Table 3.

Reported results of multilevel multicomponent obesity prevention trials

Study	Health	Behavior	Psychosocial
Ballabeina	More beneficial effects on overweight (OW) vs. normal weight children on waist circumference interaction p = 0.001, and for low fit children vs. normal fit on all adiposity outcomes (BMI, sum of four skinfolds, and waist circumference) interaction p = 0.027. Intervention children showed reductions in % body fat p = 0.02, sum of four skinfolds p = 0.001, and lower increases in waist circumference p = 0.001 than control children. No effect of prevalence of overweight p = 0.23 or BMI p = 0.31. No difference in effects on migrants vs. non-migrants. Interaction BMI p = 0.849, % body fat p = 0.966, waist p = 0.824. No difference in effects by educational level (EL), BMI interaction p = 0.306, body fat p = 0.181, waist p = 0.454	No differential effect on OW vs. normal weight children, interaction p = 0.60, p = 0.18, respectively. On low fit vs. normal fit interaction p = 0.318, p = 0.467, respectively. Significantly higher increase in aerobic fitness p = 0.01, motor agility p = 0.004, reduced ST p = 0.03, higher prevalence of active children p = 0.01 and improved healthy eating p = 0.04 in the intervention group than in the control group. No effect on measured PA p = 0.54 or sleep duration p = 0.97. No difference in effects on migrants vs. non-migrants. Interaction shuttle run p = 0.085 and obstacle course p = 0.685. No difference in effects by EL, interaction shuttle run p = 0.058, obstacle course p = 0.258	No effect on the quality of life p = 0.17 or cognitive abilities: attention duration p = 0.98, attention accuracy p = 0.87, spatial working memory p = 0.58
BHEZ	BMI for age percentiles significantly decreased on average in the intervention group but not in the comparison group in all analyses, entire sample: p = 0.04, overweight and obese girls and boys: p < 0.001, and overweight and obese girls only p = 0.001	Intervention arm significantly decreased purchasing healthful beverage p = 0.003 and snacks p = 0.01, as well as purchasing unhealthful snacks p = 0.02 and eating fast food p = 0.02. No significant impact on purchasing healthful food p = 0.13, purchasing unhealthful food p = 0.31 or beverage p = 0.52, or healthful food preparation p = 0.13	Significant impact in intervention group: decreased behavioral intentions p = 0.01, increased outcome expectancies p = 0.02, and increased knowledge p < 0.001. No significant impact on self-efficacy p = 0.54
GEMS	No significant difference in adjusted BMI difference per year 0.04 kg/m2, 95 % CI (−0.18 to 0.27). Significant decrease in total cholesterol −3.49 mean adjusted fasting, 95 % CI (−5.28 to −1.70), LDL cholesterol −3.02 mg/dL, 95 % CI (−4.74 to −1.31) and hyperinsulinemia relative risk RR = 0.35, 95 % CI (0.13 to 0.93). Greater effectiveness (lower mean BMI change per year) in high-risk groups	No difference in most measured behavioral outcomes: accelerometer counts, vigorous PA, or ST. At the Memphis site, eating habits worsened less for the intervention than control group: SSB 0.19 fewer servings/day (p = 0.075), 0.21 more servings/day water (p = 0.022), 0.15 more servings/day vegetables (p = 0.069). No significant difference in eating habits observed at Oakland site	Significant difference in depressive symptoms in intervention compared to control −0.21 (0–20 Child Depression Inventory scale), 95 % CI (−0.42 to −0.001). No difference in self-esteem, school performance, activity preferences, or other outcomes
HC2	No statistically significant association found between parent/home intervention activities and BMI p = 0.81	No statistically significant differences in PA levels between the control and intervention groups and from baseline to 6-month follow-up in both groups. Analysis of lesson plans and class schedules revealed that over time, children in the control centers spent significantly more time on the computer p < 0.01 and watching TV p < 0.0001 than children attending intervention centers	None reported
ICAPS	Intervention students had a lower increase in BMI p = 0.01 and age- and gender-adjusted BMI p < 0.02 over time than controls; increase of high-density cholesterol concentrations p < 0.0001	Independent of initial weight status, compared with controls, intervention adolescents had an increase in supervised PA p < 0.0001, and a decrease of TV/video viewing p < 0.01	Self-efficacy and social support toward PA not significant at follow-up. Intention to PA significantly improved p < 0.001
SUS	Parent BMI decreases 0.411 kg/m2 95 % CI (−0.725 to −0.097). Significant change in child z-BMI at 2 years p = 0.0054. Prevalence of child overweight/obesity decreased in males OR = 0.61, p = 0.01 and females OR = 0.78, p = 0.013. Average change in BMI z-score = 0.1005 95 % CI (0.1151 to 0.0859), p = 0.001 after controlling for covariates	Reduced SSB consumption −2.0 oz per day; 95 % CI (−3.8 to −0.2). Increased PA 0.20 sports or activities per year 95 % CI (0.06 to 0.33). Reduced ST −0.24 h per day 95 % CI (−0.42 to −0.06). Participation in school breakfast and lunch up 3 %. Fresh produce expenditure up $27,000 from previous year; 21 restaurants joined	None reported
Switch	No significant impact on BMI	At post, parent report of ST p < 0.05, Cohen’s d = 0.69 and FV consumption significant p < 0.05, Cohen’s d = 1.36. Child report of FV consumption near significant p < 0.06, Cohen’s d = 0.52. Changes in PA or child report of ST not significant	None reported
TEFNEP	Significant BMI decrease at post compared to baseline for the intervention group only; change was not maintained at follow-up p < 0.05	Greater goal attainment significantly associated with improvement in various dietary practices p < 0.05. Parents who reported attaining more goals reported greater self-efficacy p < 0.05. Goals for regular vegetables and water use correlated with regular vegetable p < 0.05 and water p < 0.01 consumption at post. Water significant at follow-up p < 0.05. Various significant dietary changes at post in control group	Significant time effect regardless of group for all measured variables