TABLE 3.
Characteristics of selected articles.
| References, country | Type of study | Sample | Intervention | Results | Risk of bias (Rob2/Robins) | Quality (MMAT) |
| Randomized studies | ||||||
| (34), USA | Randomized controlled trial |
n = 8 children with cystic fibrosis Age, y (mean ± SD): 7 ± 1.7 y (intervention) 6 ± 2.7 y (control) Weight for age, percentile (mean ± SD): 18th ± 9.7 (intervention) 9th ± 4.8 (control) |
6 weeks behavioral intervention (n = 5) Control: waiting list (n = 3) Follow-up: n.d. Professionals: clinical and pediatric psychologist, dietitian |
Behavioral group: ↑ caloric intake (p = 0.03) ↑ weight (p = 0.03) No changes on pulmonary function and resting energy expenditure or activity level Adherence/compliance rates: n.d. |
High | *** |
| (47), USA | Randomized controlled trial |
n = 7 children with cystic fibrosis Age, y (mean): 10 y Weight for age, percentile (mean): 12th |
Five 90-min treatment sessions on a weekly basis; 2 groups: Behavioral intervention: behavior-management strategies Nutrition education: no behavioral strategies Follow-up: 2 years Professionals: pediatric psychology, pediatric dietitian |
Behavioral intervention vs. nutrition education: ↑ daily caloric intake ↑ weight Improved caloric intake was maintained 2 years following treatment Adherence/compliance rates: no changes on rating for the adherence or behavioral compliance scale. |
High | **** |
| (35), USA | Randomized controlled trial |
n = 57 adolescents with prehypertension or hypertension Age, y (mean ± SD): 14.3 ± 2.1 (DASH); 14.4 ± 2.1 (RC) Weight for age, percentile (mean): n.d. |
60-min face-to-face counseling for 3-month: behavioral nutrition intervention DASH diet vs. routine care (RC) (control): Follow-up: 6 months Professionals: dietitian |
DASH compared to RC had: ↓ SBP z scores from baseline to post-treatment (p < 0.01) ↓ SBP z scores from baseline through follow-up (p < 0.1). ↑ intake of fruits (p < 0.001), potassium and magnesium (p < 0.01) ↓ total fat (p < 0.05) from baseline to post-treatment ↑ low fat dairy (p < 0.001) from baseline through follow-up Adherence/compliance rates: n.d. |
Low | **** |
| (36), USA | Randomized controlled trial |
n = 22 overweight female students Age, y (mean ± SD): 10.5 ± 0.8 (soccer); 10.3 ± 1.0 (control) BMI for age, percentile (mean) > 97th |
Social Cognitive Theory 2 months of recreational soccer (n = 14) or Control: waiting list control (n = 8) Follow-up: 5 months Professionals: chiropractic physician |
Both group: ↑ nutrition knowledge (P < 0.002) No association between nutrition knowledge and follow-up BMI (r = -0.185; p = 0.462) Adherence/compliance rates: n.d. |
High | *** |
| (37), Netherlands | Randomized controlled trial |
n = 122 obese adolescents Age, y (mean ± SD): 14.5 ± 1.7 (intervention); 14.4 ± 1.8 (control) BMI, kg/m2 (mean ± SD): 33.3 ± 4.6 (intervention); 33.6 ± 5.1 (control) BMIsds: 2.93 ± 0.41 (intervention); 2.93 ± 0.51 (control) |
Intervention: Cognitive Behavioral Therapy; 7 sessions (90 min) with an interval of 2–3 weeks Control: standard treatment Follow-up: 18 months Professionals: dietitian, pediatricians/endocrinologist and psychologist |
Intervention group: ↓ BMI at 18 months (p < 0.05) Adherence/compliance rates (> 5 sessions): 59.2% |
Some concerns | **** |
| (38), Brazil | Paired cluster randomized school-based trial |
n = 559 students (intervention: n = 277, control: n = 282) Age, y (mean ± SD): 11.2 ± 1.3 BMI, kg/m2 (mean ± SD): 17.4 ± 3.0 (intervention); 18.6 ± 3.7 (control) |
9 months intervention: monthly 1-h classroom sessions included playing games, staging of theater sketches, watching movies and puppet shows, and writing and drawing contests. Follow-up: n.d. Professionals: trained nutritionists |
Intervention group: ↓ sugar-sweetened beverages and cookies ↑ fruits NS: changes in BMI between the 2 groups (p = 0.003; p = 0.75). Adherence/compliance rates: measured as frequency of food consumption p < 0.01 |
Some concerns | **** |
| (39), USA | Randomized controlled trial |
n = 40 overweight/obese adolescents (intervention) n = 21 historical patients (control) Age, y (mean ± SD): 15.4 ± 1.8 (intervention); 15.7 ± 1.5 (control) |
Transtheoretical Model 7-min DVD + 20–30 min of standardized verbal and written nutrition education Follow-up: 4–6 weeks Professionals: registered dietitian nutritionist and physician or nurse practitioner |
Intervention group: ↑ parents’ knowledge of obesity-related comorbidities. NS: weight-related outcomes in this adolescent clinic. Adherence/compliance rates: n.d. |
Low | **** * |
| (40), Italy | Cluster randomized controlled trial |
n = 389 children Age, y (mean ± SD): 3.4 ± 0.1 BMI, kg/m2 (mean ± SD): 16.2 ± 0.07 BMI z-score, kg/m2 (mean ± SD): 0.28 ± 0.03 |
Intervention: 6-month-long Two face-to-face motivational interviews with parents; learning experiences with children about healthy behaviors Control: usual care Follow-up: 2 years Professionals: nurses, primary care pediatricians, teachers |
Intervention group compared to control group: 48.4% of children showed a low-risk of combined health behavior score 4 energy-related behaviors in the medium and long term successfully changed: FV intake, physical activity, TV-watching time and SSB intake Beneficial changes in target behaviors and CHBS in intervention children whose mothers had a medium/high level of education NS: BMI outcomes between groups. Adherence/compliance rates: n.d. |
Low | **** |
| (41), USA and Canada | Randomized clinical, parallel-group study |
n = 38 overweight/obese adolescents Age, y (mean ± SD): 14.1 ± 1.7 (intervention); 15.7 ± 1.4 (control) BMI, kg/m2 (mean): 32.0 (intervention); 31.9 (control) |
6-month of weight-reducing diet: individual nutrition education and behavioral counseling (in-person sessions and telephone counseling calls; 6 total contacts) + daily text messages Intervention group: standardized weight-reducing diet + water advice Control group: standardized weight- reducing diet Follow-up: n.d. Professionals: registered dietitian |
In intervention group: ↑ self-reported water intake at 6 months (p < 0.001) Adherence/compliance rates: lack of adherence. |
Low | **** * |
| (42), USA | Cluster-randomized controlled |
n = 1,159 students Age, y (mean ± SD): 10.6 ± 0.6 BMI, kg/m2 (mean ± SD): n.d. BMI z-score (mean ± SD): 0.7 ± 1.2 |
4 groups: – Curriculum: 23 science lessons based on social cognitive and self-determination theories – Wellness: food policy and physical activity bouts of Dance Breaks – Curriculum + wellness – Control Follow-up: n.d. Professionals: teachers | Curriculum intervention resulted in: ↓ physical activity (p = 0.04) Wellness intervention resulted in: ↓ frequency of sweetened beverages (p = 0.05) and size (p = 0.006) ↓ processed packaged snacks size (p = 0.01); candy frequency (p = 0.04) ↓ baked good frequency (p = 0.05) ↓ fast food frequency (p = 0.003), size (p = 0.01), and combo meals (p = 0.002) Prevalence of overweight and obesity not change Adherence/compliance rates: n.d. |
High | *** |
| (44), UK and Canada | Randomized controlled trial |
n = 54 F overweight/obese adolescents Age, y (mean ± SD): 14.8 ± 2.3 BMI, kg/m2 (mean ± SD): 30.2 ± 5.2 (RDa); 29.6 ± 5.0 (LDa); 24.6 ± 2.5 (Control) |
12 weeks one-to-one dietary counseling (1 h; 5 sessions): Self-determination theory open questions active listening empathy encourage to “take ownership” of their diet meaningful rationale set specific goals self monitoring specific goals specific informative and non-judgemental feedback support identification of barriers and develop plans, friendly, caring manner, step-count challenges with friends and family 3 groups: – RDa: dairy diet + exercise – LDa: low dairy diet + exercise – Control: no intervention Follow-up: n.d. Professionals: registered dietitian |
In RDa group: improvements in body composition RDa and LDa showed significant improvements in: physical self-worth (p = 0.001) body satisfaction (p = 0.002) perceived physical conditioning (p = 0.002) Adherence/compliance rates: RDa 86% and LDa 79% |
Low | *** |
| (43), China | Cluster randomized controlled trial |
n = 814 students n = 757 parents Age, y (mean ± SD): 9.3 ± 1.2 (intervention); 9.4 ± 1.2 (control) BMI, kg/m2 (mean ± SD): 17.7 ± 3.2 (intervention); 18.4 ± 3.4 (control) |
Intervention: Social Cognitive Theory; 4 components targeting children and their parents: – 4 times offline lectures – Nutrition-related manuals and books – 20 health education materials Control: eyes health promotion Follow-up: 12 months Professionals: n.d. |
In intervention group: ↑ nutrition knowledge of children and parents no BMI and WHtR reduction Adherence/compliance rates: n.d. |
High | *** |
| (45), China | Randomized controlled trial |
n = 41 students n = 26 parents Age, y (mean ± SD): n.d. BMI, kg/m2 (mean ± SD): 22.2 ± 2.1 (intervention); 22.1 ± 2.6 BMI z-score (mean ± SD): 1.6 ± 0.3 (intervention); 1.4 ± 0.3 (control) |
Intervention ↑ 12 month program: – Nutritional education (60 min monthly) – Exercise intervention (60 min regularly) – Psychological intervention (Social Cognitive Theory) – Fun activity session (during summer 1–2 activities) – Telephone follow-up (every 2 weeks) Control: no intervention Follow-up: n.d. Professionals: n.d. |
Intervention resulted: BMI-z score, WHR and WHtR significant improvements NS: ↓ BMI-P, fasting plasma glucose, cholesterol and low-density-lipoprotein cholesterol levels. Adherence/compliance rates: Intervention school: 88.5% Control school: 86.7% |
Low | **** |
| (46), Korea | Randomized trial |
n = 104 children and adolescents with moderate to severe obesity Age, y (mean ± SD): 10.9 ± 2.1 BMI, kg/m2 (mean ± SD): n.d. BMI z-score (mean ± SD): 2.3 ± 0.5 (intervention) 2.3 ± 0.5 (control) |
24 weeks (6 sessions) Intervention group (NG): nutrition education + one-to-one NC Control group (UG): nutrition education only Follow-up: n.d. Professionals: nutritional expert |
In NG: ↓ high-calorie, low-nutrient food consumption ↑ Diet Quality Index-International score ↓ BMI z-score All subjects showed (24 weeks): ↓ energy, carbohydrates, fat, sodium intake no differences between NG and UG Negative association between BMI-z-score and self-efficacy Adherence/compliance rates: n.d. |
Low risk | *** |
| Non-randomized studies | ||||||
| (27), USA | Cross-sectional |
n = 55 children with elevated blood cholesterol Age, y (mean): 11.5 BMI, kg/m2 (mean ± SD): n.d. |
Social problem-solving skills and activities. Child problem solving ability: “open middle” story completion technique Parent-child interaction: plan a meal separately and after 3 min together to reach an agreement Parenteral facilitation of children problem solving (scale from praised up to punished child) Child’s satisfaction of meal plan (scale 0–100) Child behavior problems (Child behavior checklist) Follow-up: n.d. Professionals: n.d. |
Adolescents who were able to generate multiple ways to cope with dietary temptations described in hypothetical vignettes evidenced better dietary adherence than adolescents who could produce fewer coping strategies. Parent-child interaction: child satisfaction with the diet was positively associated with parental attempts to solicit and reinforce the child’s involvement in meal planning. Adherence/compliance rates: dietary adherence p < 0.01 (measured as dietary LDLc change) |
Some concerns | **** |
| (29), USA | Experimental design consisting of pretest-posttest comparison |
n = 25 obese adolescents Age, y (mean ± SD): 13.5 ± 0.3 BMI, kg/m2 (mean ± SD): 40.1 ± 2.0 BMI z-score (mean ± SD): 2.5 ± 0.1 |
1-year comprehensive weight-management program: Non-diet, better food choices approach (45 min weekly for 6 of 12-week sessions) Problem solving approach (45 min weekly by a dietitian or social worker for 6 of 12-week sessions) 2 days/week 30-min exercise sessions Diet method subgroups: Dieting group: Structured Meal Plan Non-dieting group: Better Food Choices Follow-up: 2 years Professionals: registered dietitian, social worker |
At 1 year: ↓ BMI z score ↓ body fat% ↑ self-concept scores At 2 years: ↓ BMI z score still significant body fat% and self-concept scores remained improved Dietary method: Dieting group tended to show favorable short-term results for BMI z-score at first year (p = 0.11); at the second year, the non-dieting group improved BMI z-score (p = 0.006), while the dieting group returned toward baseline. Adherence/compliance rates (self-reported, 0 = poor compliance; 2 = high compliance): average > 1 |
Low risk | **** |
| (28), Switzerland | Experimental design consisting of pretest-posttest comparison groups |
n = 130 obese children and adolescent Age, y (median; IQR): 13.8; 12.1– 15.0 BMI, kg/m2 (median; IQR): 33.4; 30.1–36.6 |
8-week multidisciplinary inpatient obesity program: nutritional intervention + physical activity program + behavior modification: individual therapy sessions focused on increasing self-esteem, responsibilities, and working on problem-solving strategies Follow-up: n.d. Professionals: nutritionist, exercise therapist |
All patients showed: ↓ body weight improvement of all measurements of aerobic fitness ↑ quality of life Adherence/compliance rates: n.d. |
Some concerns | *** |
| (30), USA | Experimental design consisting of pretest-posttest comparison |
n = 23 obese preadolescents with risk for diabetes type 2 Age, y (mean ± SD): 11.7 ± 1.2 BMI, kg/m2 (mean ± SD): 33.1 ± 5.9 |
12-week intervention (social cognitive and self-efficacy theory): 2 weekly physical activity sessions + 4 (45-min) consultations and 2 (60-min) food demonstrations Follow-up: n.d. Professionals: registered dietitian, nurses and physicians |
Improvement in physical activity Changes in measures of both task self-efficacy (β = 0.39) and self-regulatory efficacy (β = 0.44) Significant improvement in total cholesterol and BMI Adherence/compliance rates: n.d. |
Some concerns | *** |
| (31), USA | Experimental design consisting of pretest-posttest comparison |
n = 38 African-American students Age, y (mean): 14.9 (Year I); 15.5 (Year II) BMI, kg/m2 (mean ± SD): n.d. |
6-weeks “Whole School, Whole Community, Whole Child”: collaborative, school-based integrative health promotion. health education positive role models learning healthy substitutes for unhealthy choices self-reevaluation social liberation and empowerment Transtheoretical Model of Health Behavior Change Follow-up: 2 and 8 weeks after the end of the program Professionals: certified personal exercise trainer, yoga and mindfulness instructor + other unspecified figures |
Improvements in self-reported physical activity and dietary habits No changes in stressor mindfulness New knowledge and skills ↑ self-efficacy, health behavior change, and program enjoyment Adherence/compliance rates: n.d. |
High risk | *** |
| (32), Korea | Quasi-experimental intervention trial |
n = 103 overweight/obese children Age, y (mean ± SD): 11.7 ± 1.2 (control); 12.9 ± 1.7 (intervention) BMI, kg/m2 (mean ± SD): 29.6 ± 4.2 (control); 30.3 ± 4.1 (intervention) BMI z-score (mean ± SD): 2.3 ± 0.5 (control); 2.3 ± 0.5 (intervention) |
16-week multidisciplinary lifestyle intervention program (2 groups): Intervention: usual care + exercise Control: usual care only Usual care: one-to-one medical consultation workbook provision for goal setting and behavioral modification exercise counseling physical activity monitoring and feedback one-to-one NC Exercise program (from 5th week): exercise three days/week for 60 min/session (one group exercise session and two home-based exercise sessions) Follow-up: n.d. Professionals: doctors, clinical dietitians, exercise specialists, social workers, nurses |
Exercise group showed: ↓ BMI z-score No difference in the BMI z-scores between the usual care and exercise groups after adjustment. Both groups showed: ↑ lean body mass ↓ total energy intake Positive effects on body composition, physical fitness and cardiometabolic risk markers. Adherence/compliance rates: n.d. |
Low risk | **** |
| (33), Mexico | Qualitative study |
n = 564 children teachers, directors, parents and personnel working in the school food store Age, y (mean ± SD): n.d. BMI, kg/m2 (mean ± SD): n.d. |
Health Communication Process: (1) Theory of cognitive development (2) Social Development Theory (3) Ecological Model Focus groups were conducted as a qualitative technique + Nutritional education Follow-up: n.d. Professionals: psychologists, educators, psychologists, physical educator, nutritionist |
The Health Communication Process is an effective tool for program planners to design interventions. Adherence/compliance rates: 100% | Some concerns | *** |
BMI, body mass index; CHBS, combined health behavior score; DASH, Dietary Approaches to Stop Hypertension; DVD, digital video disc; FV, fruit and vegetable; IQR, interquartile range; NS, non-significative; SD, standard deviation; SSB, sugar sweetened beverages; TV, television; Y, years; WHR, waist-to-hip ratio; WHtR, waist-to-height ratio, LDLc, low-density lipoprotein cholesterol; n.d., no date. ***, ****, *****MMAT quality.