Table 1.
Summary of findings
| Intervention outcome | Number of studies and study design | Reason for downgraded quality | Effect estimate and direction of effects | GRADE |
|---|---|---|---|---|
| Food labeling | ||||
| Energy consumed | None | NA | NA | NA |
| Energy expended | None | NA | NA | NA |
| Fiscal measures | ||||
| Energy consumed | 1 RCT | Consistency could not be assessed, study limitations | No statistically significant difference (SMD, 0.10; 95% CI: −0.24 to 0.44) | Very low |
| Energy expended | None | NA | NA | NA |
| Physical environment and transportation | ||||
| Energy consumed | 1 CT | Inconsistency | ES could not be calculated for the CT (but favored the intervention group); the control group had lower intake in the cohort study (SMD, 0.41; 95% CI: 0.14 to 0.69; 1 cohort study) | Very low |
| 1 cohort study | ||||
| Energy expended | None | NA | NA | NA |
| Supply of food and lifestyle commodities | ||||
| Energy consumed | 3 RCTs | Inconsistency, study limitations | RCTs report positive but not statistically significant differences (SMD, −0.23; 95% CI: −0.45 to −0.00; 3 RCTs); the CT reported insufficient data | Low |
| 1 CT | ||||
| Energy expended | None | NA | NA | NA |
| Work site interventions | ||||
| Energy consumed | 2 RCTs | Inconsistency, study limitations | 2 studies reported positive results, but ES could not be computed; 2 studies reported conflicting results and were based on diverse study designs (SMD, −0.20; 95% CI: −0.53 to 0.13; 1 RCT; SMD, −0.98; 95% CI: −1.32 to −0.65; 1 pre‐post study) | Very low |
| 1 CT | ||||
| 1 pre‐post study | ||||
| Energy expended | 6 RCTs | Inconsistency, imprecision | 4 RCTs found no statistically significant difference (SMD, 0.22; 95% CI: −0.17 to 0.61; 4 RCTs); 2 pre‐post studies reported improvements but could not be combined in a summary estimate | Low |
| 1 CT | ||||
| 2 pre‐post studies | ||||
| Population‐based health care initiatives | ||||
| Energy consumed | 15 RCTs | Inconsistency (sensitivity analysis) | Reduced consumption (SMD, −0.13; 95% CI: −0.18 to −0.08; 9 RCTs) | Moderate |
| Energy consumed, children only | 2 RCTs | Imprecision | No statistically significant difference (SMD, −0.19; 95% CI: −0.61 to 0.24; 2 RCTs) | Low |
| Energy expended | 5 RCTs | Study limitations, inconsistency | Studies could not be combined; effect varied | Very low |
| School‐based interventions | ||||
| Energy consumed, children | 10 | Inconsistency | Significant reduction (SMD, −0.11; 95% CI: −0.19 to −0.04; 6 studies) | Moderate |
| 6 RCTs | ||||
| 3 CTs | ||||
| 1 cohort study | ||||
| Energy expended, children | 5 RCTs | Inconsistency | No systematic effect (SMD, −0.08; 95% CI: −0.65 to 0.49; 6 trials) | Low |
| 1 CT | ||||
| 2 pre‐post studies | ||||
| Health education campaigns | ||||
| Energy consumed | 17 RCTs | Inconsistency | RCTs showed a statistically significant effect (SMD, −0.17; 95% CI: −0.26 to −0.08; 10 RCTs); pre‐post studies both positive but could not be combined | Moderate |
| 3 pre‐post studies | ||||
| Energy consumed, children only | 3 RCTs | Inconsistency, imprecision | SMD, −0.20; 95% CI: −0.41 to 0.01; 3 RCTs | Very low |
| Energy expended | 13 RCTs | Inconsistency | Positive pooled effects but individual results varied (SMD, 0.37; 95% CI: 0.07 to 0.67; 10 RCTs; SMD, 0.48; 95% CI: 0.16 to 0.79; 2 pre‐post studies) | Low |
| 2 pre‐post studies | ||||
| Energy expended, children only | 2 RCTs | Inconsistency, imprecision | Difference not statistically significant (SMD, 0.06; 95% CI: −0.41 to 0.52; 2 RCTs) | Very low |
| Social‐group approaches | ||||
| Energy consumed | 2 RCTs | Inconsistency, imprecision | Studies could not be combined; conflicting results | Very low |
| 1 CT | ||||
| Energy expended | 7 RCTs | Inconsistency | Statistically significant increase (SMD, 0.26; 95% CI: −0.07 to 0.44; 8 trials) | Moderate |
| 1 CT | ||||
| 1 pre‐post study | ||||
| Energy expended, children only | 3 RCTs | Imprecision | Not statistically significant (SMD, 0.17; 95% CI: −0.17 to 0.51; 3 RCTs) | Low |
CT, controlled trial; ES, effect size; NA, not applicable; RCT, randomized controlled trial; SMD, standardized mean difference.