Table 1.

Summary of dietary interventions on childhood obesity and their main characteristics and results.

Author (Study Title) (Reference)	Country, Year	Type of Intervention	Intervention Description	Target Audience	Results
School-Based Interventions
Niederer I, et al. (Ballabeina study) [13]	Switzerland, 2009	Cluster randomized controlled single-blinded trial	Lessons on nutrition (balanced nutrition and healthy nutritional behaviors in a didactic way), physical activity program, media use, and sleep, and adaptation of the built environment of the preschool.	Preschool children (mean 5.1 years) (n = 652), the parents, and the teachers	No differences in children’s BMI were found between groups. However, the intervention group had a reduction in body fat percentage, better motor agility, as well as benefits in reported physical activity, media use, and eating habits.
Singh AS, et al. [14,15]	Netherlands, 2006	School-based trial	Educational component (classes in biology and physical education, and a computer-based information program); and an environmental component (e.g., serving smaller portion sizes in the canteen and healthier options, restricting access to vending machines, and food awareness by posters).	Students from the ages of 12–14 years (n = 1108)	With a twelve-month follow-up, a reduction in the skinfold thickness of the intervention groups was found, as well as lower consumption of sugar-containing beverages, and less screen time (but only in boys).
Kain J, et al. [16]	Chile, 2004	School-based obesity-prevention trial	Weekly classes on physical activity and healthy nutrition for parents and students. Some environmental changes were also made (e.g., school kiosks were instructed to offer healthier choices and at the same time remain lucrative).	Parents and students from 1st to 8th grade; 2141 schools in the intervention group and 945 in the control group.	After 6 months, there was a reduction of body mass index (BMI) z-scores in boys and better physical fitness in both genders. On the other hand, the modifications in the kiosk’s food availability did not seem to change the students’ food choices.
Hollar D, et al. (Healthier Options for Public Schoolchildren (HOPS)) [17]	Florida, US, 2004–2006	Randomized trial	Modifications in the school menu, school gardens, and physical activity; monthly newsletters with healthy nutrition and physical activity lessons for the students and parents.	6 elementary schools (4588 children aged 6 to 13 years; 48% Hispanic)	After 2 years, a higher percentage of students who maintained a normal weight (<85th percentile of BMI-for-age) was found in the intervention group (52.1%) when comparing with the control group (40.7%). Students in the intervention group had improved academic performance.
Economos CD, et al. (Shape up Somerville) [18]	United States, (September 2003–June 2005)	Non-randomized controlled trial	Dietary intervention (e.g., promotion of fresh fruit and vegetables and taste tests, posters with nutritional and health information, training of food staff, modification of food offers in restaurants according to the study guidelines); increase of physical activity opportunities around the school (e.g., information on safe routes); modifications inside the school space (e.g., new equipment).	1178 children (average 7.92 years) attending public school in three different communities from Somerville, Massachusetts	After 1 year, the BMI z-scores were 0.06 lower in the intervention group than in the control group. There was a decrease in overweight and obesity and an increase in remission in both sexes in the intervention group. The study design did not include randomization of the intervention.
Bacardí-Gascon M, et al. [19]	Mexico, 2012	Randomized cluster controlled trial	Sessions discussing healthy lifestyles to the school board and the teachers; interactive lessons to the children to increase fruit and vegetables intake and physical activity practice, and reduce soda and high fat and salt-containing snacks intake, while simultaneously decreasing TV watching time; healthy eating sessions to parents.	532 school-aged children from 2nd and 3rd grade	By the sixth month, there was a greater decrease in BMI in the intervention group than in the control group (difference of −0.82 kg/m2 in children BMI), although it was not sustained after 18 and 24 months of intervention.
Foster GD, et al. [20]	USA, 2008	Multicomponent School Nutrition Policy Initiative	School self-assessment (e.g., strategies like limiting the use of food as reward/punishment, promoting active recess, and serving breakfasts in classrooms); training of school staff and children in nutrition education; nutrition policies (e.g., changing sold foods); social marketing; school association meetings/workshops.	1349 students in grades 4 through 6 from 10 schools	There were significantly fewer children in the intervention schools (7.5%) than in the control schools (14.9%) who became overweight after 2 years, but no differences after 2 years of follow-up.
Donnelly JE, et al. [21]	Nebraska, USA, 1996	2-year trial	Nutrition education (basic nutrition, diet, and general health, nutrition for growth and development, healthy food choices, snack alternatives, food safety), modified school lunches (meals planned according to the Lunchpower! Program aiming to reduce energy, fat, and sodium lunches), and increased physical activity.	Students from grades 3 to 5 in two school districts in rural Nebraska (n = 338)	After 2 years of the intervention, both schools showed no significant changes in the body fat percentage, but a significant increase in the BMI. The control school showed significantly higher total energy, total fat and sodium intake, and lower fiber intake.
Liu Z, et al. (The DECIDE-Children study) [23]	China, 2019	Cluster-randomized controlled trial	Health education activities for parents and children; supervision and encouragement of children’s physical activity practice outside of school; school policies to prevent obesity. Development of an app called ‘Eat Wisely, Move Happily’ that aids in diffusing information, monitoring the children’s behavior, and managing their weight.	4-grade primary schools (8–10 years old) (n = 1200)	No known results.
Xu H, et al. [24]	China, 2020	Multicenter randomized controlled trial	Development of a nutrition handbook that was given to all students; nutrition and health courses to students, parents, teachers, and health workers (e.g., meals proportion, how to choose healthy foods, reduce eating out and unhealthy foods); informative posters around the school; course on physical activity for parents, and physical activity classes for students.	4846 school children aged 7–13 years	The effects on children’s BMI were studied. There were some improvements in the diversity of the foods consumed at breakfast and a decrease in the consumption of some unhealthy foods.
Hannon BA, et al. (Abriendo Caminos Program) [25]	Illinois, California, Iowa, Texas, and Puerto Rico, 2019	Randomized control trial	Workshop presentations and activities on nutrition education, family wellness, and physical activity.	Families of parents and 1 child aged 6–18 years (n = 500)	No known results.
Olsen NJ, et al. (Healthy Start) [26]	Denmark, 2020	Randomized controlled trial	Guidance on how to improve the child’s diet and physical activity, quantity and quality of sleep, and reduce their stress. Cooking classes, games focused on exercise and motor skills development, access to a website with recipes.	Children aged 2 to 6 years (n = 3722)	The clinical effects of this intervention in the children’s growth and body composition were small.
Homs C, et al. (FIVALIN project) [27]	Barcelona, 2021	Quasi-experimental design	Workshops on health education and sports educational sessions.	810 children aged 8–12 years and 600 parents	No known results.
Li B, et al. (The CHIRPY DRAGON intervention) [28]	China, 2019	Cluster-randomized controlled trial	Workshops and family activities to promote physical activity and healthy eating behaviors; school support to improve physical activity and healthy food provision.	School children with a mean age of 6.15 years (n = 1641)	There was a decrease in the BMI z-scores of the children in the intervention group, along with an increase in the consumption of fruit and vegetables, and a decrease in the consumption of sugar-sweetened beverages and unhealthy snacks. There was also a decrease in screen time and an increase in physical activity in this group.
Anselma M, et al. (Kids in Action) [29]	Amsterdam, 2019	Controlled trial	Meetings with children to develop interventions that targeted their physical activity and healthy eating habits. These interventions consist of environmental changes, organizational changes, or educational approaches.	Children aged 9–12 years from four primary schools	No known results.
Hamulka J, et al. (The ABC of Healthy Eating Project) [30]	Poland, 2018	Education-based intervention study	Diet and lifestyle-related programs for the intervention group and school activities with the theme of nutrition and healthy lifestyles for both the intervention and the control group.	School children aged 11–13 years. (464 students)	No known results.
Community-based interventions
Elder JP, et al. (MOVE/me Muevo) [31]	San Diego County, USA, 2014	Randomized community trial	Activities and phone calls from health coaches on how to increase the consumption of fruit and vegetables; decrease the consumption of sugar-sweetened beverages; increase healthy food portions; reduce eating out and do healthier options when eating out; increase the availability and accessibility of healthy foods and beverages at home; reduce the screen time and avoid eating in front of the TV, and increase the number of family meals.	541 families with children between the ages of 5 and 8 years old	After 2 years, there were no significant differences between the control and the intervention group concerning BMI or waist circumference. Some changes were observed in dietary intake, namely a reduction in fat and sugary beverages in the intervention group.
De Silva-Sanigorski A, et al. (Romp & Chomp) [32]	Australia, 2020	Community-based trial	Changes in the provision of water in childcare centers, childcare policies regarding healthy eating and physical activity; teaching of skills in physical activity and nutrition to the childcare professionals; production and distribution of promotional materials (balloons, stickers, posters, postcards).	Children aged 1–5 y (n = 12,000) and their families	After 3 years of intervention, the 3.5 years old subsample showed considerably lower mean weight, BMI, and z-score BMI, and the 2 and 3.5 years old children showed a considerably lower prevalence of overweight and obesity when compared with the baseline values. The intervention group also showed a considerably lower intake of packaged snacks and fruit juice.
Crespo NC, et al. (The Aventuras Para Niños Study) [33]	Southern California, 2003	Randomized Community-based trial	Three arms: family-only, community-only, or family+community intervention. In the family-only intervention, professionals call/make home visits to discuss how to maintain a healthy diet, prepare meals, and be physically active. The community-only intervention included improving the school’s playgrounds, implementing salad bars, as well as community parks, displaying water bottles in the classrooms for the students, better physical education equipment and healthy menus for the children, all of this combined with spreading media messages through posters, news and point-of-choice messages in grocery stores, with health messages. The family+community included all described.	811 predominantly Mexican immigrant/Mexican-American mothers with children in kindergarten through second grade	No noteworthy main effects nor interactions for the family or community interventions were found, including on BMI z-scores. Despite the lack of significant effects on the children’s BMI z-score, there were multiple obesity-related behaviors in these children that were changed by the family intervention, like increased consumption of fruit and vegetables.
Borys JM, et al. (EPODE (Ensemble Prevenons l’Obesité Des Enfants/Together Let’s Prevent Childhood Obesity) [34]	France, 2004	Community-based intervention	Changes in local environments, childhood settings, and family norms to make them more supportive and aid the adoption of healthy lifestyles in children.	Children aged 1–12 years, and their families, as well as a wide variety of local stakeholders in 10 French pilot communities	No known results.
Swinburn BA, et al. and Schultz JT, et al. (Pacific Obesity Prevention in Communities (OPIC) project) [35,36]	Australia, Fiji, New Zealand, and Tonga, over 30 months, between 2004 and 2009	Community-based intervention	Interventions aiming to reduce the consumption of high sugar content drinks and energy-dense snacks and increase physical activity.	18 000 children 12–18 years, 300 stakeholders, 60 multi-professional research staff, 27 research students.	The authors state that the project can produce positive effects in diet and physical activity, but effects on childhood obesity are not clearly described.
Interventions through mass media
World Health Organization and Assembly of the Republic (TV ban/restrictions of food commercials to kids in several countries [38] and Portugal) [39]	Sweden, Norway, Denmark, Austria, Ireland, Australia, Greece, and Portugal, 2019	Mass-media based- intervention	Sweden has banned TV food commercials for children under the age of 12 and TV food advertising for children. Norway, Denmark, Austria, Ireland, Australia, and Greece have also made some restrictions on commercials for children. Portugal approved a law to restrict advertising to children for foodstuffs and beverages of high energy value, salt, sugar, and saturated fatty acids content.	Children	No efficacy results. However, energy-dense foods and drinks and fast-food companies often target children in their advertisements, since they are very easily influenced at this age, namely through TV commercials.
Interventions through the Food Sector
Goiana-da-Silva F, et al. (Taxation of sugar-sweetened beverages) [41]	Portugal, 2017	Food sector intervention	Taxation of sugar-sweetened beverages as an intervention to reduce its high consumption in the country.	Community	Decrease of 6.58 million liters per year, which translates into a decrease in consumption of 21% compared to the baseline consumption data of IAN-AF 2015–2016. The number of cases of obesity prevented had a higher impact in adolescents (0.012%), preventing 0.76 cases of obesity yearly, followed by an impact of 0.062% in adults aged 18 to <65 years, and the children showed an impact of 0.049%. These data show that Portugal achieved its goal, decreasing sales of sugar-sweetened beverages.
Young L, et al. (“Pick the Trick” program) [45]	Australia and New Zealand	Food sector intervention	Providing foods with symbols for the consumers making it easier to identify the healthier choices.	Community	No known results
Kelly B, et al. and Nielsen S, et al. (WHO front-of-pack labeling system) [47]	WHO-E Food and Nutrition Action Plan 2015–2020	Food sector intervention	Among other future policies, there is the intention of application of a single front-of-pack labeling system in all countries.	Community	No known results