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. 2021 Feb 20;18(4):2061. doi: 10.3390/ijerph18042061

Table 2.

Characteristics of the lifestyle intervention studies in children and adolescents with overweight or obesity.

Country, Year [Reference] Participants, Criteria for Overweight
and Obesity		 Duration of the Intervention, Study Design Therapeutic Team Characteristics of the Intervention Control Group Effect of the Intervention
Belgium, 2015 [35] n = 33, 27.3% boys, 12–18 years (mean 15.4 ± 1.5 years), BMI ≥ 97th pc (< 16 years old), BMI ≥ 35 (> 16 years old) 10 months, quasi-randomized trial pediatrician, physiotherapists
  • -

    nutritional intervention: low calorie diet (1500–1800 kcal a day);

  • -

    physical activity: daily 2-h supervised games and lifestyle activities, 2 h physical education a week at school, 3 supervised training sessions every week;

 n = 28, 21.4% boys, years (mean 15.1 ± 1.2 years):
  • -

    usual medical care focused on reducing calories and encouraging sports;

 Compared to control group:
↓ % BF, BMI, BMI z-score, BW, LDL-C
↑ HDL-C, SBP
↔ DBP, TC
China, 2015 [36] n = 90, 38.9% boys, 7–12 years (mean 9.41 ± 1.03 years), BMI criteria according to WGOC 1 year, nonrandomized controlled trial with cluster sampling medical research postgraduate students, physical trainer Comprehensive intervention group:
  • -

    nutritional intervention: individual dietary behavior goal settings, dietary monitoring;

  • -

    physical activity: recommendations of 60 min physical activity daily, individual goal settings to improve physical activity levels, monitoring using accelerometers;

  • -

    parental involvement: nutrition and physical activity education, encouraging children to modify unhealthy eating behavior and increase physical activity;

  • -

    rewards for achieving goals;

 n = 136, 32.4% boys, 7–12 years, mean age 9.16 ± 1.12 years:
  • -

    no intervention;

 Compared to diet only intervention group:
↓ % BF, BMI, HDL-C, SBP
↔ DBP, LDL-C, WC
↑ TC, TG
Compared to control group:
↓ % BF, DBP, SBP
↔ BMI, HDL-C, LDL-C, WC
↑ TC, TG
n = 96, 42.7% boys, 7–12 years (mean 9.27 ± 1.34 years), BMI criteria according to WGOC Diet only intervention group:
  • -

    nutritional intervention: nutritional education, textbooks for nutrition education in the form of cartoons;

  • -

    parental involvement: nutrition education;

 Compared to control group:
↔ BMI, DBP, LDL-C, SBP, TG, WC
↑ % BF, HDL-C, TC
China, 2014 [37] n = 20, 55% boys, 7–17 years, BMI ≥ 95th pc 4 weeks, intervention study no data
  • -

    nutritional intervention: energy restricted diet ranging from 1338 to 1883 kcal a day depending on age (19.4 ± 2.4% energy from protein, 2.7 ± 3.7% from fat and 60.0 ± 4.4% from carbohydrates);

  • -

    physical activity: four supervised 45-min physical activity sessions;

 no control group Compared to baseline:
↓ BFM, BMI, BW, DBP, LDL-C, SBP, TC, TG, WC, WHR
↔HDL-C
Denmark, 2016 [38] n = 55, 47.3% boys, 11–13 years (mean 12.0 ± 0.4 years), BMI criteria according to IOTF 1 year, randomized controlled trial dietician, trained instructors, school nurses Day-camp intervention (6 weeks) and family-based intervention (after day-camp):
  • -

    nutritional intervention: day-camp meals prepared according to the national Danish dietary recommendations (no caloric restriction), dietary course;

  • -

    physical activity: minimum 3 h of exercise a day at day-camp, “activity day” during family-based intervention;

  • -

    parental involvement: dietary course, information about healthy cooking, advice on how best to support the child’s health behavior;

 Standard intervention arm (SIA—6 weeks) (n = 52, 41.2% boys, 11–13 years (mean 12.0 ± 0.4 years):
  • -

    2-h weekly exercise session;

  • -

    a single health and lifestyle educational session for the parents;

 After 6 weeks, compared to SIA group:
↓ % BF, BMI, BMI z-score, TC/HDL-C ratio, SBP, WC, % of abdominal fat, clustered cardiovascular risk z-score
↔ FFM, TG
After 52 weeks, compared to SIA group:
↓ BMI, BMI z-score, TC/HDL-C ratio, clustered cardiovascular risk z-score
↔ % BF, FFM, SBP, TG, WC, % of abdominal fat
Denmark, 2012 [39] n = 117, 43.6% boys, mean age 12.1 ± 1.3 years, no criteria for assessing obesity 10 weeks, intervention study no data
  • -

    nutritional intervention: weight loss camp, approximate daily energy consumption was 1547 kcal/6475 kJ (60% energy from carbohydrates, 16% energy of protein and 24% energy from fat), 3 healthy meals a day at set times plus 3 healthy snacks,

  • -

    physical activity: at least 1 h a day individual or group activity;

 no control group Compared to baseline:
↓ % BF, BFM, BMI z-score, BW, DBP, LDL-C, SBP, TC, TG, WC, WHR
↔ HDL-C
12-month follow-up compared to the end of the weight loss camp:
↑ BFM, BMI z-score, BW, DBP, LDL-C, SBP, TG, TC, WC, WHR
↔ % BF, HDL-C
12-month follow-up compared to baseline:
↓ % BF, BFM, BMI z-score
↑ BW, DBP, SBP
↔ HDL-C, LDL-C, TC, TG, WC, WHR
France, 2013 [40] n = 28, 32% boys, mean age 14.2 ± 1.5 years, BMI > 97th pc and BMI z-score > 3 9 months, intervention study dieticians, fitness teacher
  • -

    nutritional intervention: balanced diet 2300–2500 kcal (30% energy from fat, 14% energy from proteins, 56% energy from carbohydrates), nutritional education;

  • -

    physical activity: 45–60 min exercises at least 5 times a week, physical education lesson;

 n = 20, 40% boys, mean age 14.9 ± 1.6 years:
  • -

    healthy adolescents;

  • -

    no intervention;

 Compared to baseline:
↓ BFM, BMI, BMI z-score, BW, DBP, SBP, WC
↑ HDL-C
↔ LDL-C, TC, TG
Compared to control group:
↑ BMI, BMI z-score, BW
↔ DBP, SBP
Greece, 2012 [41] n = 21, 47.6% boys, 8–18 years (mean 12.8 ± 2.1 years), BMI > 95th pc 6 months, intervention study dietician, pediatric endocrinologist Ketogenic diet group:
  • -

    nutritional intervention: information about the selection of products and composing a ketogenic diet, no caloric restriction, individual dietary counselling (education and counselling on the diet);

  • -

    physical activity: encouraging a minimum of 1 h of vigorous physical activity a day;

 no control group Compared to baseline:
↓ BFM, BMI, BW, WC
↔ DBP, HDL-C, LDL-C, SBP, TC, TG
Compared to hypocaloric diet group:
↔ BFM, BMI, BW, DBP, HDL-C, LDL-C, SBP, TC, TG, WC
n = 17, 41.2% boys, 8–18 years (mean 12.7 ± 2.8 years), BMI > 95th pc Hypocaloric diet group:
  • -

    nutritional intervention: low calorie diet (-500 kcal compared to individual daily energy requirements; 28–33% energy from fat and 50–55% from carbohydrates), individual dietary counselling (education and counselling on the diet);

  • -

    physical activity: encouraging a minimum of 1 h of vigorous physical activity a day;

 Compared to baseline:
↓ BFM, BMI, BW, WC
↔ DBP, HDL-C, LDL-C, SBP, TC, TG
Italy, 2015 [42] n = 90, 49% boys, ≥ 6 years (mean 9.7 ± 2.6 years), no criteria for assessing obesity 1 year, intervention study dietician, pediatrician
  • -

    nutritional intervention: normocaloric diet by age and sex (12–15% energy from protein, 25–30% from fat and 55–60% from carbohydrates), nutritional education;

  • -

    physical activity: at least 60 min a day, physical activity education;

  • -

    parental involvement: nutrition guidelines, telephone contact with a dietician and pediatrician;

 no control group Compared to baseline:
↓ BMI z-score, TG, TG/HDL-C ratio
↑ HDL-C
↔ DBP, LDL-C, LDL-C/HDL-C ratio, SBP, TC, TC/HDL-C ratio, WC
Italy, 2012 [43] n = 11, mean age 118.0 ± 19.6 months, BMI z-score ≥ 2 6 months, randomized controlled trial dietician Low Glycemic Index diet:
  • -

    nutritional intervention: a hypocaloric diet that provided an energy intake 30% less than the intake sufficient to maintain the ideal body weight (15–20% energy from protein, 25–30% from fat and 50–60% from carbohydrates, glycemic index = 60), individual dietary counselling, 7-day dietary records;

  • -

    parental involvement: individual dietary counselling;

 no control group Compared to baseline:
↓ BMI, BMI z-score, DBP, SBP, WC
↔ HDL-C, TC, TG
Compared to HGI group:
↓ BMI, BMI z-score, TG
↔ HDL-C, TC
n = 11, mean age 113.9 ± 19.4 months, BMI z-score ≥ 2 High Glycemic Index diet group (HGI):
  • -

    nutritional intervention: a hypocaloric diet that provided an energy intake 30% less than the intake sufficient to maintain the ideal body weight (15–20% energy from protein, 25–30% from fat and 50–60% from carbohydrates, glycemic index = 90), individual dietary counselling, 7-day dietary records;

  • -

    parental involvement: individual dietary counselling;

 Compared to baseline:
↓ BMI, BMI z-score, DBP, SBP
↔ HDL-C, TC, TG, WC
Korea, 2019 [44] n = 44, 63.6% boys, 6–16 years (mean 12.1 ± 2.2 years), BMI > 85th pc 16 weeks, intervention study doctor, clinical dietician, social workers, nurses Usual care group:
  • -

    nutritional intervention: one-to-one nutritional counselling and education,

  • -

    physical activity: goal settings—minimum 8000 steps a day and reduce inactivity time, physical activity tracker;

 no control group Compared to baseline:
↑ BFM, LM
↔ % BF, BMI z-score, DBP, HDL-C, LDL-C, SBP, TG, WC
n = 26, 65.4% boys 6–16 years (mean 12.8 ± 1.7 years), BMI > 85th pc doctor, clinical dietician, exercise specialists, social workers, nurses Exercise group:
  • -

    nutritional intervention: one-to-one nutritional counselling and education,

  • -

    physical activity: exercise for 60 min at 3 days a week, physical activity tracker and the daily exercise journal;

 Compared to baseline:
↑ LM
↓ % BF, BMI z-score, DBP, LDL-C
↔ BFM, HDL-C, SBP, TG, WC
Compared to usual care group: ↓ BMI z-score
Norway, 2011 [45] n = 230, 47.4% boys, 7–17 years, body weight > 97.5 pc for height 1 year, intervention study clinical nutritionist, pediatrician, physical activity specialist, public health nurses
  • -

    nutritional intervention: nutritional education, dietary counselling;

  • -

    physical activity: encouraging to exercise at least 60 min a day and to limit the time spent watching television and computer activities;

  • -

    parental involvement: dietary and medical counselling;

 no control group Compared to baseline:
↓ BMI z-score, LDL-C, TC
↔ HDL-C, TG
Switzerland, 2011 [46] n = 203, 56.2% boys, mean age 14.1 ± 2.0 years, BMI > 98th pc 2 months, prospective study dietician, exercise therapist pediatrician, psychologist, nurses
  • -

    nutritional intervention: a balanced diet with restricted energy value of 1200–1600 kcal a day based on basal body weight (15–20% energy from protein, 25–30% from fat and 55–60% from carbohydrates), nutritional education, individual consultations, cooking classes;

  • -

    physical activity: 60–90-min group exercise sessions twice daily, 4–5 h exercise session once a week and at least 60-min a day supervised ergometric cycling on weekends;

  • -

    parental involvement: theoretical and practical counselling;

  • -

    behavior modifications: contracting in emergency situations self-control of calorie intake and body weight, praise and stimulus control, increasing self-esteem, responsibility and problem-solving strategies, relaxation techniques;

  • -

    6- and 12-months follow up;

 no control group Compared to baseline:
↓ % BF, BFM, BMI z-score, BW, HDL-C, LDL-C, SBP, TC, TG
↔ DBP
6- and 12-months follow-up compared to baseline:
↓ % BF, BFM, BMI z-score, BW
↑ LM
Thailand, 2015 [47] n = 25, 64% boys, 9–16 years (mean 11.9 ± 1.9 years), BMI criteria according to IOTF 6 months, prospective randomized controlled trial dietician, pediatrician
  • -

    nutritional intervention: low-glycemic index diet, 1400–1500 kcal a day (15–20% energy from protein, 30–35% from fat and 50–55% from carbohydrates), nutritional education, 3-day dietary records;

  • -

    physical activity: 30 min a day at least three times a week, reducing sedentary activity, physical activity questionnaire;

  • -

    parental involvement: nutritional education;

 n = 27, 70.3% boys, 9–16 years, mean age 12.0 ± 2.1 years:
  • -

    1200–1300 kcal a day, low-fat (25% energy from fat) high fiber diet;

  • -

    physical activity the same as in the intervention group;

 Compared to baseline:
↓ BMI z-score
↔ % BF, DBP, HDL-C, LDL-C, SBP, TC, TG, WC
Compared to control group:
↔ % BF, BMI, BMI z-score, HDL-C, LDL-C, TC, TG, WC
United States, 2015 [48] n = 12, 8.3% boys, 13–17 years (mean 15.2 ± 1.3 years), BMI > 95th pc 14–18 weeks, intervention study no data
  • -

    nutritional intervention: energy value of the diet based on basal body weight (1400, 1600 or 1800 kcal a day; 20–25% energy from protein, 15–20% from fat and 45–55% from carbohydrates, nutrition courses;

  • -

    physical activity: physical training 3 times a week;

  • -

    behavioral counselling;

 no control group Compared to baseline:
↓ BMI, BMI z-score, BW, LDL-C, TC, WC
↔ DBP, SBP, TG
↑ HDL-C
United States, 2015 [49] n =14, 36% boys, 9–18 years, BMI ≥ 95th pc 4 weeks, prospective randomized trial no data Plant-based no added fat diet group:
  • -

    nutritional intervention: instructions to avoiding all animal products and fat, reducing the consumption of nuts and avocados, nutritional and cooking education, 3-day diet diary during the study;

  • -

    parental involvement: the same diet follow by one parent;

  • -

    a scholarship of fifty dollars a week;

 no control group Compared to baseline:
↓ BMI z-score, LDL-C, SBP, TC
↔ BW, DBP, HDL-C, TG, WC
Compared to AHA group:
↓ BMI z-score
↔ BW, DBP, HDL-C, LDL-C, SBP, TC, TG, WC
n = 14, 36% boys, 9–18 years, BMI ≥ 95th pc The American Heart Association diet group (AHA):
  • -

    nutritional intervention: diet based on AHA guidelines (30% energy from fat, 7% energy from saturated fat, less than 300 mg cholesterol, less than 1500 mg of sodium daily), nutritional and cooking education, 3-day diet diary during the study;

  • -

    parental involvement: the same diet follow by one parent;

  • -

    a scholarship of fifty dollars a week;

 Compared to baseline:
↓ HDL-C, WC
↔ BMI z-score, BW, DBP, LDL-C, SBP, TC, TG
United States, 2015 [50] n = 20, 55% boys, 10–19 years (mean 14.3 ± 2.1 years), BMI > 85th pc 12 weeks, intervention study nutritionist, trainer
  • -

    nutritional intervention: dietary goals based on DASH (Dietary Approaches to Stop Hypertension) diet guidelines, weekly conversations with nutritionist, food recording;

  • -

    physical activity: training sessions 3 times a week;

  • -

    $15 gift card every 2 weeks;

 no control group Compared to baseline:
↓ LDL-C, TC, WHR
↔ BMI, BMI z-score, BW, DBP, HDL-C, SBP, TG
United States, 2011 [51] n = 186, 33.9% boys, 11–18 years (mean 13.7 ± 1.8 years), BMI ≥ 95th pc 6 months, intervention study dietician, behavioral support specialist, exercise physiologist
  • -

    nutritional intervention: individual dietary counselling, nutritional education, individual dietary goals, self-monitoring of progress, grocery store tour with parents and a nutritionist;

  • -

    physical activity: 3 exercise sessions a week, self-monitoring of progress;

  • -

    parental involvement: individual dietary counselling, nutritional education, meetings with a behavioral support specialist, grocery store tour with child and a nutritionist;

  • -

    meetings with a behavioral support specialist, two $100 gift cards for the grocery store;

 no control group Compared to baseline:
↓ % BF, BMI, BMI z-score, HDL-C, LDL-C, TC, TG
United States, 2011 [52] n = 105, 44.8% boys, 8–16 years (mean 12.0 ± 2.5 years), BMI ≥ 95th pc 2 years, randomized controlled trial dieticians, physicians, exercise physiologists, social worker
  • -

    nutritional intervention: nutritional education to modify eating behavior;

  • -

    physical activity: 50 min of exercises at 2 times a week, encouraging to exercise for an additional 3 days a week at home and reducing a sedentary lifestyle;

  • -

    parental involvement: nutritional education, highlighting the role of the parent in modelling the change in healthy behavior;

  • -

    behavior modifications: techniques for self-awareness, goal setting, stimulus control, training, coping and cognitive skills behavior strategies;

  • -

    12-month follow up—no active intervention, encouragement to remain active and to use acquired nutritional knowledge;

 n = 69, 31.9% boys, 8–16 years (mean 12.5 ± 2.3 years):
  • -

    general diet and exercise counselling every 6 months.

 Compared to control group—end of intervention:
↓ % BF, BFM, BMI, BMI z-score, BW, TC
↔ DBP, HDL-C, LDL-C, SBP, TG
Compared to control group after 12-month follow-up:
↓ % BF, BFM, BMI, BMI z-score, BW, LDL-C, TC
↔ DBP, HDL-C, SBP, TG

↓—decrease; ↑—increase; ↔—no change; BF—body fat; BFM—body fat mass; BMI—body mass index; BW—body weight; DBP—diastolic blood pressure; FFM—free fat mass; HDL-C—high-density lipoprotein cholesterol; IOTF—International Obesity Task Force; LDL-C—low-density lipoprotein cholesterol; LM—lean mass; pc—percentile; SBP—systolic blood pressure; TC—total cholesterol; TG—triglycerides; WC—waist circumference; WGOC—Working Group for Obesity in China; WHR—waist to hip ratio.