C
Review of Existing Reviews on Obesity Prevention
The Committee on an Evidence Framework for Obesity Prevention Decision Making was tasked to provide an overview of the current nature of the evidence base, that is, the types of evidence that are available on the results of community, environmental, and policy-based obesity prevention initiatives. The narrative interpretation of the collection of reviews in this appendix (termed “appraisals” in this report) is provided in Chapter 3, and includes a description of current methods used to characterize the evidence base and a discussion of the challenges involved in applying traditional evidence hierarchies to population-based prevention efforts.
This overview was not meant to be carried out by an exhaustive literature review but rather through an examination of case studies and existing reviews. The search strategy involved searching major databases including Scopus, PubMed, and Web of Science, from each database’s inception through November 2009, for relevant and published reviews of obesity prevention interventions. Variations of the terms “overweight,” “obesity,” “prevention,” “physical activity,” “nutrition,” “review,” “meta-analysis,” “synthesis,” “summary,” and “recommendations” were used in the search process. Additional appraisals were identified by review of the reference lists of included appraisals and other relevant literature and by discussion with experts in the field. Appraisals that consider only studies of treatment interventions were excluded; some appraisals consider both treatment and prevention studies and were included in the committee’s analysis. Publication date was not a search criterion, yet all of the appraisals in this appendix were published between 1997 and the present.
TABLE C-1
Study |
Search Strategy |
Initial No. Identified |
Inclusion/Exclusion Criteria |
||
Sources of Informationa |
Years Included |
Type of Appraisal and Purpose |
Subject Demographics |
||
American Dietetic Association Position Statement (2006) |
(28) |
January 1982-January 2004 |
Systematic review |
Not reported |
Healthy children and adolescents aged 2-18 |
Manual searching of bibliographies from gathered articles and reviews |
To develop a position statement on individual-, family-, school-, and community-based interventions for pediatric overweight |
||||
Bluford et al. (2007) |
1966-March 2005 |
Systematic review |
Not reported |
Preschool-age children aged 2-6 |
|
To identify and summarize effective evaluated interventions for preventing or treating obesity among preschool children aged 2-6 |
|
||||
Brown and Summerbell (2009) |
January 2006-September 2007 |
Systematic review |
1,553 |
School children aged 5-18 |
|
To determine the effectiveness of school-based interventions focused on changing dietary intake and physical activity levels to prevent childhood obesity |
|||||
Excluded: studies that recruited children on the basis of weight; studies in children with critical illness or eating disorders |
|
|
|
|
|
Types of Studies (e.g., RCTs, quasi-experimental, qualitative) |
Outcome Measures (e.g., BMI, diet, physical activity, other behaviors, environment) |
Length of Intervention and/or Follow-up |
Other |
No. After Applying Criteria |
Included: any study design |
Measure of adiposity (BMI, body weight, skinfold thickness, percent body fat) |
> 8 weeks (for secondary prevention trials) |
Included: English language |
Not reported |
Excluded: meta-analyses and reviews (different selection criteria) |
||||
Excluded: conducted in a developing country; not peer-reviewed; n < 30 in secondary prevention trials, n < 60 in primary prevention trials |
||||
≥ 6 months (for primary prevention trials) (not including duration of follow-up) |
||||
Included: domestic and international studies that used physical activity and nutritional strategies in interventions to prevent or treat overweight |
Measure of weight status, BMI, or body fat |
≥ 3 months study length |
Studies were not excluded because of their aim (for example, did not have to include weight change), design, or duration of intervention or follow-up if ≥ 3 months |
7 (2 treatment and 5 prevention) |
Excluded: case reports or series |
||||
RCTs or controlled clinical trials of lifestyle interventions |
Included: same criteria used by National Institute for Health and Clinical Excellence (NICE) obesity guidance with one exception—included studies had to report a weight outcome, either as absolute or change, and could use BMI, BMI z-score, percentage of body fat, skin-fold thickness, and percentage of overweight |
≥ 12 weeks study length |
Included: minimum duration of 12 weeks; done in a school setting (studies were not included or excluded based on their aim) |
38 |
Included: study designs that compared lifestyle interventions (defined in article) with usual care or with other active interventions |
Study |
Search Strategy |
Initial No. Identified |
Inclusion/Exclusion Criteria |
||
Sources of Informationa |
Years Included |
Type of Appraisal and Purpose |
Subject Demographics |
||
Campbell et al. (2001) |
January 1985-October 1999 |
Systematic review |
1,043 |
Included: subjects under age 18 when the study began |
|
To assess the effectiveness of interventions designed to prevent obesity in childhood |
|||||
Expert opinion |
Excluded: pregnant women, those with eating disorders, and the critically ill |
||||
Connelly et al. (2007) |
Up to April 30, 2006 |
Systematic review |
Not reported |
n ≥ 30; nonclinical child populations aged 0-18 |
|
To present practice-relevant guidance on interventions aimed at reducing at least one measure of adiposity in child populations that do or do not contain overweight or obese children |
|||||
Manual searching of bibliographies from gathered articles and reviews |
|||||
Conroy et al. (2007) |
(2), (12), (13), (14), (17), (19), (20), (23), (27), (28), (35), (38), (39), (43) |
1980-September 2005 |
Integrative review |
2,028 |
Not reported |
To examine successful Canadian nursing and health promotion intervention programs for childhood obesity prevention during gestation and infancy |
|||||
Grey literature, excluding newspaper articles/editorials; manual searching of bibliographies from gathered articles and reviews; ancestry searches on key papers |
Types of Studies (e.g., RCTs, quasi-experimental, qualitative) |
Outcome Measures (e.g., BMI, diet, physical activity, other behaviors, environment) |
Length of Intervention and/or Follow-up |
Other |
No. After Applying Criteria |
RCTs, non-RCTs with concurrent control groups |
Included: had to report one or more outcomes (estimates of percent body fat, BMI, ponderal index, or skin-fold thickness) and report outcome data at baseline and at postintervention, or at baseline and change from baseline |
Follow-up 1 year, later amended to include studies with an observation period of ≥ 3 months |
Not reported |
7 |
Included: RCTs, controlled trials of interventions to prevent overweight or obesity |
Included: measure of index of adiposity |
≥ 12 weeks study period |
Not reported |
28 |
Included: peer-reviewed and/or research-based, published articles, policy reports |
Diet, BMI (adult), high birth weight > 4000 g, low birth weight < 2500 g but > 2000 g |
Not reported |
Canadian only; English and French language |
6 |
Excluded: newspaper articles, editorials, general reports, general women’s health materials |
Study |
Search Strategy |
Initial No. Identified |
Inclusion/Exclusion Criteria |
||
Sources of Informationa |
Years Included |
Type of Appraisal and Purpose |
Subject Demographics |
||
DeMattia et al. (2007) |
1966-June 2004 |
Systematic review |
222 |
Children or adolescents, including at-risk or obese children/teens at outset of study |
|
To examine studies that used an intervention to reduce sedentary behavior (SB; defined in article) to control weight in order to answer the question: Is an emphasis on reducing SB (e.g., TV, video games) effective at changing behaviors and controlling weight in children and adolescents? |
|||||
Updated search, 1966-February 2005 |
|||||
Manual searching of bibliographies from gathered articles and reviews; expert opinion |
|||||
Doak et al. (2006) |
(28) |
Through June 2003, with additional update in August 2005 |
Review |
102 |
Children and adolescents aged 6-19; targeting of obese children if drawn from a broad-based school population |
Personal contacts with researchers; Internet; manual searching of bibliographies from reviews; MEDLINE searches of authors with ongoing intervention studies |
To identify aspects of overweight and obesity prevention programs that are most likely to succeed if implemented on a large scale |
||||
Dobbins et al. (2001) |
1985-September 2000 |
Systematic review |
143 |
Children and adolescents aged 6-18 |
|
Review of reference list of retrieved articles |
To summarize the evidence for the effectiveness of school-based interventions in promoting physical activity and fitness in children and adolescents |
|
|
|
|
|
Types of Studies (e.g., RCTs, quasi-experimental, qualitative) |
Outcome Measures (e.g., BMI, diet, physical activity, other behaviors, environment) |
Length of Intervention and/or Follow-up |
Other |
No. After Applying Criteria |
Included: RCTs, controlled clinical trials, comparative studies, multicenter studies that aimed to reduce SB in a natural setting |
Included: Measure of SB and weight (either BMI or % overweight) |
Not reported |
Validity criteria applied |
12 |
Excluded: observational cross-over and cohort studies, studies of behavior in a controlled laboratory setting |
||||
Included: school-based studies seeking to alter diet and/or physical activity–related behaviors and having a broad public health base; studies that monitored and evaluated in a manner that has been documented (e.g., published) |
Included: anthropometric measurement of body weight or obesity, at baseline and follow-up |
Not reported |
Not reported |
25 |
Excluded: studies with aims so narrow that an impact on obesity is unlikely; clinical settings focused on treatment of obese children; pilot studies |
||||
RCTs; studies with a control group and measures taken pre- and postintervention; prospective study designs |
Outcomes must have been reported for children and adolescents |
|
Included: intervention applicable to public health practice; intervention could be implemented, facilitated, or promoted by staff in local public health units in Ontario |
19 |
Study |
Search Strategy |
Initial No. Identified |
Inclusion/Exclusion Criteria |
||
Sources of Informationa |
Years Included |
Type of Appraisal and Purpose |
Subject Demographics |
||
Eden et al. (2002) |
1994-March 2002 |
Systematic review |
~1,000 |
Adults in general primary care populations |
|
Expert opinion; manual searching of bibliographies from pertinent articles |
To determine whether counseling adults in primary care settings improves and maintains physical activity levels |
|
|
|
|
No. After Applying Criteria |
Types of Studies (e.g., RCTs, quasi-experimental, qualitative) |
Outcome Measures (e.g., BMI, diet, physical activity, other behaviors, environment) |
Length of Intervention and/or Follow-up |
Other |
|
Included: controlled trials, case-control studies, observational studies |
Included: behavioral outcomes (physical activity); if the study was of “good” or “fair” quality, according to criteria developed by the U.S. Preventive Services Task Force (USPSTF) |
Not reported |
The patient’s primary care clinician performed some of the counseling intervention |
8 (7 RCTs, 1 non-RCT) |
Study |
Search Strategy |
Initial No. Identified |
Inclusion/Exclusion Criteria |
||
Sources of Informationa |
Years Included |
Type of Appraisal and Purpose |
Subject Demographics |
||
Faith et al. (2007) |
Earliest data indexed through November 2004 |
Narrative review |
Not reported |
Not reported |
|
To review critically the evidence addressing three questions that are pertinent to potential macro-level environmental influences on obesity management |
|||||
Manual searching of bibliographies from pertinent articles and chapters; expert opinion; grey literature (government and private foundation reports, excluded dissertations) |
|
|
|
|
|
Types of Studies (e.g., RCTs, quasi-experimental, qualitative) |
Outcome Measures (e.g., BMI, diet, physical activity, other behaviors, environment) |
Length of Intervention and/or Follow-up |
Other |
No. After Applying Criteria |
For substudy 1: |
Included: had to have at least one of the following: food acquisition or purchasing behavior, reported or weighed food intake, or body weight or composition |
Not reported |
Not reported |
5 (substudy 1), 17 (substudy 2), 1 (substudy 3) |
Included: focus group, observational study, quasi-experimental and experimental designs, RCTs |
||||
Excluded: position or conceptual articles |
||||
For substudy 2: |
||||
Included: the macro-environmental factor must be studied in such a way that it was not confounded with education-based manipulations aimed at changing behavior through structured information dissemination |
||||
Excluded: comprehensive multicomponent interventions targeting multiple behaviors (because the specific effects of manipulating individual components could not be disaggregated) |
||||
For substudy 3: |
||||
Excluded: studies testing the effects of restrictive parental feeding practices and strategies on child eating behavior and weight (these studies, being largely confined to the home, are less central to the topic of macro-environmental influences) |
||||
For all substudies: |
||||
Excluded: studies aimed primarily (or to a large degree) at achieving behavior change through information dissemination |
Study |
Search Strategy |
Initial No. Identified |
Inclusion/Exclusion Criteria |
||
Sources of Informationa |
Years Included |
Type of Appraisal and Purpose |
Subject Demographics |
||
Flodmark et al. (2006) |
Articles published until 2004 added to an earlier (2002) review by the Swedish Council on Technology Assessment in Health Care |
Systematic literature review |
136 |
Included: participants representing a normal group (school, or the population within a particular area), studies of high-risk groups |
|
Manual searching of bibliographies from relevant articles, journals, and reviews |
To review the scientific evidence for medical interventions aimed at preventing obesity during childhood and adolescence |
||||
Excluded: participants selected only for having the risk factor overweight/obesity (i.e., treatment) |
|||||
Flynn et al. (2006) |
(2), (3), (12), (13), (14), (17), (19), (20), (23), (24), (25), (27), (28), (29), (31), (38), (39) |
1982-2003 |
Synthesis research study |
13,158 (library database hits) |
Included: studies with a majority of participants under age 17 |
To develop best practice recommendations based on a systematic approach to finding, selecting, and critically appraising programs addressing prevention and treatment of childhood obesity and related risk of chronic diseases |
|||||
Excluded: those with compromised physical health; those with mental illness; programs with a primary focus on children of diabetic mothers, low-birth-weight/preterm babies, and pregnant adolescents |
|||||
Manual searching of bibliographies from International Journal of Obesity (1987-2003), relevant reports; Internet searches of relevant domestic and foreign organization and society sites, Google; expert opinion |
|
|
|
|
No. After Applying Criteria |
Types of Studies (e.g., RCTs, quasi-experimental, qualitative) |
Outcome Measures (e.g., BMI, diet, physical activity, other behaviors, environment) |
Length of Intervention and/or Follow-up |
Other |
|
Study addresses prevention of obesity or overweight; must include a control group |
Measure of BMI, skinfold thickness; % overweight/obesity |
≥ 12 months with follow-up |
Accepted Swedish, German, Norwegian, Danish, English, and French languages |
24 |
Excluded: case studies; surgical interventions; programs associated with marketing products/services |
Included: a measure of either outcome or process (or both) |
Not reported |
Excluded: foreign-language articles without an English abstract |
158 |
(1) an index of overweight/obesity: anthropometry, BMI, body fat distribution, growth rates |
||||
(2) risk factors for obesity (e.g., activity levels) |
||||
(3) chronic diseases (or risk factors) associated with overweight/obesity (e.g., type 2 diabetes or blood pressure) |
||||
(4) adverse effects |
||||
(5) process indicators (e.g., no. invited vs. no. participating, information evaluating how the program proceeded, or description of participant groups) |
Study |
Search Strategy |
Initial No. Identified |
Inclusion/Exclusion Criteria |
||
Sources of Informationa |
Years Included |
Type of Appraisal and Purpose |
Subject Demographics |
||
Galani and Schneider (2007) |
1995-2005 (because of advances in research toward conducting higher-quality studies and better reporting) |
Systematic literature review with meta-analysis |
273 (for prevention) |
Children ≥ 18 years old |
|
Manual searching of bibliographies from included articles, relevant books, individual-based studies of type 2 diabetes mellitus and cardiovascular disease |
|||||
To assess the mid- to long-term effectiveness of lifestyle interventions in the prevention and treatment of obesity (defined in article) |
|||||
Glenny et al. (1997) |
(20), (28), (32), Bath Information and Data Services (BIDS) (depending on author’s subscription) |
Not reported |
Systematic review |
97 for both prevention and treatment |
Overweight or obese children and adults |
To determine the effectiveness of interventions designed to prevent and treat obesity and maintain weight loss |
|||||
Manual searching of bibliographies from gathered articles and reviews; expert opinion |
1995-2007 (English only) |
Meta-analysis |
41 |
Children and adolescents (schoolchildren) |
|
Gonzalez-Suarez et al. (2009) |
(1), (4), (6), (9), (14), (15), (16), (20), (22), (28), (34), (35), (41), Ovid (depending on author’s subscription) |
To evaluate the effectiveness of school-based programs in the prevention and management of childhood obesity |
|||
Normal BMI only |
|||||
Manual searching of bibliographies from relevant studies |
|
|
|
|
No. After Applying Criteria |
Types of Studies (e.g., RCTs, quasi-experimental, qualitative) |
Outcome Measures (e.g., BMI, diet, physical activity, other behaviors, environment) |
Length of Intervention and/or Follow-up |
Other |
|
Included: RCTs of lifestyle interventions (defined in article) |
Included: body weight, BMI, waist circumference, systolic/diastolic blood pressure, total cholesterol, LDL, HDL, triglycerides, glucose control (2-hour plasma glucose, fasting plasma glucose, or 3-month average blood glucose level [A1c]) |
≥ 12 months observation period |
Included: prevention and treatment studies |
13 (for prevention) |
RCTs (for treatment of obesity and maintenance of weight loss); RCTs and nonrandomized studies with a concurrent control group (for prevention of obesity) |
Postintervention changes relevant to baseline in one of the following: weight, fat content, fat distribution |
≥ 12 months (for intervention only, or intervention + follow-up) |
Not reported |
4 (for prevention) |
Included: RCTs and clinical controlled trials in which odds ratios or standardized mean differences and their 95% confidence intervals were reported or could be calculated |
BMI, waist girth, percentage body fat, triceps skinfold, waist-to-hip ratio |
Not limited |
Seeking interventions that increase physical activity, improve dietary behaviors, modify poor exercise or dietary behaviors, or a combination of strategies |
19 |
Study |
Search Strategy |
Initial No. Identified |
Inclusion/Exclusion Criteria |
||
Sources of Informationa |
Years Included |
Type of Appraisal and Purpose |
Subject Demographics |
||
Hardeman et al. (2000) |
20: 1980-present; 28: 1966-present; 32: 1974-present |
Systematic review |
Not reported |
Participants not selected by weight or age |
|
To identify and review published studies on interventions aimed at the prevention of weight gain |
|||||
Excluded: interventions in specific subgroups (e.g., those stopping smoking) |
|||||
Manual searching of bibliographies from gathered articles |
|||||
Queried authors of included papers |
|||||
Harris et al. (2009) |
As early as 1966 for some databases, up to September 2008 for all databases |
Systematic review and meta-analysis |
398 |
Children aged 5-18 |
|
Manual searching of bibliographies from relevant journals and articles |
To determine whether school-based physical activity interventions improve children’s body composition, as measured by BMI |
||||
Hudson (2008) |
1997-2007 |
Integrative review |
Not reported |
Included: African American children aged 2-18 or their parents/caretakers |
|
To explore attitudes, perceptions, and lifestyle behaviors that influence obesity risk in African American children |
|||||
Excluded: studies targeting subjects with BMI ≥ 85% |
|
|
|
|
No. After Applying Criteria |
Types of Studies (e.g., RCTs, quasi-experimental, qualitative) |
Outcome Measures (e.g., BMI, diet, physical activity, other behaviors, environment) |
Length of Intervention and/or Follow-up |
Other |
|
All study designs included |
Data extracted based on: behaviors targeted for change; psychological model; behavior change methods and modes of delivery; methodological quality; characteristics of participants; outcomes related to body weight; self-reported diet and physical activity |
Any duration |
Included: published reports of interventions with the primary aim of preventing weight gain |
11 |
Excluded: if weight control was part of a multifactorial intervention aimed primarily at preventing a specific disease; if weight loss was primary aim |
||||
Included: RCTs, non-RCTs with an appropriate control group |
Included: objective data for BMI from before and after the intervention (in both intervention and control groups) |
≥ 6 months |
Included: school-based exercise or physical activity interventions |
18 |
Included: qualitative, experimental, and nonexperimental designs |
Included: BMI for age/gender or BMI z-score as primary outcome |
Not a criterion |
Included: English, published in peer-reviewed journal |
28 |
Excluded: prevalence studies |
||||
Excluded: studies not reporting outcomes by racial/ethnic characteristics |
Excluded: non-U.S. studies |
Study |
Search Strategy |
Initial No. Identified |
Inclusion/Exclusion Criteria |
||
Sources of Informationa |
Years Included |
Type of Appraisal and Purpose |
Subject Demographics |
||
Jago and Baranowski (2004) |
(28) |
1970-2002 |
Systematic review |
Not reported |
Children aged 5-18 |
Manual searching of bibliographies from gathered articles and reviews; contacting of leading authors in the field for copies of articles “in press” |
To study noncurricular approaches to increasing physical activity in children and adolescents |
||||
Kahn et al. (2002) |
1980-2000 |
Systematic review and meta-analysis |
6,238 |
Included: studies that compared outcomes among groups |
|
To evaluate the effectiveness of various approaches to increasing physical activity: informational, behavioral and social, and environmental and policy approaches |
|||||
Manual searching of bibliographies from gathered reviews; expert opinion |
Excluded: studies that used physical activity solely as a therapeutic intervention; training studies |
||||
Kamath et al. (2008) |
Inception of the databases until February 2006 |
Systematic review and meta-analysis |
1,162 |
Included: children and adolescents aged 2-18 |
|
To summarize evidence on the efficacy of interventions aimed at changing lifestyle behaviors to prevent obesity |
Excluded: prevention reviews focused exclusively on obese children; studies with participants with eating disorders, underlying diagnosis predisposing to obesity and/or inhibiting normal growth; adults or patients with type 1 diabetes |
||||
Manual searching of bibliographies from gathered articles and reviews; expert opinion |
|
|
|
|
No. After Applying Criteria |
Types of Studies (e.g., RCTs, quasi-experimental, qualitative) |
Outcome Measures (e.g., BMI, diet, physical activity, other behaviors, environment) |
Length of Intervention and/or Follow-up |
Other |
|
Excluded: case reports, unpublished reports, dissertations |
Included: any increase in the level of physical activity; objective and self-report assessments of physical activity; interventions that measured physical activity before and after the intervention |
Not reported |
Included: English language; effect of a noncurricular physical activity intervention was evaluated |
9 |
Included: interventions selected for evaluation, not guidelines or reviews; study design with a concurrent or before-and-after comparison |
Included: aerobic capacity as an indicator of physical activity behavior |
Not reported |
Used Guide to Community Preventive Services’ methods (CDC, 2005); English language only |
94 |
Included: RCTs only |
Included: BMI; behavioral endpoints of dietary or physical activity changes (e.g., accelerometer); self-report or reported by a family member or responsible adult, research or health care personnel |
Used longest period of follow-up where data were available and not excessive loss to follow-up (> 20%) |
Review conducted in accordance with Cochrane Collaboration methods and Quality of Reporting of Meta-analysis of Randomized Trials (QUOROM) standards (Moher et al., 1999) |
34, BMI; 29, behavioral endpoints (usable data for meta-analysis) |
Excluded: treatment articles |
||||
Excluded: foreign language studies not yet translated |
Study |
Search Strategy |
Initial No. Identified |
Inclusion/Exclusion Criteria |
||
Sources of Informationa |
Years Included |
Type of Appraisal and Purpose |
Subject Demographics |
||
Katz et al. (2005) |
1966-2001 |
Systematic review |
44 (school setting), 35 (worksite) |
School-based interventions up to age 18, and workplace-based interventions (working-age adults) |
|
To identify effective strategies for weight control in school or work settings involving nutrition, physical activity, combinations of these, and other behavioral interventions |
|||||
Manual searching of bibliographies from gathered reviews and reports |
|||||
Katz et al. (2008) |
(14), (20), (23), (27), (28), Ovid (depending on database access) |
Systematic review and meta-analysis |
64 |
Included: studies targeting children aged 3-18 in a school setting |
|
To evaluate the effectiveness of school-based strategies for obesity prevention and control |
|||||
Manual searching in (15) and other meta-analyses |
|||||
Khan et al. (2009) |
(28) |
January 1, 2005-July 3, 2007 |
Systematic review |
270 |
Included: policy and environmental-level strategies |
Expert opinion |
To identify and recommend a set of strategies and associated measurements that communities and local governments can use to plan and monitor environmental and policy-level changes for obesity prevention |
|
|
|
|
No. After Applying Criteria |
Types of Studies (e.g., RCTs, quasi-experimental, qualitative) |
Outcome Measures (e.g., BMI, diet, physical activity, other behaviors, environment) |
Length of Intervention and/or Follow-up |
Other |
|
Included: used Guide to Community Preventive Services (RCTs); control measurement between or within groups |
Included: Weight loss of ≥ 4 pounds, intermediate outcomes: change in diet or physical activity levels; common weight-related measures used (BMI, body weight, anthropometic measures); in the school setting, meaningful changes in weight based on intervention goal and population characteristics; among adults, 4-pound minimum weight loss |
≥ 6 months after intervention start |
Used methods of the Guide to Community Preventive Services (CDC, 2005) for conducting systematic reviews to assess study design, validity, quality limitations; English only |
10 (school setting) |
20 (worksite) |
||||
Included: studies that contained a control measurement (pre/post, control group) |
Included: common weight outcomes (BMI, body weight) |
Follow-up at least 6 months from the beginning of the intervention |
Used Guide to Community Preventive Services (CDC, 2005) to abstract data and assess methodological quality; English only |
8 (combination of nutrition and physical activity interventions) |
Excluded: studies with “poor methodological quality”; 11 studies because of data usability limitations |
||||
Not reported |
Not reported; used criteria to rate measurements: utility, construct validity, feasibility |
Not reported |
Common Community Measures for Obesity Prevention Project Team (CDC, experts, consultants); used criteria to rate strategies: reach, mutability, transferability, effect size, sustainability of health impact |
179 |
Study |
Search Strategy |
Initial No. Identified |
Inclusion/Exclusion Criteria |
||
Sources of Informationa |
Years Included |
Type of Appraisal and Purpose |
Subject Demographics |
||
Kropski et al. (2008) |
January 1, 1990-December 31, 2005 |
Systematic review |
Unknown |
Children (school-based programs) |
|
Manual searching of bibliographies from gathered articles; expert opinion |
To examine the effectiveness of school-based programs for reducing childhood overweight or obesity |
||||
Lemmens et al. (2008) |
(15), (20), (27), (28), (43), Ovid (depending on author’s subscription) |
January 1996-June 2006 |
Systematic review |
13,198 |
Included: nonobese adults (> age 18) with an average BMI at the starting point < 30 or overweight/not yet obese (25-30) |
To examine the efficacy of obesity prevention interventions in adults, with a focus on dietary intake, physical activity, or a combination of these |
|||||
Excluded: those with BMI higher than 30; weight maintenance interventions; institutionalized adults; those with chronic conditions; drug interventions; health care providers, preoperative settings; bariatric surgery |
|||||
Matson-Koffman et al. (2005) |
1970-October 2003 |
Narrative review |
Not reported |
Included: all demographics |
|
To assess policy and environmental interventions aimed at increasing physical activity or improving nutrition |
|||||
Reports of U.S. Department of Agriculture, U.S. Department of Transportation |
|
|
|
|
No. After Applying Criteria |
Types of Studies (e.g., RCTs, quasi-experimental, qualitative) |
Outcome Measures (e.g., BMI, diet, physical activity, other behaviors, environment) |
Length of Intervention and/or Follow-up |
Other |
|
Included: experimental or quasi-experimental designs |
Included: BMI, a measure of body fat or obesity/overweight prevalence |
Evaluation ≥ 6 months post baseline |
Used Grading of Recommendations Assessment, Development, and Evaluation (GRADE) criteria for analyzing evidence (Atkins et al., 2004, 2005) |
14 |
Included: RCTs, nonrandomized trials, and interrupted time series designs; with control group |
Included: BMI or body weight change, self-report or measured |
Minimum 3-month follow-up |
Used Cochrane Collaboration Handbook for systematic review protocol |
9 (5 long-term, at least 1 year; 4 short-term, 3 months to 1 year) |
Not reported |
Included: behavioral, psychological, or organizational change outcomes |
Not reported |
Excluded: studies that did not provide a description of the intervention or those that reported on determinants research (individual-level only) or media-only campaigns; studies that linked the built environment to physical activity (in another review) |
65 |
Study |
Search Strategy |
Initial No. Identified |
Inclusion/Exclusion Criteria |
||
Sources of Informationa |
Years Included |
Type of Appraisal and Purpose |
Subject Demographics |
||
Mayer (2009) |
2001-January 2008 |
Integrative review |
356 |
Included: those aged 2-21 years |
|
To assess community-based obesity prevention interventions focused on changing the nutrition environment for children |
|||||
Internet (Google) |
Excluded: adults (> 21 years) |
||||
Micucci et al. (2002) |
1990-January 2002 |
Review of reviews using a chronic disease model (i.e., risk factors for type 2 diabetes) |
1,448 (195 with potential relevance) |
Included: school-aged youth in a school setting |
|
Expert opinion to find unpublished material |
|||||
To assess the effectiveness of school-based interventions in primary prevention of obesity and promotion of physical activity and nutrition |
|||||
Pignone et al. (2003) |
(28) |
1966-December 2001 |
Systematic review |
129 (74 reported on counseling on dietary behavior) |
Included: studies with patients with known risk factors for chronic disease |
Manual searching of bibliographies from gathered articles and reviews; expert opinion |
To examine the effectiveness of counseling to promote healthful diet among patients in primary care settings |
||||
Excluded: studies with patients that had previously diagnosed chronic illness or required special diets; obese or overweight patient studies for the purpose of weight management |
|
|
|
|
No. After Applying Criteria |
Types of Studies (e.g., RCTs, quasi-experimental, qualitative) |
Outcome Measures (e.g., BMI, diet, physical activity, other behaviors, environment) |
Length of Intervention and/or Follow-up |
Other |
|
Included: RCTs, pre−post trials, longitudinal, follow-up studies |
Did not limit these criteria, but reported what they found |
Did not limit this criterion, but reported what they found |
English language |
12 |
Excluded: systematic reviews, descriptive articles, treatment-focused studies |
||||
Not specified, but followed Cochrane Collaboration Handbook |
Included: physiological indicators (body fat, metabolic indices, change in physical activity, healthful eating/nutrition) |
Not reported |
Followed the guidelines of the Cochrane Collaboration Handbook; quality ratings used; only strong and moderate reviews included |
12 (7 strong, 5 moderate) |
Included: RCTs |
Included: dietary behavior; net change in consumption |
At least 3 months’ duration |
Excluded: studies that controlled the diet externally |
21 |
Excluded: studies with dropout rates of > 50% or with presence of a disease |
||||
Excluded: studies with only biochemical or anthropomorphic endpoints |
Study |
Search Strategy |
Initial No. Identified |
Inclusion/Exclusion Criteria |
||
Sources of Informationa |
Years Included |
Type of Appraisal and Purpose |
Subject Demographics |
||
Rees et al. (2006) |
Coverage of database until 2001 |
Systematic review |
7,048 (90 studies reported on physical activity) |
Included: youth aged 11-16 |
|
To examine the barriers to and facilitators of physical activity among young people, focused on examining community- and society-level interventions |
|||||
Reilly and McDowell (2003) |
June 2000-May 2002 |
Systematic review |
Not reported |
Included: children and adolescents; nonclinical groups of subjects |
|
To examine interventions for prevention and treatment of childhood obesity targeting physical activity (included separate analyses of treatment and prevention) |
|||||
Manual searching of bibliographies from gathered systematic reviews and individual intervention articles; Internet |
|
|
|
|
No. After Applying Criteria |
Types of Studies (e.g., RCTs, quasi-experimental, qualitative) |
Outcome Measures (e.g., BMI, diet, physical activity, other behaviors, environment) |
Length of Intervention and/or Follow-up |
Other |
|
Included: trials and studies that used a comparison group design and reported both pre- and posttest data; also outcome or process evaluation, systematic review or study that did not involve an intervention, and nonintervention studies that studied young people’s definitions of ideas about physical activity or factors that influence their own or other young people’s physical activity |
Measured behavior or health of young people |
Not reported |
Included: interventions that aimed to make a change at the level of the community or society; quality of trials assessed using the Evidence for Policy and Practice Information and Coordinating Centre (EPPI-Centre) review guidelines (Peersman et al., 1997); quality of people’s views studies as described by Harden et al. (2004) |
12 trials, 16 studies of young people’s views |
Included: RCTs |
Included: body weight, BMI, body composition |
At least 12 months |
Used Checklist for Appraising the Quality of Controlled Trials (Scottish Intercollegiate Guidelines Network, 2002) for quality appraisal |
3 |
Study |
Search Strategy |
Initial No. Identified |
Inclusion/Exclusion Criteria |
||
Sources of Informationa |
Years Included |
Type of Appraisal and Purpose |
Subject Demographics |
||
Renzaho et al. (2010) |
Until September 2008 |
Systematic review |
599 |
Included: studies targeting immigrants |
|
To study the effectiveness of prevention programs for obesity and chronic diseases among immigrants in developed countries |
|||||
Excluded: studies focused on nonimmigrants; specifically, at least 40% of multiethnic samples needed to be non–African American migrants |
|||||
Internet (Google Scholar) |
|||||
Salmon et al. (2007) |
(14), (15), (26), (27), (28), (34), (37), (39), (43), Ovid (depending on access) |
January 1985-June 2006 |
Narrative review |
Not reported |
Included: children aged 4-12, adolescents aged 13-19 |
To study the effectiveness of interventions in studies that report physical activity outcomes in children and adolescents |
|||||
Sharma (2007) |
1999-2005 |
Narrative review |
21 |
Included: general population of children aged 3-18, in a school setting |
|
To review international school-based interventions for preventing childhood obesity |
|||||
Excluded: studies that focused solely on overweight/obese children or adolescents |
|||||
Small et al. (2007) |
Not reported |
Narrative review |
12 |
Included: children aged 4-7 |
|
To conduct a critical appraisal of current evidence on prevention and early treatment of overweight and obesity in young children |
|
|
|
|
No. After Applying Criteria |
Types of Studies (e.g., RCTs, quasi-experimental, qualitative) |
Outcome Measures (e.g., BMI, diet, physical activity, other behaviors, environment) |
Length of Intervention and/or Follow-up |
Other |
|
Included: RCTs; quasi-randomized, controlled before-and-after studies |
Included: BMI (weight, waist and hip measurements), lean tissue mass, body fat; nutritional targets for patients with diabetes; self-reported nutrition adherence for diabetes self-management; diabetes knowledge; self-efficacy and self-management; dietary fat consumption; glycemic control; cardiovascular risk factors |
Not reported |
Included: intervention group needed at least 40 subjects |
13 |
Excluded: “poor-quality” studies; medical and/or drug interventions; studies that did not define the migrant group or intervention or clearly outline the methodological approach |
||||
Included: RCTs, group randomized trials, quasi-experimental study designs; postintervention, assessment-only designs or no control (decided on a case-by-case basis) |
Included: physical activity outcomes (survey, observational, and objective) |
Not reported |
Included: sample size of more than 16 |
99 |
Excluded: obesity treatment |
||||
Excluded: studies published in non–peer reviewed journals |
Not reported, but ended up with studies that targeted nutrition and physical activity behaviors |
Not reported, but a majority were 1 academic year long |
Included: studies outside of U.S. only |
12 |
English language |
||||
Included: RCTs, systematic reviews, meta-analyses |
Not reported |
Not reported |
Looking to see what they could find to critically appraise the current evidence |
6 prevention; 6 treatment |
Study |
Search Strategy |
Initial No. Identified |
Inclusion/Exclusion Criteria |
||
Sources of Informationa |
Years Included |
Type of Appraisal and Purpose |
Subject Demographics |
||
Stice et al. (2006) |
1980-2005 (October) |
Systematic review and meta-analysis |
Not reported |
Included: children and youth (up to age 22) |
|
Manual searching of tables of contents of pertinent journals (Preventive Medicine, Journal of Pediatrics, Health Education Quarterly), narrative reviews, gathered articles; expert opinion for unpublished articles |
To investigate obesity prevention programs and their effects; to identify features of the program associated with these effects |
||||
Summerbell et al. (2005) |
1990-February 2005 |
Systematic review |
828 |
Included: children below age 18 |
|
To assess the effectiveness of interventions designed to prevent obesity in childhood through diet, physical activity, and/or lifestyle and social support |
|||||
Manual searching of bibliographies from gathered articles and reviews; Internet; expert opinion |
|
|
|
|
No. After Applying Criteria |
Types of Studies (e.g., RCTs, quasi-experimental, qualitative) |
Outcome Measures (e.g., BMI, diet, physical activity, other behaviors, environment) |
Length of Intervention and/or Follow-up |
Other |
|
Included: RCTs, evaluations of obesity prevention programs, trials; needed relevant comparison group, logistic regression or survival models |
Included: proxy measure of body fat (BMI, skinfold thickness); effect sizes for weight gain (not self-report) |
Not reported |
Excluded treatment |
46 trials (61 programs) |
Included: controlled clinical trials (with and without randomization) |
Included: primary outcomes: weight and height, percent fat content, BMI, Ponderal index, skinfold thickness; secondary outcomes: activity levels, dietary intake, change in knowledge, environmental change, stakeholders’ views of findings, measures of self-esteem, etc., harm associated with process or outcomes, cost-effectiveness |
Minimum duration of 12 weeks (short-term) |
Used Cochrane Collaboration Handbook, health promotion theory |
22 (10 long-term, 12 short-term) |
Excluded: treatment |
Study |
Search Strategy |
Initial No. Identified |
Inclusion/Exclusion Criteria |
||
Sources of Informationa |
Years Included |
Type of Appraisal and Purpose |
Subject Demographics |
||
Thomas (2006) |
See above |
1985-2003 |
See above |
See above |
Included: studies with elementary or secondary school-aged children, school component |
Thomas et al. (2004) |
1984-2003 |
Systematic review |
More than 1,100 |
Children and adolescents aged 6-18 |
|
To examine the effectiveness of interventions for promoting healthy weight, preventing overweight/obesity, and increasing physical activity among school-aged children and youth |
|||||
Manual searching of 24 relevant peer-reviewed journals (June 1998-June 2003) |
|||||
Timperio et al. (2004) |
1999-September 2003 |
Review (update) |
Not reported |
Included: children, adolescents, young adults |
|
To study the effectiveness of intervention strategies to promote physical activity among children, adolescents, and young adults |
|
|
|
|
No. After Applying Criteria |
Types of Studies (e.g., RCTs, quasi-experimental, qualitative) |
Outcome Measures (e.g., BMI, diet, physical activity, other behaviors, environment) |
Length of Intervention and/or Follow-up |
Other |
|
Included: studies with a comparison group; RCTs and other study designs |
Included: self-reported dietary intake, BMI, skinfold thickness, moderate to vigorous physical activity (MVPA) changes |
See above |
Used a recent review to critique the results of primary studies related to the effectiveness of physical activity and nutrition programs for obesity prevention in children and youth |
57 |
Included: RCTs, cohort studies (prospective, with a control group) |
Included: changes in total caloric intake and percent calories from fat, fruit, and vegetable intake; changes in body fat; changes in perception of body image; self-reported changes in duration, rate, and frequency of physical activity; changes in lung capacity (VO2 max); self-reported changes in inactivity; BMI |
Not reported |
Excluded: studies related to therapeutic nutrition and physical activity programs and those that included children with known illnesses or obese/overweight children; quality assessed using Mulrow et al. (1997) and Jadad et al. (1996) |
425 |
Excluded: studies that measured only changes in vitamin or fiber intake, changes in knowledge and attitudes re physical activity and nutrition |
||||
Included: RCTs |
Not reported |
Not reported |
Review of new evidence (update) |
31 |
Study |
Search Strategy |
Initial No. Identified |
Inclusion/Exclusion Criteria |
||
Sources of Informationa |
Years Included |
Type of Appraisal and Purpose |
Subject Demographics |
||
Van Sluijs et al. (2007) |
Up to December 2006 |
Systematic review |
3,045 |
Included: children and adolescents (< 18 years) |
|
To study the effectiveness of interventions aimed at promoting physical activity in children and adolescents |
|||||
Manual searching of bibliographies from gathered articles |
Excluded: participants with a specific disease or health problem |
||||
Wareham et al. (2005) |
2000-2005 |
Critical review |
Not reported |
Included: adults and children |
|
To study the effectiveness of physical activity interventions for obesity prevention |
|||||
Wofford (2008) |
Not reported |
Systematic review |
> 5,000, then limited by date (2004-2008), but included seminal articles, articles on preschool-aged children and relevance to prevention of obesity |
Included: Eventually limited search to preschoolers (prevention) |
|
Manual searching of bibliographies from gathered articles; Joanna Briggs Institute database (depending on author’s subscription) |
To review evidence related to obesity prevention in young children |
|
|
|
|
No. After Applying Criteria |
Types of Studies (e.g., RCTs, quasi-experimental, qualitative) |
Outcome Measures (e.g., BMI, diet, physical activity, other behaviors, environment) |
Length of Intervention and/or Follow-up |
Other |
|
Included: controlled trials (with or without randomization); control group (non–physical activity intervention) |
Included: outcomes related to physical activity (self-reported or objectively measured) |
Not reported |
Used 10-item quality assessment scale for methodological quality (internal validity) |
57: 33 children, 24 adolescents |
Included: observational studies (longitudinal, prospective cohort) |
Included: physical activity or body composition change |
Not reported |
30: 14 adults, 16 children |
|
Excluded: cross-sectional studies |
||||
Not reported |
Not reported |
Not reported |
The 41 selected for review were chosen because of their relevance to the prevention of overweight and obesity in the preschool population and the “stronger” quality of evidence they presented English language |
41 |
Study |
Search Strategy |
Initial No. Identified |
Inclusion/Exclusion Criteria |
||
Sources of Informationa |
Years Included |
Type of Appraisal and Purpose |
Subject Demographics |
||
Zenzen and Kridli (2009) |
2000-2007 |
Integrative review |
Not reported |
Included: children aged 4-18 (kindergarten through high school) |
|
Manual searching of bibliographies from gathered articles |
To study the degree of variability in the methodological approaches and theoretical frameworks of school-based obesity prevention programs, focused on the following interventions: dietary, physical activity, and healthy lifestyle education; parental involvement |
||||
NOTES: BMI = body mass index; CDC = Centers for Disease Control and Prevention; N/A = not available; RCT = randomized controlled trial. aElectronic databases are denoted numerically as outlined below: (1) Academic Search Elite (2) ACP Journal Club (American College of Physicians Evidence Based Medicine) (3) AGRICOLA (4) AMED (Allied and Complementary Medicine Database) (5) ARC Service (Agricultural Research Council) (6) AustHealth (7) Best Evidence Database (8) Biological Abstracts (9) BioMed Central (10) BIOSIS Previews (11) Chronic Disease Prevention File (National Center for Chronic Disease Prevention and Health Promotion) (12) CDSR (Cochrane Database of Systematic Reviews) (13) CENTRAL/CCTR (Cochrane Central Register of Controlled Trials) (14) CINAHL (Cumulative Index of Nursing and Allied Health Literature) (15) Cochrane Library (16) Current Contents—Life Sciences (17) DARE (Database of Abstracts of Reviews of Effects) (18) Education Abstracts (19) ERIC (Education Resources Information Centre) (20) EMBASE (Excerpta Medica Database) (21) Environline |
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