Hostname: page-component-745bb68f8f-cphqk Total loading time: 0 Render date: 2025-01-11T11:56:07.107Z Has data issue: false hasContentIssue false
  • English
  • Français

Physical activity interventions in the prevention and treatment of paediatric obesity: systematic review and critical appraisal

Published online by Cambridge University Press:  05 March 2007

John J. Reilly  and
Zoe C. McDowell
Zoe C. McDowell
Affiliation:
University of Glasgow Department of Human Nutrition, Royal Hospital for Sick Children, Yorkhill, Glasgow, G3 8SJ, UK
Rights & Permissions [Opens in a new window]

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.

Interventions for prevention and treatment of childhood obesity typically target increases in physical activity and, more recently, reductions in physical inactivity (sedentary behaviour such as television viewing). However, the evidence base for such strategies is extremely limited. The main aim of the present review was to update the systematic review and critical appraisal of evidence in the light of the recent rapid expansion of research in this area. Randomised controlled trials (RCT) that targeted activity or inactivity, that followed up children or adolescents for at least 1 year and that included an objective weight-related outcome measure were included. Trials were appraised using previously published criteria (Harbour & Miller, 2001), and literature search strategies described previously (Reilly et al. 2002) were updated to May 2002. A total of four new RCT, two new systematic reviews and one meta-analysis were identified. The evidence base has increased markedly since the completion of earlier reviews, although high-quality evidence is still lacking. The evidence on childhood obesity prevention is not encouraging, although promising targets for prevention are now clear, notably reduction in sedentary behaviour. There is stronger evidence that targeting activity and/or inactivity might be effective in paediatric obesity treatment, but doubts as to the generalisability of existing interventions, and the clinical relevance of the interventions is unclear. Further research in settings outside the USA is urgently needed, and two ongoing RCT in Scotland are summarised.

Keywords

Obesity preventionObesity treatmentSystematic reviewChildhoodAdolescence
Type
Symposium on ‘Physical activity, energy expenditure and obesity’
Information
Proceedings of the Nutrition Society , Volume 62 , Issue 3 , August 2003 , pp. 611 - 619
Copyright
Copyright © The Nutrition Society 2003

References

Armstrong, J, Reilly, JJ & Child Health Information Team (2002) Breastfeeding and lowering the risk of childhood obesity. Lancet 359, 2003–2004.CrossRefGoogle ScholarPubMed
Campbell, K, Waters, E, O'Meara, S & Summerbell, C (2001 a) Interventions for preventing obesity in childhood: a systematic review. Obesity Reviews 2, 149–157.CrossRefGoogle ScholarPubMed
Campbell, K, Waters, E, O'Meara, S & Summerbell, C (2001 b) Interventions for preventing obesity in children (Cochrane Review). In The Cochrane Library , issue 2. Oxford: $$Update Software; available at www.nelh.nhs.uk/cochrane.asp$$.Google Scholar
Dietz, WH (1996) The role of lifestyle in health: the epidemiology and consequences of inactivity. Proceedings of the Nutrition Society 55, 829–840.CrossRefGoogle ScholarPubMed
Dietz, WH (2001) Breastfeeding may help prevent childhood overweight. Journal of the American Medical Association 285, 2506–2507.CrossRefGoogle ScholarPubMed
Dorosty, AR (2001) Epidemiology of childhood obesity. PhD Thesis, University of Glasgow.Google Scholar
Epstein, LH, Gordy, CC, Raynor, HA, Beddome, M, Kilanowski, CK & Paluch, R (2001 a) Increasing fruit and vegetable intake and decreasing fat and sugar intake in families at risk for childhood obesity. Obesity Research 9, 171–178.CrossRefGoogle ScholarPubMed
Epstein, LH, Myers, MD, Rayner, HA & Saelens, BE (1998) Treatment of pediatric obesity. Pediatrics 101, 554–570.CrossRefGoogle ScholarPubMed
Epstein, LH, Paluch, RA, Gordy, CC & Dorn, J (2000) Decreasing sedentary behaviours in treating pediatric obesity. Archives of Pediatric and Adolescent Medicine 154, 220–226.CrossRefGoogle ScholarPubMed
Epstein, LH, Paluch, R, Saelens, BE, Ernst, MM & Wilfley, DE (2001 b) Changes in eating disorder symptoms with pediatric obesity treatment. Journal of Pediatrics 139, 58–65.CrossRefGoogle ScholarPubMed
Epstein, LH, Valoski, AM, Vara, LS, McCarley, J, Wisniewski, L, Kalarchian, MA, Klein, KR & Shrager, LR (1995) Effects of decreasing sedentary behaviour and increasing activity on weight change in obese children Health Psychology 14, 109–115.CrossRefGoogle ScholarPubMed
Fairweather, SC, Reilly, JJ, Grant, S, Whittaker, A & Paton, JY (1999) Using the Computer Science and Applications activity monitor in pre-school children. Pediatric Exercise Science 11, 414–421.CrossRefGoogle Scholar
Gortmaker, SL, Must, A, Sobol, AM, Peterson, K, Colditz, GA & Dietz, WH (1996) Television viewing as a cause of increasing obesity among children in the United States, 1986–1990. Archives of Pediatric and Adolescent Medicine 150, 356–362.CrossRefGoogle ScholarPubMed
Gortmaker, SL, Peterson, K, Wiecha, J, Sobol, AM, Dixit, S, Fox, MK & Laird, N (1999) Reducing obesity via a school-based interdisciplinary intervention among youth: Planet Health. Archives of Pediatric and Adolescent Medicine 151, 409–418.CrossRefGoogle Scholar
Gregory, JR, Collins, DL, Davies, PSW, Hughes, JM & Clarke, PC (1995) National Diet and Nutrition Survey: Children Aged 1.5 to 4.5 Years. vol. 1 , Report of the Diet and Nutrition Survey. London: H M. Stationery Office.Google Scholar
Harbour, RH & Miller, J (2001) A new system for grading recommendations in evidence based guidelines. British Medical Journal 323, 334–336.CrossRefGoogle ScholarPubMed
Hill, RJ & Davies, PSW (2001) The validity of self-reported energy intake as determined by the doubly-labelled water technique. British Journal of Nutrition 85, 415–430.CrossRefGoogle ScholarPubMed
Jackson, DM, Reilly, JJ, Kelly, LA, Montgomery, C, Grant, S & Paton, JY (2002) Objectively measured habitual physical activity and inactivity in a representative sample of 3–4 year old children. Proceedings of the Nutrition Society 61, 154A.Google Scholar
Koplan, JP & Dietz, WH (1999) Caloric imbalance and public health policy. Journal of the American Medical Association 282, 1579–1581.CrossRefGoogle ScholarPubMed
Le Mura, LM & Maziekas, MT (2002) Factors that alter body fat, body mass, and fat-free mass in pediatric obesity. Medicine and Science in Sports and Exercise 34, 487–496.CrossRefGoogle ScholarPubMed
Luepker, RV, Perry, CL, McKinlay, SM, Nader, PR, Parcel, GS, Stone, EJ, Webber, LS, Elder, JP, Feldman, HA & Johnson, CC (1996) Outcomes of a field trial to improve children's dietary patterns and physical activity, the CATCH (Child and Adolescent Trial for Cardiovascular Health). Journal of the American Medical Association 275, 768–776.CrossRefGoogle ScholarPubMed
Maffeis, C, Schultz, Y, Zaffarello, M, Piccoli, R & Pirelli, L (1994) Elevated energy expenditure and reduced energy intake in obese pre-pubertal children: paradox or poor dietary reliability in obesity?. Journal of Pediatrics 124, 348–354.CrossRefGoogle ScholarPubMed
Martorell, R, Khan, LK, Grummer-Strawn, LM (2000) Overweight and obesity in pre-school children from developing countries International Journal of Obesity 24, 959–967.CrossRefGoogle ScholarPubMed
Mellin, LM, Slinkard, LA & Irwin, CE (1987) Adolescent obesity intervention: validation of the SHAPEDOWN program. Journal of the American Dietetic Association 87, 337–338.CrossRefGoogle ScholarPubMed
Moher, D, Schulz, KF & Altman, DG (2001) The CONSORT statement: revised recommendations for improving the quality of reports of parallel group randomised trials. Lancet 357, 1191–1194.CrossRefGoogle Scholar
Montgomery, C, Kelly, LA, Jackson, DM, Reilly, JJ, Grant, S & Paton, JY (2002) Changes in total energy expenditure in a representative sample of young children: cross-sectional and longitudinal analysis. Proceedings of the Nutrition Society 61, 160A.Google Scholar
Muller, MJ, Asbeck, I, Mast, M, Langnasek, K & Grand, A (2001) Prevention of obesity – more than a concept. International Journal of Obesity 25, Suppl. 1 s66–s74.CrossRefGoogle Scholar
Reilly, JJ, (1998) Assessment of body composition in infants and children. Nutrition 14, 821–825.CrossRefGoogle ScholarPubMed
Reilly, JJ, (2002 a) Understanding chronic malnutrition in childhood and old age: role of energy balance research. Proceedings of the Nutrition Society 61, 321–327.CrossRefGoogle ScholarPubMed
Reilly, JJ (2002 b) Assessment of childhood obesity: national reference data or international approach?. Obesity Research 10, 838–840.CrossRefGoogle ScholarPubMed
Reilly, JJ, Burke, G, Coyle, J, Grant, S & Paton, JYP (2001 a) Can accelerometry quantify physical inactivity in young children?. Obesity Research 9, Suppl. 1 PC23.Google Scholar
Reilly, JJ & Dorosty, AR (1999) Epidemic of obesity in UK children. Lancet 354, 1874–1875.CrossRefGoogle ScholarPubMed
Reilly, JJ, Methven, E, Kelnar, CJH, Hacking, B & Alexander, D (2003) Consequences of obesity: results of a systematic review and evidence appraisal. Archives of Disease in Childhood (In the Press).CrossRefGoogle Scholar
Reilly, JJ, Montgomery, C, Jackson, D, MacRitchie, J & Armstrong, J (2001 b) Energy intake by multiple pass 24 hour recall and total energy expenditure: a comparison in a representative sample of 3–4 year olds. British Journal of Nutrition 86, 601–605.CrossRefGoogle Scholar
Reilly, JJ, Ventham, JC, Ralston, JM, Donaldson, M & Gibson, BES (1998) Reduced energy expenditure in preobese children treated for acute lymphoblastic leukemia. Pediatric Research 44, 557–562.CrossRefGoogle ScholarPubMed
Reilly, JJ, Wilson, ML, Summerbell, CD & Wilson, DC (2002) Obesity: diagnosis, prevention, and treatment; evidence based answers to common questions. Archives of Disease in Childhood 86, 392–395.CrossRefGoogle ScholarPubMed
Resnicow, K, Robinson, TN (1997) School-based cardiovascular disease prevention studies: review and synthesis. Annals of Epidemiology 7, s14–s31.CrossRefGoogle Scholar
Robinson, TN (1999 a) Reducing children's television to prevent obesity: a randomised controlled trial. Journal of the American Medical Association 282, 1561–1567.CrossRefGoogle Scholar
Robinson, TN (1999 b) Behavioural treatment of childhood and adolescent obesity. International Journal of Obesity 23, s5–s58.CrossRefGoogle ScholarPubMed
Sahota, P, Rudolf, MCJ, Dixey, R, Hill, AJ, Barth, JH & Cade, J (2001) Randomised controlled trial of primary school based intervention to reduce risk factors for obesity. British Medical Journal 323, 1–5.Google ScholarPubMed
Scottish Intercollegiate Guidelines Network (2002) Checklists for appraising the quality of controlled trials; available at www.sign.ac.uk/guidelines/fulltext/50/ ; accessed 1 July 2002.Google Scholar
Story, M (1999) School based approaches for preventing and treating obesity. International Journal of Obesity 23, s43–s51.CrossRefGoogle ScholarPubMed
Strauss, RS & Pollack, HA (2001) Epidemic increase in childhood overweight, 1986–1998. Journal of the American Medical Association 286, 2845–2848.CrossRefGoogle ScholarPubMed
Summerbell, C, Kelly, S, Waters, E, Edmunds, L, O'Meara, S, Ashton, V & Campbell, K (2002) Interventions for treating obesity in children (Protocol for a Cochrane Review). In The Cochrane Library , issue 2. Oxford: Update Software; available at www.nelh.nhs.uk/cochrane.asp.Google Scholar
Swinburn, B, Egger, G & Raza, F (1999) Dissecting obesogenic environments: the development and application of a framework for identifying and prioritising environmental interventions for obesity.Preventive Medicine 29, 513–570.CrossRefGoogle ScholarPubMed
Troiano, RP & Flegal, KM (1998) Overweight children and adolescents: description, epidemiology and demographics. Pediatrics 101, 497–504.CrossRefGoogle ScholarPubMed
Warschburger, P, Fromme, C, Petermann, F, Wojtalla, N & Oepen, J (2001) Conceptualisation and evaluation of a cognitive behavioural training programme for children and adolescents with obesity. International Journal of Obesity 25, s93–s95.CrossRefGoogle ScholarPubMed
Wells, JCK, Fuller, NJ, Dewit, O, Fewtrell, MS, Elra, M & Cole, TJ (1999) Four component model of body composition in children: density and hydration of fat-free mass and comparison with simpler models. American Journal of Clinical Nutrition 69, 904–912.CrossRefGoogle ScholarPubMed