Table 1.
Study characteristics of trials on parental involvement in weight control interventions in children aged 0–12 years in the European Union
| Study, country and risk of bias | Design and participants | Data points (duration) | Setting and intervention | Parental involvement | Behaviour change component | Summary of results of primary outcomes | |
|---|---|---|---|---|---|---|---|
| Primary prevention of obesity | |||||||
| Tigerkids 20 Germany Low to unclear risk Consort: 15 out of 26 | Cluster randomized controlled trial children from German Kindergarten day-care centres Age at baseline: 3–6 years | Baseline and 6 months post-intervention, N = baseline/follow-up Intervention: 838 out of 866 Control: 466 out of 463 | Setting: school-based Intervention: school year promoting healthy lifestyle by trained teachers | Low intensity Two information evenings. Parents were informed with newsletters providing messages on health related behaviour. An Internet platform was offered. | Primary agent of change: child, kindergarten, parent Health education model five behaviour techniques reported spanning four out of five behaviour change process steps | Prevalence of overweight and obesity not statistically different Summary: 6 months (post-intervention): not effective | |
| Crete Health Education Program 21,22 Crete, Greece Unclear risk of bias Consort 15 out of 26 | Longitudinal controlled clinical trial First grade primary school children Intervention: children 1–6th grade Age at baseline: 5.5–6.5 years | Baseline, 3 years, 6 years (end of intervention), 4 years post-intervention N = baseline/follow-up Intervention: 602/*/*/284 Control: 444/*/*/257 *During 3 and 6 years follow-up, subsamples of participants were analysed (3 year: n = 471 and 6 year: n = 831 total both groups) | Setting: school-based Intervention: teacher-delivered health and nutritional component, physical education sessions. Workbooks covering dietary issues, physical activity and fitness. Control: no health promotion intervention | Low intensity Annual meetings, parents were given a file containing their child's medical screening results. Nutritional information booklets. Workbook exercises by pupils and their parents | Primary agent of change: child, school, parent Health education model five behaviour techniques reported spanning four out of five behaviour change process steps | Three-year follow-up: control group had a significantly higher change in mean body mass index (BMI) than intervention group (adjusted mean gain 1.8 kg m−2 vs. 0.7 kg m−2, P < 0.001) and suprailiac skin-fold (2.9 vs. 0.8 mm, P < 0.05) 6-year follow-up (end of intervention): in the intervention group larger change in BMI (+3·68 vs. +4·28 kg m−2 for BMI +2·97 P < 0.05 vs. +4·47 mm for biceps skin-fold P < 0.001) 10-year follow-up (4 years post-intervention): intervention group: lower average BMI (by 0.7 kg m−2, SE 0.28, P < 0.019) compared with control group. No differences in the prevalence of overweight between the two groups Summary: 3 years: effective 6 years (end of intervention): effective 4 years (post-intervention): effective | |
| Fit von Klein auf 24–27 Germany Unclear risk of bias Consort: unclear to determine | Cluster randomized cross-over study School children from Kindergarten Age at baseline: 4.6 years (±0.4 years) | Baseline, 1 year (end of intervention), 1-year post-intervention N = baseline/follow-up Intervention: 426/?/? Control: 401/?/? | Setting: school based Intervention: teacher-delivered. health tool kit (physical activity, nutrition, stress management), record card of physical exercises for care givers in the kindergarten. Control: no intervention | Low intensity Parent evenings on the theme ‘healthy diet for preschoolers’ and an evening on food and health conducted by a psychologist and a nutritionist. | Primary agent of change: child, school, parent Health education model seven behaviour techniques reported spanning five out of five behaviour change process steps | At 12 months BMI deviation scores (BMI-SDS) of the intervention group declined from 0.08 ± 1.02 (7.2% overweight, 4.4% obese) at baseline with 0.04 SDS, BMI-SDS. Control increased BMI-SDS 0.11 (P < 0.001) 1 year after the intervention the BMI-SDS declined further with 0.03 SDS. Summary: 1 year (end of intervention): effective 1 year (post-intervention): effective | |
| Lekker Fit 28–29 The Netherlands Rotterdam Low risk of bias Consort: 19 out of 26 | Cluster RCT Primary school children Age at baseline: Grades 3–5: Intervention: 7.7 (1.0) years Control: 7.8 (1.0) years Grades 6–8: Intervention: 10.8 (1.0) years Control: 10.8 (1.0) years | Baseline and 1 year after start of the programme N = baseline/follow-up Intervention: 1,240 out of 1,149 (92%) Control: 1,382 out of 1,267 (91%) | Setting: school based Intervention: increased physical activity over the school year and an educational programme on healthy living Control: usual curriculum | Low intensity Homework assignments and fitness score card, written information on the intervention and inviting them for a health promotion gathering at the beginning of the school year | Primary agent of change: child, school, parent Theory of planned behaviour and the ecological model of Egger/Swinburn six behaviour techniques reported spanning three out of five behaviour change process steps | One year after the start of the programme: significant positive intervention effects were found for percentage overweight children (odds ratio [OR] 0.53; 95% CI 0.36–0.78), waist circumference (−1.29 cm; 95% confidence interval [CI] −2.16–−0.42 cm) and 20 m shuttle run (0.57 laps; 95% CI 0.13–1.01 laps) among pupils of grades 3–5 (6–9 year olds). No significant effects were found for BMI or for grades 6–8 (9–12 year olds). Summary 1 year after start of the programme: effective | |
| Gezond Gewicht Overvecht 30 The Netherlands Utrecht Low-unclear risk of bias Consort: 17 out of 26 | Non-randomized (quasi-experimental) study Youth (aged 0–19 years) and their community | Baseline (2004/2005), 5 year after start of the intervention (2010) N = baseline/follow-up Intervention: 04/05: n = 791 05/06: n = 830 06/07: n = 777 07/08: n = 699 08/09: n = 419 Total: n = 3,532 Control: n = 4,163 | Setting: district health programme community based Intervention: multiple interventions. Joint initiative of council, health care and municipal organizations Control district: no health promotion intervention | Could not be clearly extracted | No assessment made | Prevalence of overweight (including obesity) in 4–12 year olds was significantly reduced from 26% in 2004/2005 to 20% in 2008/2009 (OR = 0,85 [0,77–0,94]) Summary: 5 years after start of the intervention: effective | |
| Epode (Fleurbaix–Laventie Ville Sante Study) 31–32 France unclear to high risk of bias Consort: 14 out of 26 | Cross-sectional study (1992 and 2000 data) Observational study (2002–2004 data) Schoolchildren Age at baseline: 5–12 years old | Baseline (1992), 2000, 2002, 2003, 2004 N = sample size Intervention: 1992: n = 804, 2000: n = 601, 2002: n = 515, 2003: n = 592 2004: n = 633, Control: 2004 out of 2005: n = 349 | Setting: School/community Intervention: 1. (1992–1997) A school-based nutrition information programme 2. (1997–2002) Every 2 years, health survey families 3. (2002–2007) family-oriented advice on healthy living Control: no intervention | Could not be clearly extracted | No assessment made | (1992–2000) An increase in BMI and height in both boys and girls were observed. Girls: increase in obesity 1.6 to 4.4% (P < 0.03) increase in overweight 14.1–18.6% (P < 0.11) Boys: increase in overweight 13.8 to 20% (P = 0.03) Over a period from 2000 to 2004: Compared with 2002, the age-adjusted OR for overweight in the intervention town was significantly lower in 2003 and 2004 (but for girls only). In the 2004 school year, the overweight prevalence was significantly lower in the intervention town (8.8%) than in the comparison towns (17.8%, P < 0.001) Summary 12 years after start of the programme: effective | |
| Both prevention and treatment of overweight and/or obesity | |||||||
| OKIDO 33–34 The Netherlands Unclear risk of bias Consort: 15 out of 26 | Non-randomized (quasi-experimental) study Primary school children, grade 3–5 Age at baseline: 7–10 years old | Baseline, 4 months (end of intervention), 4 months and 5 years post-intervention N = baseline/follow-up Intervention: 129/124/93 (72%) Control: 101/96/74 (73%) | Setting: school and family Intervention: schools: three class sessions on diet and physical activity and a ‘project corner’ in school for children. Family: a family course for parents and overweight children. Control schools: no intervention | School: low intensity Family: medium intensity Only parents of obese or overweight children were directly involved in family intervention. All children: Parents received written health information and child's weight status. | Primary agent of change: child, school, parent Theory of planned behaviour Family: 10 behaviour techniques reported spanning five out of five steps School: four techniques spanning two out of five processes | Effects of both family and school intervention: At 4 months: BMI-SDS increase less in intervention group vs. control (P = 0.038), not maintained at 5 years Summary 4 months (end of intervention): not effective 4 months (post-intervention): not effective 5 years (post-intervention): not effective | |
| Kiel Obesity Prevention Study: KOPS 35–38 Germany Unclear risk of bias Consort: 14 out of 26 | Cluster-sampled quasi-randomized crossover trial nested in a cohort School children Age at baseline: 5–7 years Family-based intervention: Non-randomized open clinical trial | Baseline, 1 year (end of intervention), 3-year post-intervention N = baseline/follow-up School intervention: Intervention: 440/?/345 Control: ?/?/1,419 Family intervention: Intervention: 368/92 (25%) (discontinued at 1-year follow-up) | Setting: school and family Intervention: school intervention: nutritional education by nutritionist and trained teacher. Family intervention: individual counselling by a nutritionist over a period of 3 months. Additional 6 months sports programme | Low intensity School intervention: Health promotion was aimed at school children and their parents. A parent evening for education at school. Family intervention: 3–5 home visits with a nutritionist within a period of 3 months | Primary agent of change: child, school, parent No theory of behaviour specified Family and school: eight behaviour techniques reported spanning three out of five behaviour change process steps | One-year follow-up Significant effects in percentage fat mass of overweight children (increase by 3.6 vs. 0.4% per year without and with intervention, respectively; P < 0.05) No differences in BMI between control and intervention schools Significant effects on the age dependent increases in median triceps skin-folds (from 10.9 to 11.3 mm in ‘intervention schools’ vs. from 10.7 to 13.0 mm in ‘control schools’, P < 0.01) 3 years post-intervention Intervention had no effect on mean BMI. No significant difference in prevalence of overweight and obesity. Summary 1 year (end of intervention): effective 3 year (post-intervention): not effective | |
| Treatment of overweight and/or obesity | |||||||
| SCOTT 39–40 UK Low risk of bias Consort: 18 out of 26 | Randomized controlled trial Overweight children Age at baseline: mean 8.5 (5–11 years) | Baseline, 6 months (end of intervention) and 6 months (post-intervention) N = baseline/follow-up Intervention: 69/49/45 (65%) Control: 65/48/42 (63%) | Setting: outpatient hospital clinic Intervention: eight individual appointments Family centred, lifestyle monitoring, aimed at behavioural change in nutrition, activity and weight control Control: standard care | High involvement eight sessions were for child and parent together. Parents had one separate parental session discussing their skills and exploring parental concerns | Primary agent of change: child and parent No theory of behaviour specified 17 behaviour techniques reported spanning five out of five behaviour change process steps | The intervention had no significant effect compared with standard care on BMI z-score from baseline to 6 months and 6 months post-intervention. BMI z-score decreased significantly in both groups from baseline to 6 and 6 months post-intervention. Summary 6 months (end of intervention): not effective 6 months (post-intervention): not effective | |
| Magnificent kids 41–42 Finland Unclear risk of bias Consort: 19 out of 26 | Randomized controlled trial Obese children Age at baseline: mean 8 years (standard deviation [SD] 0.8, 6.6–9.7 years) | Baseline, 6 months (end of intervention), 6 months post-intervention, 1,5 and 2.5 years post-intervention, N = baseline/follow-up Control: 35/34/35/35/34 (97%) Intervention: 35/34/34/34/34 (97%) | Setting: family-based in school health care Intervention: Control: routine treatment. Intervention: family-based group treatment sessions including nutrition education, physical activity education and behavioural therapy | High intensity Control: information booklets Intervention: 15 sessions of 90 min. group treatment for parents and children. Group sessions were held separately for children and parents | Primary agent of change: parent Cognitive behavioural and solution oriented therapy 15 behaviour techniques reported spanning five out of five behaviour change process steps | In the intervention group, children lost more weight for height (6.8%) than children receiving routine counselling (1.8%) (P < 0.001). The respective decreases in BMI were 0.8 vs. 0.0 (P < 0.003) and in BMI-SDS 0.3 vs. 0.2 (P < 0.022) 6 months post-intervention, small but significant changes in weight for height and BMI were found. No significant differences between treatment arms in 2- or 3-years follow-up visits Summary 6 months (end of intervention): effective 6 months (post-intervention): effective 1,5 year (post-intervention): not effective 2,5 year (post-intervention): not effective | |
| Mi Piace Piacermi 43 Italy Unclear risk of bias Consort 15 out of 26 | Longitudinal observational clinical study Obese children with parents Age at baseline: 8.4 years (6.1–11.9 years) | Baseline, 10 weeks (end of intervention), 5 years (post-intervention) N = baseline/follow-up Intervention: 31/22/20 (65%) | Setting: outpatient hospital clinic Intervention: a cognitive-behavioural lifestyle multidisciplinary programme. eight Follow-up visits over the course of 3 years | High intensity Treatment programme activities are proposed to children and their parents, sometimes together and sometimes separately | Primary agent of change: parent cognitive behavioural and transtheoretic model of Prochaska and Di Clemente 16 behaviour techniques reported spanning five out of five behaviour change process steps | In subjects who completed the 5-year follow-up, BMI-SDS was 4.23 ± 0.71 at baseline and 2.74 ± 0.85 at follow-up. Adjusted BMI was 54.7% ± 9.0 at baseline and 43.2% ± 17.3 at the last visit. Both reductions were highly significant Waist circumference decreased. Summary 10 weeks (end of intervention): effective 5 years (post-intervention): effective | |
| Obeldicks mini 44–45 Germany Unclear risk of bias Consort: 15 out of 26 | Pre-test/post-test design Obese children Age at baseline: 6.1 ± 1 year (4–7.9 years) | Three months before baseline, baseline, 1 year (end of intervention), 3 years (post-intervention) N = baseline/follow-up Intervention: 103/84/64/50 (60%) | Setting: clinic for child and youth health care Intervention: based on diet, exercise and behaviour therapy including individual psychological care of the child and parents. Multidisciplinary team | High intensity Separate parent groups. 13 monthly 1,5-h group sessions for parents. Individual care every 2 months 30 min. Exercise sessions with children every month | Primary agent of change: parent Cognitive behaviour and system therapy 24 behaviour techniques reported spanning five out of five behaviour change process steps | The mean SDS-BMI reduction was 0.46 ± 0.35 (P < 0.001). 3 years after end of intervention, the achieved weight loss sustained Summary 1 year (end of intervention): effective 3 year (post-intervention): effective | |
| Fitoc 46–50 Germany Unclear to high risk of bias Consort: 11 out of 26 | Non-randomized clinical study Obese children Age at baseline: mean 10.5 years | Baseline, 8 months (end of intervention), 10 months post-intervention, 22/3 year post-intervention N = baseline/follow-up Intervention: 496/461/297/137 (28%) Control: 35/35/65/no control in final follow-up | Setting: outpatient university clinic/sports centre Intervention: regular physical exercise plus comprehensive dietary and behavioural education Controls: no intervention | Medium intensity Seven separate parents evenings every 4 to 6 weeks, regular nutrition discussions for parents and children | Primary agent of change: parent and child No theory of behaviour specified 14 behaviour techniques reported spanning four out of five behaviour change process steps | After 8 months BMI as well as BMI-SDS decreased in both sexes (P < 0.001). In controls, BMI increased (P < 0.001) and BMI-SDS remained constant. Ten months post-intervention: Significant improvements in BMI-SDS measured from baseline (P < 0.001) Summary 8 months (end of intensive phase intervention): effective 10-month post-intervention: effective 22/3 year post-intervention: not effective | |
| TAKE 51,52 Switzerland Unclear risk of bias Consort: 17 out of 26 | Randomized controlled trial Overweight children Age at baseline: 10 years (range 8–12 years) | Baseline, 9 months (end of intervention), 4 1/3 years post-intervention N = baseline/follow-up Intervention 1 (mother and child): 31/25/20 (65%)/13 Intervention 2 (mother only): 25/12/7/(28%)/14 | Setting: outpatient university clinic Intervention: Intervention 1 involved mother and child in cognitive behavioural therapy Intervention 2 involved mother in cognitive behavioural therapy and child in progressive muscle relaxation training. | High intensity Cognitive behavioural therapy for parents only (intervention 2) or for parent and child (intervention 1- parent and child in separate groups) using ‘individual treatment in group approach’ by trained psychologists | Primary agent of change: parent Cognitive behavioural therapy 18 behaviour techniques reported spanning five out of five behaviour change process steps | Both interventions reduced children's percent overweight significantly and equally by the end of intervention. 5-year follow-up: Moderate effects on BMI-SDS (−0,11 4.4%) Summary 9 months (end of intervention): effective 4 1/3 year (post-intervention): effective | |
| Obeldicks 54–55 Germany Risk of bias: unclear to high risk Consort: 13 out of 26 | Pre-test/post-test design Obese children Age at baseline: mean 10.5 years (6–16 years) | Baseline, 1 year (end of intervention), 1, 2 and 3 years (post-intervention) N = baseline/follow-up Intervention: 170/151/142 (83%) | Setting: outpatient university clinic Intervention: multidisciplinary programme is based on physical exercise (1 year), nutrition education and behaviour therapy for children and parents separately | High intensity six group sessions for parents separately from the children: intensive phase/maintenance phase/follow-up phase | Primary agent of change: parent Cognitive behavioural therapy 27 behaviour techniques reported spanning five out of five behaviour change process steps | The mean reduction of SDS-BMI compared to baseline was 0.41 (95% CI 0.37–0.46) at the end of intervention, 0.40 (95% CI 0.34–0.46) 1 year, 0.41 (95% CI 0.33–0.48) 2 years and 0.48 (95% CI 0.37–0.59) 3 years after the end of intervention, respectively. Summary 1 year (end of intervention): effective 1 year (post-intervention): effective 2 year (post-intervention): effective 3 year (post-intervention): effective | |
| Families for Health 56–57 UK Risk of bias: unclear Consort 16 out of 26 | Pre-test/post-test design Families with children who were overweight or obese Age at baseline: 7–11 years | Baseline, 3 months (end of intervention), 6 months and 1.5 years (post-intervention) N = baseline/follow-up Intervention 27/22/22/19 (70%) | Setting: community/family Intervention: 12 weekly group sessions of 2.5 h parallel for children and parents by local trained health care professionals | High involvement Parent sessions addressed parenting, lifestyle change, social and emotional development. Parents and children eat mid-session for a snack and an activity. | Primary agent of change: parent No theory specified 18 behaviour techniques reported spanning five out of five behaviour change process steps | BMI z-score change from baseline was: −0.18 (95% CI −0.30 to −0.05) at 3 months and −0.21 (−0.35 to −0.07) at 6 months post-intervention and −0.23 (95% CI: −0.42 to −0.03, P = 0.027) at 1.5 year post-intervention Summary 3 months (end of intervention): effective 6 months (post-intervention): effective 1.5 years (post-intervention): effective | |
| Mend 58–59 UK low risk of bias Consort: 19 out of 26 | Randomized controlled trial Obese children Age at baseline: 10 years (8–12 years) | Baseline, 6 months (end of intervention), 6 months (post-intervention) N = baseline/follow-up Control: 56/45/38/ (68%) Intervention: 54/37/42 (70%) | Setting: community/family Intervention: parents and children attended 18 2-h group educational and physical activity sessions held twice weekly in sports centres and schools, Control: waiting list (delayed intervention) | High intensity Sessions for parents and children together, five sessions on behaviour change parents/carers only | Primary agent of change: parent and child Social cognitive theories 21 behaviour techniques reported spanning five out of five behaviour change process steps | Intervention group had a reduced waist circumference z-score (−0.37; P < 0.0001) and BMI z-score (−0.24; P < 0.0001) at 6 months when compared with the controls. At 6 months post-intervention in the intervention group reduced their waist and BMI z-scores by 0.47 (P < 0.0001) and 0.23 (P < 0.0001), respectively Summary 6 months (end of intervention): effective 6 months (post-intervention): Effective | |
| Greece 60–61 Unclear to high risk of bias Consort: 12 out o of 26 | Randomized controlled trial Overweight children Age at baseline: 9.2 ± 0.2 years | Baseline, 3 months, 6 months (end of intervention) and 1 year (post-intervention) N = baseline/follow-up Intervention (child): 19/18/18/16 (84%) Intervention (parent and child): 23/18/18/16 (70%) | Setting: family based Intervention 1 and 2: a multidisciplinary programme assigned high self-regulation in children, but differed in parental involvement Intervention 1 is child only, intervention 2 is parent and child | Medium intensity In the child-and-parent group, parents participated in the last 10 min of each session, acting as helpers in general | Primary agent of change: parent and child Cognitive behavioural therapy nine behaviour techniques reported spanning four out of five behaviour change process steps | Percent overweight decreased by 4.9 ± 1.4 at 1 year post-intervention (P < 0.001); the reduction occurred during the active phase of the treatment (0–3 months) and was maintained thereafter Summary 6 months (end of intervention): effective 1 year (post-intervention): effective | |
| Sweden 62–63 unclear to high risk of bias Consort: 13 out of 26 | Randomized open trial Overweight or obese children Age at baseline: 10 years (8–12 years) | Baseline, 1 year (end of intervention), 1 year (post-intervention) N = baseline/follow-up Control: 48/28/27 (56%) Intervention: 45/30/29 (64%) Total: 83/52 (62%) | Setting: family based Intervention: programme aimed at improving food and physical activity habits, changing behaviour and improving self-esteem and weight control Control: standard care | Medium intensity 14 group 1–1.5 h sessions for parents and children over 1 year led by dietician. Parent and child were in separate sessions meeting at the end of session | Primary agent of change: parent Behavioural and solution focused group work 19 behaviour techniques reported spanning five out of five behaviour change process steps | No effects on BMI BMI (kg m−2) Intervention 23.1 ± 2.65 Control: 23.0 ± 2.97 P = 0.132 BMI 1 year post-intervention: no statistical difference was found between the groups regarding body mass index Summary 1 year (end of intervention): not effective 1 year (post-intervention): not effective | |
| Iceland 64–65 unclear to high risk of bias Consort: 12 out o of 26 | Pre-test/post-test design Obese children and parent Age at baseline: mean age 11.0 years (SD 1.4, range 7.5–13.6 years) | Baseline, 18 weeks (end of intervention), 1 year (post-intervention) N = baseline/follow-up Intervention: 84/61 (73%) | Setting: outpatient hospital treatment Intervention: Epstein family-based behavioural treatment: nutritional education, physical activity programme, energy restricted diet, self- monitoring and maintenance of behaviour change | High intensity 12 group and 12 individual (parent and child) treatment sessions (12 weeks delivered over 18 weeks). Individual sessions were 20 min, group meetings 90 min. | Primary agent of change: parent and child No behavioural therapy defined 20 behaviour techniques reported spanning five out of five behaviour change process steps | BMI-SDS at baseline: 3.12 (SD 0.5) Change in BMI –SDS (post treatment) −0.40 (SD 0.3) Change in BMI –SDS (1-year post-intervention) −0.35 (SD 0.3) Summary 18 weeks (end of intervention): effective 1 year (post-intervention): effective | |
| Dikke Vrienden Club 66 The Netherlands Rotterdam Unclear to high o risk of bias Consort: 14 out of 26 | Pre-test-post-test design Overweight or obese children Age at baseline: 10.5 years ( 8.0–14.0 years) | Baseline; 3 months (end of intervention), 9 months (post-intervention) N = baseline/follow-up 73/70/49 (67%) | Setting: outpatient hospital clinic Intervention: eight children sessions and two parent sessions during the first 12 weeks. Multidisciplinary team. The children are paired into age-matched buddy teams. Follow-up visits | Medium intensity Two separate parent sessions in groups over the course of 12 weeks. Follow-up: parent sessions aimed at prevention of relapse are organized | Primary agent of change: parent and child Cognitive behavioural therapy and operant behavioural therapy 10 behaviour techniques reported spanning five out of five behaviour change process steps | Mean BMI-SDS showed a significant reduction of 0.3 BMI-SDS after the 12-week programme (P < 0.0001) The participants achieved a 0.6 BMI-SDS reduction; comparable with a weight loss of 18.7% 9 months post-intervention (P < 0.0001). Summary 3 months ( end of intervention): effective 9 months (post-intervention): effective | |
| Dikke Vrienden Club 67 The Netherlands Rotterdam Unclear to high risk of bias Consort 14 out of 26 | Pre-test-post-test design with 1-year follow-up Overweight or obese children Age at baseline: 11.0 (±1.6) (8.0–14.9 years) | Baseline; 3 months (end of the 12-week intensive programme), 6 and 9 months N = baseline/follow-up 248/238/178/151 (63%) | Setting: outpatient hospital clinic Delivery: as above study Intervention: as above study | Medium intensity Minimum of three separate parent sessions in groups over the course of 12 weeks, as above | Primary agent of change: parent and child Cognitive behavioural therapy and operant behavioural therapy nine behaviour techniques reported spanning five out of five behaviour change process steps | Completers had a mean reduction of 0.42 BMI-SDS 9 months post-intervention (P < 0.001). At the start of treatment, 82% (n = 202/N = 248) of the children were obese, while 40% (n = 61/N = 151) of the children were obese 9 months post-intervention. Summary 3 months (end of the 12-week intensive programme): effective 9 months post-intervention: effective | |
| Door Dik en Dun Stichting Right Step 68 The Netherlands Unclear to high risk of bias Consort: 13 out of 26 | Non-randomized (quasi-experimental) study Overweight or obese children Age at baseline: 10.3 (1.8 years) | Baseline; 4 months (end of the intensive programme) and 8 months (post-intervention) N = baseline/follow-up Intervention: 47/46/47 Control: 35/33/31 | Setting: paramedic setting Intervention: family treatment aiming for change in lifestyle behaviour, Control: standard care of individual dietetic counselling | High intensity Multidisciplinary team group sessions seven group sessions for parents. Follow-up over the course of 8 months consisting of five family sessions. Website. Two individual family counselling sessions | Primary agent of change: parent and child No theory specified 18 behaviour techniques reported spanning five out of five behaviour change process steps | Significant reduction in percentage of obese children 9 months post-intervention The BMI-SDS of the intervention group was significantly reduced from 2.42 (SD = 0.47) to 2.10 (SD = 0.58) versus 2.62 (SD = 0.54) to 2.54 (SD = 0.53) in the control 9 months post-intervention. Summary 4 months (end of the intensive programme): effective 8 months (post-intervention): effective | |
| Weet en Beweeg 69 The Netherlands Low to unclear risk of bias Consort: 17 out of 26 | Randomized controlled trial Obese and overweight children and adolescents Age at baseline: 11.3 years (range 6–18) | Baseline, 1 year (end of intervention), 1 year (post-intervention) N = baseline/follow-up Intervention: 33/32/not stated Control: 36/33/not stated | Setting: (municipal) Centre for Family and Youth care Intervention: nutrition and physical activity training and behavioural change through a cognitive behavioural therapeutic approach targeting the family as a whole. Control: standard care | High intensity Parents are targeted in 10 separate parent sessions and involved in all aspects of the therapy in order to support the child make lifestyle changes | Primary agent of change: parent and child Cognitive behavioural theory, ASE-model, stages of change model 14 behaviour techniques reported spanning five out of five behaviour change process steps | The mean BMI-SDS significantly decreased in the intervention group (BMI-SDS decrease 0.27), while the mean BMI-SDS remained the same in the control group (BMI-SDS decrease 0.01). The intervention group could preserve the effect reached during the intervention up to 1 year post-intervention Summary 1 year (end of intervention): effective 1 year (post-intervention): effective | |