Effectiveness of parent-centred interventions for the prevention and treatment of childhood overweight and obesity in community settings: a systematic review.

Worldwide in 2000, 10% of children aged five to 17 years were reported as being overweight with an additional 2-3% being obese. Overweight and obesity in childhood can adversely impact on both physical and psychological health. The rise in the prevalence of childhood obesity is a complex issue but widely recognised contributors include increased energy intake, decreased levels of physical activity and greater time spent in sedentary pursuits. A large number of environmental and cultural factors have also been identified as contributing to the problem. Evidence to support an optimal approach to treating childhood obesity is limited with many studies showing only modest results at best in the long-term. However, the importance of family-based treatment that combines diet, physical activity and behavioral components has been acknowledged in a recent Cochrane Systematic Review. It has also been suggested that interventions offered in the community setting may help overcome barriers to participation, by making programs more accessible and allowing the targeting of specific sub-groups of the population. Objectives The objective of this review was to identify the effectiveness of parent-centred interventions implemented in the community setting in modifying eating and physical activity behaviors or weightrelated outcomes of children. Inclusion criteria Types of participants This review considered studies that included free-living children of pre-school, primary and secondary school age and/or their parents/guardians aged >18 years. Types of intervention(s)/phenomena of interest Intervention programs were required to have a parental component, to target eating and/or exercise behaviors for the prevention or treatment of obesity, and child weight status reported. Types of studies All intervention studies were included in the review including: randomized controlled trials (RCTs); non-randomized controlled trials, longitudinal studies, cohort (both retrospective and prospective), case control and time series studies which had been conducted in a community setting. Types of outcomes This review considered studies that included overweight/obesity related outcomes, eating behavior outcomes, physical activity behaviour outcomes, and sedentary behavior outcomes and constructs. Search strategy A literature search of community-based parent-centred intervention studies to promote nutrition and physical activity for the prevention and treatment and of childhood overweight and obesity was performed in eight electronic databases dating from 1975 to April 2009. Methodological quality Studies were critically appraised for methodological quality using standardized tools. Data collection Data was extracted by one reviewer using a standardized data extraction form developed by the researchers and checked for accuracy and consistency by a second reviewer. Data synthesis Data in relation to setting, methodology, intervention components and effect on weight, dietary intake and physical activity was extracted, and described in a narrative synthesis. Where possible a metaanalysis was undertaken. Results Of the home-based interventions, five of nine studies reported statistically significant changes in anthropometric outcomes post intervention. Of the 10 studies in the before and after school care setting, seven reported a significant decrease in a weight-related outcome post intervention, with only one reporting an increase. Conclusions Results from the review support the after-school setting as the most promising for community intervention setting for targeting parents as agents of change within child obesity prevention and treatment programs. Implications for practice At this stage, interventions to support parents should target the after-school environment as opposed to being conducted in the home, summer camps, leisure centers or churches. Targeting a decrease in energy intake and sweetened beverages in parallel with increasing number of daily steps and decreasing screen time use. Implications for research Future studies of high quality are needed across the full range of community settings. Given that currently most of the higher quality RCTs and the studies showing positive impacts of weight change are in the after-school setting, further studies in this area using similar methodologies to those already published will facilitate future meta-analyses in this area.