Systematic review of physical activity and exercise interventions on body mass indices, subsequent physical activity and psychological symptoms in overweight and obese adolescents.

Ruotsalainen H1, Kyngäs H2,3, Tammelin T4, Kääriäinen M2.

 J Adv Nurs. 2015 May 29. doi: 10.1111/jan.12696. (Review) PMID: 26031309

Abstract

AIMS:

To examine the effects of physical activity and exercise interventions on body mass index, subsequent physical activity and psychological symptoms for overweight and obese adolescents (12-18 years).

BACKGROUND:

Overweight and obesity have increased among adolescents globally and physical activity has decreased. Healthcare systems face challenges promoting physical activity and in treating obesity. Promotion of physical activity must be effective and school nurses should be equipped with the information and resources required to implement counselling for overweight and obese adolescents.

DESIGN:

A systematic review of randomized controlled trials was conducted according to procedures by the Centre for Reviews and Dissemination and the Joanna Briggs Institute.

DATA SOURCES:

Research studies published between 1950-2013 were identified from the following databases. CINAHL, MEDLINE (Ovid) and PsycINFO.

REVIEW METHODS:

Selected studies were reviewed for quality and a risk-of-bias assessment was conducted for the included studies. A narrative synthesis was used to report results, while a fixed-effect meta-analysis was used to analyse the interventions effects on physical activity and body mass index.

RESULTS:

Fourteen published studies were included to this review. Supervised exercise interventions most affected adolescents' body mass index. The interventions effect on adolescents' physical activity was small and heterogeneous. Two interventions positively affected psychological symptoms.

CONCLUSION:

Interventions were complex, with more than one component and the aspect that effectively promotes physical activity in obese adolescents was not clear. However, it seems that exercise interventions affect the body mass index of overweight or obese adolescents. Interventions that include a component for promoting physical activity with or without supervised exercise can affect subsequent physical activity and body mass index.

Primary prevention of childhood obesity, second edition.

Primary prevention of childhood obesity, second edition.

Registered Nurses' Association of Ontario (RNAO). Primary prevention of childhood obesity, second edition. Toronto (ON): Registered Nurses' Association of Ontario (RNAO); 2014 May. 140 p. [265 references]

Major Recommendations

The levels of evidence supporting the recommendations (Ia, Ib, IIa, IIb, III, IV) are defined at the end of the "Major Recommendations" field.

Practice Recommendations

Assessment

Recommendation 1.1

Routinely assess children's nutrition, physical activity, sedentary behaviour, and growth according to established guidelines, beginning as early as possible in a child's lifespan.

(Level of Evidence = IV)

Recommendation 1.2

Assess the family environment for factors (e.g., parenting/primary caregiver influences and socio-cultural factors) that may increase children's risk of obesity.

(Level of Evidence = IV)

Recommendation 1.3

Collaborate with school leaders to assess elementary-school environments for risk and protective conditions that influence childhood obesity, including:

• Student demographics
• School policies
• Food and physical activity environments

(Level of Evidence = IV)

Recommendation 1.4

Assess neighbourhoods for community-level risk and protective conditions that influence childhood obesity.

(Level of Evidence = IV)

Planning

Recommendation 2.1

Engage community stakeholders when planning primary-prevention interventions for childhood obesity.

(Level of Evidence = IIb)

Recommendation 2.2

Develop interventions that are:

• Universally applied, as early as possible (Level of Evidence = IV)
• Targeted toward multiple behaviours (Level of Evidence = IV)
• Implemented using multiple approaches (Level of Evidence = IIa)
• Inclusive of parents/primary caregivers and the family (Level of Evidence = IIa), and
• Implemented simultaneously in multiple settings (Level of Evidence = IIa)

Implementation

Recommendation 3.1

Support exclusive breastfeeding for the first six months of life followed by breastfeeding and complementary feeding up to two years of age or beyond.

(Level of Evidence = III)

Recommendation 3.2

Provide education and social support to help parents/primary caregivers to promote healthy eating and physical activity in infants and toddlers.

(Level of Evidence = Ib)

Recommendation 3.3

Collaborate with parents/primary caregivers, educators and support staff (e.g., teachers, child care providers, school leaders) to promote healthy eating and physical activity in all settings where preschool children gather.

(Level of Evidence = Ib)

Recommendation 3.4

Collaborate with school communities to promote regular physical activity among elementary-school children.

(Level of Evidence = IIb)

Recommendation 3.5

Facilitate and support the integration of health and nutrition education into elementary-school programs and support the improvement of the school food environment.

(Level of Evidence = IIa–III)

Evaluation

Recommendation 4.1

Monitor and evaluate the effectiveness of the family's approach to healthy eating and physical activity.

(Level of Evidence = IV)

Recommendation 4.2

Evaluate the effectiveness and sustainability of school- and community-based primary-prevention initiatives.

(Level of Evidence = IV)

Recommendation 4.3

Advocate and support the evaluation of an organization's compliance with healthy public policies, and the impact of such policies on childhood eating behaviours and physical activity.

(Level of Evidence = III)

Education Recommendations

Recommendation 5.1

Incorporate foundational primary-prevention curricula based on this Guideline into the undergraduate education of nurses and other health-care providers.

(Level of Evidence = IV)

Recommendation 5.2

Health-care professionals should participate in continuing education to enhance their ability to support the positive behavioural and environmental changes for children, families, and communities recommended in this Guideline.

(Level of Evidence = IV)

.../...

Effectiveness of web-based programs on the reduction of childhood obesity in school-aged children: a systematic review.

Original bibliographic details:

Antwi FA, Fazylova N, Garcon MC, Lopez L, Rubiano R, Slyer JT. Effectiveness of web-based programs on the reduction of childhood obesity in school-aged children: a systematic review. JBI Database of Systematic Reviews and Implementation Reports 2013; 11(6): 1-44. DOI 10.11124/jbisrir-2013-459

[In: DARE http://www.crd.york.ac.uk/crdweb/ShowRecord.asp?ID=12013057780#.UzaP8_l5Oup]

CRD summary

The authors concluded that a web-based programme, as part of a multi-component intervention, could reduce besity and being overweight, in school-aged children. The authors' conclusions may be overstated given the mixed results in the individual trials, the variation between the interventions, and the limited synthesis.

Authors' objectives

To assess the effectiveness of web-based programmes to reduce childhood obesity in school-aged children.

Searching

A broad range of 15 databases, including CINAHL, PubMed, EMBASE, PsycINFO and ERIC, was searched for articles from 1991 to August 2012; search strategies for each database were reported. Reference lists of included studies were checked. Studies had to be in English.

Study selection

Randomised controlled trials (RCTs) or pseudo-randomised trials of web-based programmes, alone or with other components, aimed at reducing obesity in four- to 18-year-olds, were eligible for inclusion. The outcomes of interest were measures of weight including body mass index (BMI), body weight and waist circumference.

The included trials were all conducted in the USA, except one that was conducted in the Netherlands. The trials included normal-weight, at-risk or overweight children. Most trials were of adolescent boys and girls. The interventions were typically weekly sessions of web-based programmes targeting weight loss, body image improvement, or behaviour modification for weight control. In all trials, the web-based intervention was delivered with other interventions, such as counselling sessions, parental involvement, or phone or email prompts. The interventions lasted between five and 52 weeks.

The authors did not state how many reviewers selected studies.

Assessment of study quality

Two reviewers independently assessed trial quality using the Joanna Briggs Institute (JBI) critical appraisal checklist for randomised controlled or pseudo-randomised trials. Trials had to meet a minimum of six out of the 10 checklist criteria to be included in the review. Disagreements were resolved through discussion or by a third reviewer.

Data extraction

The mean and standard deviation of the body mass index (BMI), BMI z-score, waist-hip ratio, waist circumference, and body fat at the start and after intervention were extracted.

Two reviewers independently extracted the data; disagreements were resolved by discussion or by a third reviewer.

Methods of synthesis

A narrative synthesis was presented, due to significant clinical and methodological variation.

Results of the review

Twelve reports of eight RCTs were included (1,717 school-aged children; range 30 to 883). Follow-up ranged from three to 24 months. All RCTs were judged to be of adequate quality.

Four RCTs showed that web-based programmes reduced either BMI, BMI z-score, waist-hip ratio, or body fat. Reductions were not observed beyond nine months after the intervention. One RCT showed no difference in BMI, one showed no difference in BMI z-score, and two showed an increase in BMI at follow-up.

Parents were involved as part of the intervention in all the trials that showed an improvement or no change from the start. Telephone or email reminders were part of the intervention in four of these six trials.

Authors' conclusions

A reduction in obesity and being overweight, for school-aged children, was possible with web-based weight-reduction interventions that had other components.

CRD commentary

The review question and inclusion criteria were clear. The restriction to trials in English may have excluded some relevant data. Data extraction and quality assessment were undertaken by two reviewers independently, which reduced the potential for error, but it was unclear whether the same process was used for study selection. While all the included trials were considered to be of adequate quality, some were at risk of bias.

A narrative synthesis was appropriate given the differences in the included interventions and populations, but the synthesis was very limited. The synthesis was also limited by the small size and relatively short follow-up in the included trials. As all the interventions included other components it was difficult to determine whether any benefits were due to the web-based programme or to the other components.

The authors' conclusions may be overstated given the mixed results in the individual trials, the variation between the interventions, and the limited synthesis.

Implications of the review for practice and research

Practice: The authors stated that using web-based technology as part of a multi-component intervention for weight reduction in school-aged children was promising.

Research: The authors stated that future studies should evaluate the effects of web-based technology as a single intervention, on a large sample, over a long period of time.

Estimating overweight risk in childhood from predictors during infancy.

Pediatrics. 2013 Aug;132(2):e414-21. doi: 10.1542/peds.2012-3858.Epub 2013Jul15.

Weng SF, Redsell SA, Nathan D, Swift JA, Yang M, Glazebrook C.

OBJECTIVE: The aim of this study was to develop and validate a risk score
algorithm for childhood overweight based on a prediction model in infants.
METHODS: Analysis was conducted by using the UK Millennium Cohort Study. The
cohort was divided randomly by using 80% of the sample for derivation of the risk
algorithm and 20% of the sample for validation. Stepwise logistic regression
determined a prediction model for childhood overweight at 3 years defined by the 
International Obesity Task Force criteria. Predictive metrics R(2), area under
the receiver operating curve (AUROC), sensitivity, specificity, positive
predictive value (PPV), and negative predictive value (NPV) were calculated.
RESULTS: Seven predictors were found to be significantly associated with
overweight at 3 years in a mutually adjusted predictor model: gender, birth
weight, weight gain, maternal prepregnancy BMI, paternal BMI, maternal smoking in
pregnancy, and breastfeeding status. Risk scores ranged from 0 to 59
corresponding to a predicted risk from 4.1% to 73.8%. The model revealed
moderately good predictive ability in both the derivation cohort (R(2) = 0.92,
AUROC = 0.721, sensitivity = 0.699, specificity = 0.679, PPV = 38%, NPV = 87%)
and validation cohort (R(2) = 0.84, AUROC = 0.755, sensitivity = 0.769,
specificity = 0.665, PPV = 37%, NPV = 89%).
CONCLUSIONS: Using a prediction algorithm to identify at-risk infants could
reduce levels of child overweight and obesity by enabling health professionals to
target prevention more effectively. Further research needs to evaluate the
clinical validity, feasibility, and acceptability of communicating this risk.