Cochrane commentaries

Interventions for preventing obesity in children.1 Tamara Brown, Theresa Hm Moore, Lee Hooper, Yang Gao, Amir Zayegh, Sharea Ijaz, Martha Elwenspoek, Sophie C Foxen, Lucia Magee, Claire O'Malley, Elizabeth Waters, Carolyn D Summerbell https://doi.org/10.1002/14651858.CD001871.pub4 Are dietary and/or physical activity interventions effective childhood obesity? Only randomised control trials (RCTs) that assessed or were included. The intervention could be educational, behavioural, psychological, counselling family strategies. Multiple scientific databases searched from June 2015 to January 2018 and 153 RCTs identified. studies varied period duration but needed report outcomes a minimum of 12 weeks baseline. Included focused on children <18 years age classified as ‘at risk’ obesity. only enrolled obese excluded, this was considered treatment rather than prevention. Just over half participants aged 6–12 age, quarter 0–5 the remaining teenagers 13–18 years. Most based USA (69) Europe (43) Australasia (15); however, some upper middle-income countries (Brazil, Ecuador, Lebanon, Mexico, Thailand, Turkey, USA–Mexico border) one lower country (Egypt). None meta analyses with more 10 had evidence funnel plot asymmetry tested using Egger test suggesting there no small study effects publication bias. findings summarised three types (diet, diet combined) groups (0–5 years, years) outcome measures (zBMI score, BMI adverse events). prevalence is increasing world-wide public health priority. Pooled data population-based indicate 5.6% girls 7.8% boys are obese2 known higher upper-middle-income countries.3 In Australia, four adolescents 2–17 reported overweight 2017–2018.4 Children who at risk significant cardiometabolic development adult obesity.5 Hypertension, hyperlipidaemia abnormal glucose tolerance being diagnosed an increasingly early age. Additional co-morbidities include obstructive sleep apnoea, asthma, poorer psychological well-being musculoskeletal issues. last Cochrane Review regarding prevention undertaken 2011.6 A meta-analysis 37 preventative such education promotion therapy focus diet, life-style changes. review heterogeneous included non-randomised studies, variability components reporting, participant numbers lack post-intervention making long-term difficult ascertain. conclusion supported hypothesis can effective, caveat interpreted cautiously. No comment which most able made. 2019 Review1 updated version now includes all RCTs. Trials restricted management effectiveness particular. There has been concern within practitioner paediatric weight programmes might increase rates eating disorder diagnoses negatively impact mental health. Previous have shown association between dieting increased developing disorder, albeit related predominantly healthy individuals.7 Therefore it pertinent examine safety implications interventions. review,1 did not negative effect result signs disordered eating. recent systematic explored relationship disorders actually found reduction disorders, range symptoms (bulimic symptoms, binge eating, emotional drive thinness concern).8 Another structured associated depression anxiety, also symptoms.9 summary, those under although quality low (6–12 moderate (5 under). Data other reassuring issues disorders. contrast, well-supported clinical may improve outcomes.