Elsevier

Academic Pediatrics

Volume 15, Issue 4, July–August 2015, Pages 353-361
Academic Pediatrics

Systematic Review
Treatment Interventions for Early Childhood Obesity: A Systematic Review

https://doi.org/10.1016/j.acap.2015.04.037Get rights and content

Abstract

Context

With 25% of preschool-age children in the United States being overweight or obese, effective interventions for these children would have significant public health implications. Randomized trials targeting this age group have been performed since the last systematic review.

Objective

To systematically review the literature on treatment interventions for overweight or obesity in preschool-age children.

Data Sources

Medline (1948–July 2014), the Cochrane Central Registry (1991–July 2014), CINAHL (1990–July2014), and PAS abstracts (2000–2014).

Study Selection

Inclusion criteria were children aged 0 to 6 in the study and adiposity as an outcome. Exclusions were having normal-weight children in the trial and not having a comparison group.

Data Extraction

Data were extracted independently by 2 authors using a template.

Results

The initial search yielded 1981 results, narrowed to 289 abstracts after initial review. Further analysis and cross-referencing led to the selection of 6 randomized controlled trials representing 1222 children. Two studies used systems changes and motivational interviewing and showed no significant effect on adiposity. Two studies used an intensive, multidisciplinary approach over 6 months and demonstrated significant decreases in adiposity. One study tested parental coaching and showed a significant reduction in adiposity at 6 months. One study used education on a dairy-rich diet and showed a possible effect on adiposity.

Limitations

The study designs were too heterogeneous for meta-analysis; few ethnic minority subjects were included.

Conclusions

Multidisciplinary, intensive interventions have some evidence of efficacy in reducing adiposity in preschool children.

Section snippets

Review Protocol

A detailed protocol was developed and is available by request from the corresponding author. A priori inclusion criteria were studies that enrolled children aged 0 to 6, included a measure of adiposity as an outcome, and had a specific strategy for addressing children aged 0 to 6 if other ages were included. Inclusion of normal-weight children was an exclusion criterion, as we chose to focus on intervention rather than primary prevention. We used 3 accepted definitions for overweight or obesity

Search Results

The initial search yielded 1981 results that were narrowed down to 289 abstracts after initial review of title and abstract for inclusion criteria (done by BF, JF, PP) (Figure). Further analysis of full articles and cross-referencing led to the selection of the 6 studies included in this review (BF, JF); any conflicts were resolved via discussion. Of the 289 articles, 81 were excluded as a result of an inability to analyze the 0- to 6-year-old age group independently of other age groups. For

Discussion

In this systematic review of treatment interventions for obesity in early childhood, the more intensive multidisciplinary studies14, 17 demonstrated significant reductions in adiposity measures compared to usual care, while negative results were seen in 2 large studies done using systems-based interventions along with motivational interviewing.18, 19 The other study that demonstrated a significant change in adiposity measure16 differed from the more intensive studies in 2 ways. First, they

Acknowledgments

BAF was supported by a grant from the US NIH/NCATS (KL2 TL001118). The sponsor had no role in the study design, collection, analysis or interpretation of data; nor in the writing of the report or the decision to submit the article for publication.

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