: 76.63

(83.68), 6m:

50.40 (42.35),

12m: 60.94 (55.0)

(a) B: 0.97 (0.82),

6m: 1.24 (1.28),

12m: 1.15 (1.05)

By grp

P<0.05

Youth

behavior risk

survey

VPA (d/wk)

MPA(d/wk)

Sedentary

(a) B: 4.30 (2.08SE),

6mo: 4.44 (2.04SE),

12mo: 4.04 (2.05SE)

(b) B: 3.75 (2.24), 6m:

3.57 (2.24), 12m: 3.47

(2.09)

3.97 (1.94), 12m: 4.32

(2.13)

(a) B: 2.56 (2.26, 6m:

2.82 (2.35, 12m: 2.36

(2.61)

(b) B: 2.01 (2.54), 6m:

2.64 (2.35), 12m: 2.71

(2.21)

By grp

6m,12m

P<0.05

JBI Database of Systematic Reviews & Implementation Reports 2013;11(9) 180- 257

Source Diet

assessment

tool

Dietary

Outcome

Measure

Result

Significance Physical

Activity

Assessment

tool

Physical

Activity

Outcome

Measure

Result Significance

(b) B: 1.32 (1.14),

6m: 1.76 (2.29),

12m: 1.26 (1.88)

(c )B: 1.2 (0.9),

6m: 1.1 (1.2),

12m: 1.22 (1.32)

(a) B: 1.01 (0.99,

6m: 1.27 (1.42),

12m: 1.48 (1.8)

(b) B: 1.36 (1.37),

6m: 1.5 (1.66),

12m: 1.41 (1.39)

(c )B: 1.61 (1.75),

6m: 1.54 (1.73),

12m: 1.26 (1.34)

Screen Time

(hr/d)

2.47 (2.10), 12m: 2.79

(1.96)

(a) B: 5.39 (2.22), 6m:

5.49 (2.55), 12m: 5.64

(2.61)

(b) B: 5.63 (2.54), 6m:

5.7 (2.2), 12m: 5.6

(2.04)

(c ) B: 5.27 (2.15, 6m:

5.00 (2.05), 12m: 5.47

(1.96)

Harvey-Berino

& Rouke

3 day food

record (2

weekdays and 1

Mean energy

intake

(kcal/kg per

(a)

B138.3(85.8SD),

16wk

By group

P=0.06

Acceleromet

er 3 days

Mean PA

(Vmag/h)

(a) B 20 457(8 670SD),

16wk 17 886 (6 746SD)

By group

JBI Database of Systematic Reviews & Implementation Reports 2013;11(9) 180- 257

Source Diet

assessment

tool

Dietary

Outcome

Measure

Result

Significance Physical

Activity

Assessment

tool

Physical

Activity

Outcome

Measure

Result Significance

2003 (RCT) weekend) d)

Mean fat

intake (g/d)

Fat intake (%

kcal/d)

Mean

change child

feeding

score

102.1(37.8SD)

(b) B115.1 (53.6),

16wk 122(56.2)

(a) B 60(43),

16wk 50.4(19.8),

(b) B 52(22),

16wk 56.9(22.3)

(a) B 34.9(6.4),

16wk 34.0(7.2)

(b) B 35.8(8.7),

16wk 32.7(5.2)

(a) -0.22 (0.42)

(b) 0.08 (0.63)

(b) B 19417 (5 735),

16wk 17 637 (8 151)

By group

P<0.05

Jiang et al.

2005

nr nr nr nr nr nr nr

JBI Database of Systematic Reviews & Implementation Reports 2013;11(9) 180- 257

Source Diet

assessment

tool

Dietary

Outcome

Measure

Result

Significance Physical

Activity

Assessment

tool

Physical

Activity

Outcome

Measure

Result Significance

Paineau et al.

2008 (RCT)

3 day dietary

record (2

weekdays + 1

weekend)

Mean

change total

energy

(kcal/d)

Mean

change fat

intake (%

total EI)

Mean

change

sugar intake

(% total EI)

Mean

change

(a) −60 (−104 to

−15 (95% CI))

(b) −96 (−146 to

−45)

(c )19 (− 19 to 59)

(a) − 3.3 (− 4.0 to

− 2.6)

(b) − 2.3 (− 3.0 to

− 1.5)

− 0.1)

(a) -0.4 (− 1.0 to

0.1)

(b) −1.0 (− 1.7 to

− 0.4)

P<0.05

P<0.01

Modifiable

Activity

Questionnair

Daily Screen

Viewing

No significant change

JBI Database of Systematic Reviews & Implementation Reports 2013;11(9) 180- 257

Source Diet

assessment

tool

Dietary

Outcome

Measure

Result

Significance Physical

Activity

Assessment

tool

Physical

Activity

Outcome

Measure

Result Significance

complex

CHO intake

(% total EI)

Mean

change CHO

intake (%

total EI)

Mean

change pro

intake (%

total EI)

0.0)

(a) 3.3 (2.6 to 4.0)

(b) 2.4 (1.6 to

3.1)i

(c )1.2 (0.6 to 1.7)

(a) 2.9 (2.2 to 3.6)

(b) 1.3 (0.5 to 2.1)

(a) 0.4 (0.0 to 0.7)

(b) 0.9 (0.5 to 1.3)

0.2

P<0.01

JBI Database of Systematic Reviews & Implementation Reports 2013;11(9) 180- 257

Source Diet

assessment

tool

Dietary

Outcome

Measure

Result

Significance Physical

Activity

Assessment

tool

Physical

Activity

Outcome

Measure

Result Significance

Ransdell et al.

2002 (RCT)

nr nr Sit and

Reach test

1 mile walk

test

Mean

flexibility

(cm)

Mean

Aerobic

capacity

(mL/kg/1/min

/1)

Mean push-

ups (reps

p/min)

Mean Sit-ups

(reps/min)

(a) B 34.40(9.72SD),

12wk 35.53 (7.12SD)

(b) B 27.64(13.43),

12wk 30.50(12.67)

(a) B 39.06 (8.13),

12wk 40.44 (5.09)

(b) B 42.26(3.35), 12wk

43.59(3.55)

(a) B 22.20(10.82)

12wk 29.20(12.48)

(b) B 22.00(12.34)

12wk 23.43(7.66)

(a) B 28.90(17.170,

12wk 61.00(16.67)

(b) B 39.14 (11.88),

By group

Time P ≤

0.001

Interaction P=

0.03

JBI Database of Systematic Reviews & Implementation Reports 2013;11(9) 180- 257

Source Diet

assessment

tool

Dietary

Outcome

Measure

Result

Significance Physical

Activity

Assessment

tool

Physical

Activity

Outcome

Measure

Result Significance

12wk P 52.29(10.44)

Ransdell

2004

USA

nr nr Pedometer

(3 day

average)

Sit and reach

1 mile test

Mean

steps/d

Mean

participation

flexibility

exercises

(d.wk-1)

Mean

participation

aerobic

activity (d.wk

(a) B.8422.85

6mo11517.39

(b) B9411.15

I(a) B .95 (1.51),6mo

3.55(2.06)

(b):1.62(2.77), 6mo

1.37(2.39)

I(a) B 2.10(1.86), 6mo

4.35(1.35)

By group P=<

0.001

By group P=<

0.001

By group P=<

0.03

JBI Database of Systematic Reviews & Implementation Reports 2013;11(9) 180- 257

Source Diet

assessment

tool

Dietary

Outcome

Measure

Result

Significance Physical

Activity

Assessment

tool

Physical

Activity

Outcome

Measure

Result Significance

-1)

Mean

participation

muscular

strength

activity(d.wk-

(a) B 1.159(1.84), 6mo

3.55(2.06)

(b) B 1.25(1.75), 6mo

1.50(1.41)

By group

P= 0.05

Before-and after-school

Alexandrov et

al.

1992

Russia

nr nr

Economous et Questionnair

e (details not

nr nr Questionnaire

(details not

nr nr nr

JBI Database of Systematic Reviews & Implementation Reports 2013;11(9) 180- 257

Source Diet

assessment

tool

Dietary

Outcome

Measure

Result

Significance Physical

Activity

Assessment

tool

Physical

Activity

Outcome

Measure

Result Significance

al.

2007

USA

well

described)

Dietary intake and

eating behaviours

at baseline were

assessed

however not post

intervention.

well described)

Johnson et al.

1991

USA

Multiple 24 hour

food record

Mean %

Change E

intake (kcal)

Mean %

Change Total

fat (%kcal)

Mean %

Change

Saturated

fat(%kcal)

Mean %

Change Total

(a)I -41

(b) 34

(a) -9

(b) 12

(a) -19

(b) 5

(a) -40

(b) 3

P=<0.01

Physical

activity

questionnaire

(not well

described)

1-mile

run/walk

(minutes)

Average -1.5 min

(14.9 to 13.4)

P= <0.01

JBI Database of Systematic Reviews & Implementation Reports 2013;11(9) 180- 257

Source Diet

assessment

tool

Dietary

Outcome

Measure

Result

Significance Physical

Activity

Assessment

tool

Physical

Activity

Outcome

Measure

Result Significance

Sugar(%

kcal)

Joose et al.

2008

USA

Weekly log book

to record food

and

Family/child

habit

questionnaire

Knowledge

and attitude

of healthy

lifestyle

(mean score)

B 103.37 (12.32

SD)

12wk 114.27

(12.8 SD)

Weekly log

book to record

food and

Family/child

habit

questionnaire

PA and SB

log

59% increased time in

32% reduced time in

P<0.0001

Kalevainen et

al.

2007

Finland

nr nr nr nr

Melnyk et al..

2007 RCT

Program

Evaluation

questionnaire

Increase in

knowledge of

nutritional values

Program

evaluation

questionnaire

There was an

increase in time spent

walking

JBI Database of Systematic Reviews & Implementation Reports 2013;11(9) 180- 257

Source Diet

assessment

tool

Dietary

Outcome

Measure

Result

Significance Physical

Activity

Assessment

tool

Physical

Activity

Outcome

Measure

Result Significance

Increase F&V

Perman et al.

2008

Non RCT

nr nr nr nr

Story et al.

2003 (RCT)

2 x 24 hour

recall (weekday

+ weekend)

Mean F&V

intake

(serve/d)

Mean intake

sweetened

beverages

(serve/d)

Mean EI

(kcal/d)

(a) B nr, 12wk

1.5(0.2 SE)

(b) 12wk 1.8 (0.2)

Adjusted mean

difference -0.4

(0.1)

(a) 12wk 1.1(0.2)

(b) 12wk 0.9(0.1)

Adjusted mean

difference 0.6

(0.1)

Acceleromet

er worn 3

days +

GEMS

activity

questionnair

PA (CSA

count/min)

PA (Min Mod-

Vig PA)

PA (GAQ, me-

adjusted

score)

(a) 12wk

503.7(26.9SE)

(b) 12wk 446(24.6)

(a) 12wk 119(10.1)

(b) 12wk 116.1(9.2)

(a) 12wk 4.6(0.3)

(b) 12wk 4.3(0.3).

JBI Database of Systematic Reviews & Implementation Reports 2013;11(9) 180- 257

Source Diet

assessment

tool

Dietary

Outcome

Measure

Result

Significance Physical

Activity

Assessment

tool

Physical

Activity

Outcome

Measure

Result Significance

Mean fat

intake (%

total EI)

(a) 12wk 1225(70)

(b) 12wk

1369(68.7)

Adjusted mean

difference -1.24

(98.1)

(a) 12wk 31.0(1.2)

(b) P 32.1(1.1)

Adjusted mean

difference -1.1

(1.7)

Vizcaino et al.

2008

Custer RCT

nr nr nr nr

JBI Database of Systematic Reviews & Implementation Reports 2013;11(9) 180- 257

Source Diet

assessment

tool

Dietary

Outcome

Measure

Result

Significance Physical

Activity

Assessment

tool

Physical

Activity

Outcome

Measure

Result Significance

Weintraub et

al.

2009

USA

nr nr Acceleromet

ers 6 days

Mean total

activity 7am-

10pm

(counts/min)

MPA 3000-

5200

counts/min

(min)

VPA, >5200

counts/min

(min)

(a) B

641.65(92.77SD),

3mo

633.48(132.15SD)

6mo 545.41

(97.92SD)

(b) B 508.97(87.78),

3m 408.34(97.66)

6m 412.69(93.16)

(a) B 22.96(10.18),

3m 24.81(11.92)

6m 18.70(9.31)

(b) B 14.20(7.07),

3m10.00(6.68)

6m 11.10(5.89)

P=0.04

6m NS

3m P=0.03

6m NS

3m P=0.02

6m NS

JBI Database of Systematic Reviews & Implementation Reports 2013;11(9) 180- 257

Source Diet

assessment

tool

Dietary

Outcome

Measure

Result

Significance Physical

Activity

Assessment

tool

Physical

Activity

Outcome

Measure

Result Significance

Self report

screen time

questionnair

Television and

other

screen time

(h/wk)

(a) B 7.06(3.33, 3m

9.21(4.29)

6m4.95(3.09)

(b) B 5.96(4.72), 3m

4.71(3.25)

6m 3.63(2.54)

(a) B 17.14(15.00),

3m 13.72(8.96)

6m 10.83(11.40)

(b) B 19.67(16.50),

3m 11.60(10.65)

6m 18.65(16.94)

Community/ leisure centre

Beech et al. 2x 24 hour

recalls (non

Mean F&V

intake

(a) 2.9 (0.46 SE) Between grp Acceleromet

er (3 days)

PA (CSA

count/min)

I: 361.0 (17.3) NS

JBI Database of Systematic Reviews & Implementation Reports 2013;11(9) 180- 257

Source Diet

assessment

tool

Dietary

Outcome

Measure

Result

Significance Physical

Activity

Assessment

tool

Physical

Activity

Outcome

Measure

Result Significance

2003 (RCT) consecutive

days)

(serve/d)

Mean intake

sweetened

beverages

(serve/d)

Mean energy

Intake

(kcal/d)

Mean fat

intake (%

(b) 3.13 (0.48)

Adjusted mean

difference (a + b

vs c) 0.43 (0.20)

(a) 2.38 (0.38)

(b) 1.52 (0.1)

(c ) 2.96 (0.46)

Adjusted mean

difference 1.57

(0.40)

(a) 1387 (114.0)

(b) 1472 (116.4)

P= 0.03

Min Mod-Vig

GAQ, me-

adjusted

score

C:347.3 (18.2)

I:72.0 (8.2)

C:67.5 (8.5)

I: 4.0 (0.5)

C:3.8 (0.5)

JBI Database of Systematic Reviews & Implementation Reports 2013;11(9) 180- 257

Source Diet

assessment

tool

Dietary

Outcome

Measure

Result

Significance Physical

Activity

Assessment

tool

Physical

Activity

Outcome

Measure

Result Significance

total EI)

Adjusted means

difference -85.2

(162.9)

(a) 36.3 (1.5)

(b) 34.9 (1.5)

Adjusted mean

difference 1.4

(2.1)

Lake

2007

Not well

described

F&V

80% increased nr Not well

described

Fitness

(n= 87.5%) improved

fitness level by 33%

80% increased

Nemet et al. 48 hour diet

recall (incl 1

Mean total EI

(kcal/d)

(a) B 1691 (224

SEM), 3mo 1403

NS Not well

described

Screen Time

(h/d)

(a) B 3.8 (0.5 SEM),

3mo 1.9 (0.3 SEM)

Between grp

JBI Database of Systematic Reviews & Implementation Reports 2013;11(9) 180- 257

Source Diet

assessment

tool

Dietary

Outcome

Measure

Result

Significance Physical

Activity

Assessment

tool

Physical

Activity

Outcome

Measure

Result Significance

2008 (RCT) weekday + 1

weekend)

(129 SEM)

(b) B 1932 (117),

3mo 1591 (85)

Progressive

treadmill test

Endurance

Time (sec)

(b) B 4.5 (0.5), 3mo 4.6

(0.5)

(a) B 595 (45), 3mo 776

(40)

(b) B 637 (27), 3mo 649

(67)

P= <.0.05

Peerbhoy et

al.

2008 Pre post

Adult and young

persons survey

I: P Increase in

healthy and

reduction in

unhealthy foods

(Data not

provided)

nr Adult and

young

persons

survey

I: P increase in number

attending gym and

swimming, increased

number feeling more fit

(no data)

• Increased enjoyment

in undertaking physical

activity (no data).

Robinson et 2 x 24 hour

recalls ( non

Mean total EI (a) B 1561.5

(473.9SD), 12wk

Acceleromet PA noon±6

PM (avg

(a) B 721.6 (298.4SD),

JBI Database of Systematic Reviews & Implementation Reports 2013;11(9) 180- 257

Source Diet

assessment

tool

Dietary

Outcome

Measure

Result

Significance Physical

Activity

Assessment

tool

Physical

Activity

Outcome

Measure

Result Significance

al.

2003 (RCT)

consecutive

days)

(kcal/d)

Mean total

fat intake (%

total EI)

1601.4 (718.6SD)

(b) B 1627.8

(671.0), 12wk

1545.0(502.6)

(a) B 33.7 (7.3),

12wk 34.1(5.2)

(b) B 36.2

(5.2),12wk

35.1(7.5)

er (3 days)

Media

Questionnair

CSA

counts/min)

Moderate-to-

vigorous PA

noon±6 PM

(avg

minutes)

Ate dinner

with TV on

(d/wk)

Household

TV use ((0-4

scale)

12wk 744.9 (239.2SD)

(b) B 810.3 (329.7),

12wk 750.8 (437.7)

(a) B 113.0 (53.1) 12wk

102.1 (41.1)

(b) B 133.9 (68.1) 12wk

106.6 (70.5)

(a) B 2.93(2.79) 12wk

2.27(2.57)

(b) B 3.36(3.19) 12wk

3.97(2.90)

(a) 2.22 (0.92),

12wk1.85 (0.90)

P =0.03

P= 0.007

JBI Database of Systematic Reviews & Implementation Reports 2013;11(9) 180- 257

Source Diet

assessment

tool

Dietary

Outcome

Measure

Result

Significance Physical

Activity

Assessment

tool

Physical

Activity

Outcome

Measure

Result Significance

(b) 2.27 (1.15), 12wk

2.41 (1.11)

Tyers

2005

Pre post

Diet history F&V intake

(serves/d)

Sweets/choc

olate intake

(frequency/w

Crisp intake

(frequency/w

IB 2

12mo 3.5

B 3

12mo 2

B 5

12 mo 3

nr Not well

described

Increased level of PA,

no data reported.

Community clinic

Gillis et al.

2007 (RCT)

1 week food

recrod

Number of

participants

with intake

sweetened

beverage ≥

(a) 8

(b) 11

By grp NS

1 week

exercise

record

Modified

Harvard Step

Test

(a) B: 39.2 ± 18.8, 6mo

40.2 ± 13.1

(b) B: 33.2 ± 16, 6mo

43 ± 5.2

By grp

JBI Database of Systematic Reviews & Implementation Reports 2013;11(9) 180- 257

Source Diet

assessment

tool

Dietary

Outcome

Measure

Result

Significance Physical

Activity

Assessment

tool

Physical

Activity

Outcome

Measure

Result Significance

1/d

Number of

participants

with F & V

intake intake

≥ 1x/d

(a) 11

(b) 12

Number of

participants

eating

between

meals

Number of

participants

reporting

nocturnal

eating

(a) 13

(b) 8

(a) 5

(b) 6

Golan et al.

1998

Isreal

7 day food

records +24

hour recall

Mean E

intake (%

RDA)

(a) 1yr 75%

(b) 1yr 89%

Baseline E intake

in both groups =

9.5J/d

By grp

P=<0.01

Family

Eating and

activity

habits

questionnair

Mean PA

(h/wk)

Mean TV

viewing (h/d)

(a) B 3.70(0.6) 1y

4.47(0.5)

(b) B 3.45(0.4) 1y

3.54(0.6)

(a) B 3.10(0.1) 1y 2.72

(0.1)

(b) B 2.80(0.1) 1y

By grp

JBI Database of Systematic Reviews & Implementation Reports 2013;11(9) 180- 257

Source Diet

assessment

tool

Dietary

Outcome

Measure

Result

Significance Physical

Activity

Assessment

tool

Physical

Activity

Outcome

Measure

Result Significance

2.69(0.1)

Niinikoski et

al.

2007

Finland

4 day food

records

(annually)

Total E

intake (kJ)

SFA Intake

(%E)

Boys

(a) 13mo, 4116,

4y 5625, 7y 6803,

10y 756311y

7592, 12y 7934,

13y 8098, 14y

8569

(b) 13mo 4217, 4y

5885, 7y 8945,

10y 7883,

11y7894,

12y8302, 13y

8699, 14y 9219

Girls

(a) 13m 3858, 4y

5226, 7y 6243,

10y 6953, 11y

By grp

P=<0.001

Sex

P=<0.001

By group

P= <0.001

Sex P=0.035

JBI Database of Systematic Reviews & Implementation Reports 2013;11(9) 180- 257

Source Diet

assessment

tool

Dietary

Outcome

Measure

Result

Significance Physical

Activity

Assessment

tool

Physical

Activity

Outcome

Measure

Result Significance

7064, 12y 7329,

13y7516, 14y

7369

(b) 13m 3986, 4y

5398, 7y 6348,

10y 6809, 11y

7002, 12y 7140,

13y 7177, 14y

Boys

(a) 13m 9, 4y 12,

7y 12, 10y 11,

11y 11, 12y 11,

13y 12, 14y 11

(b) 13m 13, 4y 14,

7y 13, 10y 13,

11y 13, 12y 11,

13y 13,14y 13

Girls

JBI Database of Systematic Reviews & Implementation Reports 2013;11(9) 180- 257

Source Diet

assessment

tool

Dietary

Outcome

Measure

Result

Significance Physical

Activity

Assessment

tool

Physical

Activity

Outcome

Measure

Result Significance

(a) 13m 10, 4y 12,

7y 12, 10y 11,11y

11, 12y 12, 13y

11, 14y 12

(b) 13m 13, 4y 14,

7y 14,10y 14, 11y

13, 12y, 13, 13y

13, 14y 13

Summer camp

Gately et al.

2000

USA

nr nr nr

Baranowski et

al.

2003 RCT

Food intake

recorded for 2

days

Mean total EI

(kcal/d)

adjusted

difference or

-231.5 (209.1 SE)

Acceleromter

+ GEMS

Activity

Questionnair

CSA, 24

hours

(counts/min)

adjusted

6.0 (34.4SE)

JBI Database of Systematic Reviews & Implementation Reports 2013;11(9) 180- 257

Source Diet

assessment

tool

Dietary

Outcome

Measure

Result

Significance Physical

Activity

Assessment

tool

Physical

Activity

Outcome

Measure

Result Significance

estimated

ratio

Mean total

fat intake (%

total EI)

adjusted

difference or

estimated

ratio

Mean F&V

(serve/d)

adjusted

difference or

estimated

ratio

-1.6 (1.8)

1.2 (0.2)

0.8 (0.2)

e difference or

estimated

ratio

CSA, mod to

vigorous, min

adjusted

difference or

estimated

ratio

CSA, noon-6

(counts/min)

adjusted

difference or

estimated

ratio

-7.3 (11.8)

8.3 (62.1)

JBI Database of Systematic Reviews & Implementation Reports 2013;11(9) 180- 257

Source Diet

assessment

tool

Dietary

Outcome

Measure

Result

Significance Physical

Activity

Assessment

tool

Physical

Activity

Outcome

Measure

Result Significance

Mean

sweetened

beverage

intake

(serve/d)

adjusted

difference or

estimated

ratio

Mean water

intake

(serve/d)

adjusted

difference or

estimated

ratio

1.4 (0.5)

MET

adjusted

GAQ-usually

adjusted

difference or

estimated

ratio

0.8 (0.6)

University

JBI Database of Systematic Reviews & Implementation Reports 2013;11(9) 180- 257

Source Diet

assessment

tool

Dietary

Outcome

Measure

Result

Significance Physical

Activity

Assessment

tool

Physical

Activity

Outcome

Measure

Result Significance

Ransdell et al.

2001

Pre Post

nr nr Behavioural

Risk factor

Surveillance

survey

PA (d/wk)

B: 2.6 (0.73SE), 12wk

3.6 (0.5SE), 6mo (f/u)

3.3 (0.51SE)

Church

Resnicow et

al.

2005 (RCT)

nr nr nr nr

B= Baseline, F&V= fruit and vegetable, d= day, SD= standard deviation, PA= physical activity, FFQ-= food frequency questionnaire, nr= not reported, CI=

confidence interval, EI= energy intake, CHO= carbohydrate, pro= protein, Vmag/h= vector magnitude per hour, avg= average, wk- week, mo= month, RDA=

recommended daily allowance, E= energy, h= hour, SFA= saturated fatty acid, y= year

VPA= vigorous physical activity

MPA=moderate physical activity