Article Figures & Tables
Figures
- Figure 1:
Selection of studies for inclusion in the systematic review and meta-analyses.
- Figure 2:
Effect of treatment interventions on body mass index and body mass index z-score (behavioural, pharmacological plus behavioural). Note: BMI z = body mass index z-score, F = female, M = male, SMD = standardized mean difference.
Tables
Study Mean age at baseline, yr No. of participants Baseline weight category Intervention Location Date Type Target Comparator Length, mo Bäcklund et al.52 10 105 Overweight + obese Lifestyle Family No intervention 24 Sweden 2011 Bryant et al.40 11 70 Obese Lifestyle Family Wait list 12 UK 2011 Chanoine et al.31 14 539 Obese Orlistat, diet+exercise Individual Placebo 12 US + Canada 2005 Coppins et al.43 10 65 Overweight + obese Lifestyle Family No intervention 12 UK 2011 Croker et al.42 10 72 Obese Lifestyle Individual Wait list 6 UK 2012 DeBar et al.41 14 208 Overweight + obese Lifestyle Individual Minimal component 5 US 2012 Doyle et al.37 15 83 Overweight + obese Lifestyle Individual Minimal component 4 US 2008 Ebbeling et al.57 15 224 Overweight + obese Diet Individual No intervention 12 US 2012 Epstein et al.38 6 70 Overweight + obese Lifestyle Family Minimal component 24 US 2008 Golley et al.33 8 111 Overweight + obese Lifestyle Family Minimal component 12 Australia 2007 Janicke et al.54 11 93 Overweight + obese Lifestyle Family Wait list 4 US 2009 Lisón et al.56 11 110 Overweight + obese Diet+exercise Individual Usual care 6 Spain 2012 Lochrie et al.60 10 130 Overweight + obese Lifestyle Family Minimal component 6 US 2013 Maahs et al.39 16 40 Overweight + obese Orlistat, diet+exercise Individual Placebo 6 US 2006 Maddison et al.46 12 322 Overweight + obese Exercise Individual No intervention 6 New Zealand 2011 McCallum et al.34 7 163 Overweight + obese Lifestyle Family No intervention 3 Australia 2007 Nemet et al.36 11 54 Obese Diet+exercise Family Usual care 3 Israel 2005 O’Connor et al.61 7 40 Overweight + obese Lifestyle Family Wait list 6 US 2011 Racine et al.49 9 62 Overweight + obese Diet Individual Placebo 6 US 2010 Reinehr et al.48 11 71 Overweight Lifestyle Individual No intervention 6 Germany 2010 Sacher et al.53 10 116 Obese Lifestyle Family Usual care 6 UK 2010 Saelens et al.35 14 44 Overweight + obese Lifestyle Individual Usual care 4 US 2002 Savoye et al.32 12 174 Obese Lifestyle Family Usual care 12 US 2007 Taveras et al.45 5 445 Overweight + obese Lifestyle Family Usual care 12 US 2011 Toulabi et al.58 16 152 Obese Diet+exercise Individual No intervention 24 Iran 2012 Vos et al.55 13 81 Obese Lifestyle Family Wait list 3 Netherlands 2011 Wafa et al.44 10 107 Obese Lifestyle Family No intervention 6 Malaysia 2011 Wake et al.50 7 258 Overweight + obese Diet+exercise Family Usual care 3 Australia 2009 Wake et al.59 7 118 Obese Lifestyle Family No intervention 12 Australia 2013 Waling et al.47 10 105 Overweight + obese Diet+exercise Family No intervention 12 Sweden 2010 Weigel et al.51 11 73 Obese Diet+exercise Individual No intervention 12 Germany 2008 Study Sequence generation Allocation concealment Blinding of personnel/
participantsBlinding of outcome assessors Incomplete reporting Selective reporting Other bias Objective* Subjective† Self-reported‡ Objective* Subjective† Self-reported‡ Bäcklund et al.52 U U H U L L L Bryant et al.40 L U H U H H H Chanoine et al.31 U L U L U U H H H L H Coppins et al.43 U U H U L L L Croker et al.42 L U H L H H H L L DeBar et al.41 L U H L L H L L L L L Doyle et al.37 L L H L L L L Ebbeling et al.57 U U H L H L L L L Epstein et al.38 L U H U L L L Golley et al.33 L L H L L L L Janicke et al.54 U U H U L L H Lisón et al.56 H H H U L L H Lochrie et al.60 U U H U H L H Maahs et al.39 U U L L L L L L L L H Maddison et al.46 L L H U U L L L L McCallum et al.34 L U H U L L L Nemet et al.36 L U H U L L L O’Connor et al.61 L U H U L L H Racine et al.49 U U H L U U L L U L H Reinehr et al.48 L U H H L L H Sacher et al.53 L U H L H H H L L Saelens et al.35 L L H U L L H Savoye et al.32 L L H L U H H L L Taveras et al.45 L U H U L L L Toulabi et al.58 U U H U U L L Vos et al.55 L U H L U H L L L L H Wafa et al.44 L L H L H H H L L Wake et al.50 L L H L H L L L U Wake et al.59 L U H L H L L L H Waling et al.47 U U L U H L L Weigel et al.51 H H H U L L L Note: H = high risk, L = low risk, U = unclear risk. *Total cholesterol, triglyceride levels, high- and low-density lipoprotein levels, fasting glucose. †Weight, blood pressure, quality of life, physical fitness, adverse effects. ‡Quality of life, adverse effects.
Outcome; group or subgroup Meta-analysis, standard mean difference (95% CI) Statistical heterogeneity (within-group) Test for between-group differences No. of participants No. studies GRADE quality of evidence* p value I2 value, % p value I2 value, % Change in BMI and BMI z-score (baseline to end of intervention period) Overall –0.53 (–0.69 to –0.36) < 0.001 83 NA 3908 30 Moderate Behavioural –0.54 (–0.73 to –0.36) < 0.001 85 0.37 0 3346 28 Low Pharmacological + behavioural –0.43 (–0.60 to –0.25) 0.34 0 562 2 Moderate Behavioural — diet –0.36 (–0.65 to –0.06) 0.27 19 0.36 6.8 270 2 Moderate Behavioural — exercise –0.43 (–0.65 to –0.21) NA 322 1 High Behavioural — diet + exercise –1.09 (–1.84 to –0.34) < 0.001 94 684 6 Moderate Behavioural — lifestyle –0.42 (–0.61 to –0.23) < 0.001 76 2070 19 Moderate Behavioural ≤ 12 mo –0.54 (–0.73 to –0.35) < 0.001 84 0.97 0 3056 25 Low Behavioural > 12 mo –0.53 (–1.31 to 0.26) < 0.001 90 290 3 Low Behavioural — aged 2–12 yr –0.54 (–0.76 to –0.32) < 0.001 86 0.81 0 2612 22 Low Behavioural — aged 13–18 yr –0.59 (–0.92 to –0.25) < 0.001 78 734 6 Moderate Behavioural — individually-focused –0.90 (–1.27 to –0.53) < 0.001 89 0.007 86.2 1347 11 Moderate Behavioural — family-based –0.34 (–0.52 to –0.16) < 0.001 73 1999 17 Moderate Behavioural — low risk of study bias –0.41 (–0.59 to –0.22) 0.92 0 0.51 0 479 3 High Behavioural — unclear risk of study bias –0.49 (–0.68 to –0.30) < 0.001 81 2638 22 Low Behavioural — high risk of study bias –1.24 (–2.79 to 0.32) < 0.001 96 229 3 Very Low Weight loss maintenance: change in BMI and BMI z-score Baseline to end of intervention period –0.51 (–0.86 to –0.16) 0.001 81 NA 716 4 Moderate End of intervention to 6–12 mo follow-up 0.08 (–0.07 to 0.23) 0.44 0 686 4 Low Note: GRADE = grading of recommendations assessment, development and evaluation, NA = not applicable. *Rating reflects confidence in the estimate of effect assessed through 5 domains of the evidence (risk of bias, indirectness, imprecision, inconsistency and reporting bias) as follows: high = no downgrades, moderate = downgraded for risk of bias, low = downgraded for risk of bias and imprecision, very low = downgraded for very serious risk of bias (double downgrade) and imprecision.
Outcome; group or subgroup Meta-analysis, mean difference (95% CI) Statistical heterogeneity (within-group) Test for between-group differences No. participants No. of studies GRADE quality of evidence* p value I2 value, % p value I2 value, % Change in body mass index (kg/m2) (baseline to immediate post) Overall –1.12 (–1.52 to –0.72) < 0.00001 92 NA 3100 21 Moderate Behavioural –1.15 (–1.59 to –0.72) < 0.00001 93 0.29 10.4 2538 19 Moderate Pharmacological + Behavioural –0.86 (–1.19 to –0.52) 0.81 0 562 2 Moderate Change in systolic blood pressure (mmHg) (baseline to immediate post) Overall –3.42 (–6.65 to –0.29) 0.003 75 NA 808 5 Moderate Change in diastolic blood pressure (mmHg) (baseline to immediate post) Overall –3.39 (–5.17 to –1.60) 0.11 47 NA 808 5 Moderate Change in total cholesterol (mmol/L) (baseline to immediate post) Overall –0.06 (–0.19 to 0.07) 0.03, 63 NA 904 5 Low Change in low-density lipoprotein cholesterol (mmol/L) (baseline to immediate post) Overall 0.01 (–0.11 to 0.13) 0.009 70 NA 904 5 Low Change in high-density lipoprotein cholesterol (mmol/L) (baseline to immediate post) Overall –0.02 (–0.05 to 0.01) 0.16 37 NA 971 6 Low Change in triglycerides (mmol/L) (baseline to immediate post) Overall –0.02 (–0.12 to 0.09) 0.19 35 NA 937 5 Low Change in fasting glucose (mmol/L) (baseline to immediate post) Overall 0.06 (–0.29 to 0.17) NA NA 528 1 Low Change in overall quality of life (pediatric quality of life inventory or DISABKIDS questionnaire) (baseline to immediate post) Overall 2.10 (0.60 to 3.60) 0.37 8 NA 777 6 Moderate Note: GRADE =Grading of Recommendations Assessment, Development and Evaluation.
*Rating reflects confidence in the estimate of effect assessed through 5 domains of the evidence (risk of bias, indirectness, imprecision, inconsistency and reporting bias) as follows: high = no downgrades, moderate = downgraded for risk of bias, low = downgraded for risk of bias and imprecision, very low = downgraded for very serious risk of bias (double downgrade) and imprecision.Outcome, subgroup Effect Statistical heterogeneity (within-group), Test for between-group differences, No. of participants No. of studies GRADE quality of evidence* Risk ratio (95% CI) Absolute risk increase, % No. needed to harm (95% CI) p value I2 value, % p value I2 value, % Any adverse events Behavioural Not estimable† — — NA NA 482 3 Moderate Pharmacological + behavioural 1.03 (0.99 to 1.08) — — NA 533 1 Low Serious adverse events Behavioural 0.51 (0.09 to 2.73) — — NA 0.37 (0) 322 1 Moderate Pharmacological + behavioural 1.25 (0.46 to 3.35) — — 0.56 0 573 2 Low Gastrointestinal events Pharmacological + behavioural 3.77 (2.56 to 5.55) 36.7 3 (2 to 5) NA NA 533 1 Moderate Study withdrawal due to adverse events Pharmacological + behavioural 2.49 (0.79 to 7.87) — — 0.45 0 NA 573 2 Low Note: Note: GRADE =Grading of Recommendations Assessment, Development and Evaluation, NA = not applicable. * Rating reflects confidence in the estimate of effect assessed through 5 domains of the evidence (risk of bias, indirectness, imprecision, inconsistency and reporting bias) as follows: moderate = downgraded for risk of bias; low = downgraded for risk of bias and imprecision. †No events reported in both groups in all studies.
Study Sex Mean age at baseline, yr Baseline weight category Intervention Sessions Parental
involvementTechnology-based Duration, mo Estimated no. of sessions Focus Target Group Individual DeBar et al.41 Female 14 Overweight + obese 6 28 total; 16 group meetings for teens, 12 parent sessions Lifestyle Individual Yes — Yes — Ebbeling et al.57 Mixed 15 Overweight + obese 12 3 check-in visits, 12 phone calls Diet Individual Yes — — Yes Janicke et al.54 Mixed 11 Overweight + obese 4 12 group sessions Lifestyle Family Yes — Yes — Lison et al.56 Mixed 11 Overweight + obese 6 120 exercise sessions Diet + exercise Individual — Yes — — Lochrie et al.60 Mixed 10 Overweight + obese 6 14 (8 weekly, 4 bimonthly, 2 monthly) Lifestyle Family Yes — Yes — Maddison et al.46 Mixed 12 Overweight + obese 6 Not specified: children encouraged to meet recommendations (60 min moderate to vigorous physical activity on most days) Exercise Individual — — — Yes Nemet et al.36 Mixed 11 Obese 3 34 total; 24 training sessions, 6 individual meetings with dietician, 4 evening lectures Diet + exercise Family Yes Yes Yes — Racine et al.49 Mixed 9 Overweight + obese 6 1 session with a dietician Diet Individual — Yes Yes — Reinehr et al.48 Mixed 11 Overweight 6 48 total; 37 sessions for children, 6 for parents, 5 for families Lifestyle Individual Yes — Yes — Sacher et al.53 Mixed 10 Obese 6 18 sessions over 9 wk (2-h group sessions held twice weekly) Lifestyle Family Yes — Yes — Saelens et al.35 Mixed 14 Overweight + obese 4 1 meeting with pediatrician; 1 wk later meeting with author, 11 calls from phone counselor (10–20 min weekly first 8x, biweekly last 3x) Lifestyle Individual — Yes Yes Yes Savoye et al.32 Mixed 12 Obese 12 2 sessions per week for first 6 mo; biweekly next 6 mo Lifestyle Family Yes Yes Yes — Toulabi et al.58 Mixed 16 Obese 24 4 1-h weekly parents sessions on nutrition; 8 45-min student sessions 2x/wk on nutrition and physical activity; exercises 1 h per day, 3x/wk for 6 wk Diet + exercise Individual Yes — Yes — Vos et al.55 Mixed 13 Obese 3 7 group meetings for children, 5 for parents; 1 for families (2 h 40 min biweekly) Lifestyle Family Yes Yes Yes — Weigel et al.51 Mixed 11 Obese 12 2 sessions per week; monthly parent meetings Diet + exercise Individual Yes — Yes —
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Treatment of overweight and obesity in children and youth: a systematic review and meta-analysis
