ReviewParent participation in weight-related health interventions for children and adolescents: A systematic review and meta-analysis
Highlights
► Parent participation predicts success of children’s weight-related interventions. ► Taken together, parent participation and intervention durations predict success. ► Review of parent interventions with children as passive beneficiaries is warranted.
Introduction
Diet and weight of both youth and adults in the American population are a national concern, and overweight conditions among children and adolescents have become a growing focus of public health (United States Department of Health and Human Services [USDHHS], 2010). According to results from the National Health and Nutrition Examination Survey (NHANES), the prevalence of overweight conditions among children and adolescents has had an increasing trend since the mid-1970s (USDHHS, 2006). In the U.S., more than 10% of children aged 2 to 5 years, 19.6% of children aged 6 to 11 years, and 14.5% of adolescents aged 12 to 19 years are overweight or obese (Ogden et al., 2010).
Overweight conditions in childhood are associated with increased risk for chronic diseases (Freedman et al., 2008, Murthy et al., 2009, Rees et al., 2009, Signorino and Winter, 2008, Wang et al., 2011b, Weintrob et al., 2008) and other health concerns (Lobstein et al., 2004, Yancey and Kumanyika, 2007). Lobstein et al. suggest that multiple organ systems are negatively affected by excessive bodyweight in children, and almost all organ systems are negatively affected by obesity. Related health conditions include Type II diabetes, breathing disorders, fatty liver disease, and cardiovascular disease symptoms (Lobstein et al.). In addition, overweight children and adolescents experience reduced physical abilities, mental health problems, and related social consequences (Lobstein et al.).
Juvenile overweight conditions usually persist into adulthood, and the aforementioned consequences follow or worsen (Heath and Panaretto, 2005, Serdula et al., 1993, Yancey and Kumanyika, 2007). Individual and societal costs related to overweight and obese conditions are difficult to establish but are likely innumerable. They include healthcare costs, decreased productivity, reduced quality of life, and premature mortality (United States Department of Health and Human Services, 2010, Wang et al., 2011b).
Weight-related health promotion programs have been conducted across numerous communities and have targeted a wide range of audiences. Current research suggests that when weight-related interventions target children rather than adults, long-lasting change in related health behaviors and prevention of weight-related health problems may be more likely (Fussenegger et al., 2007, Seidell et al., 2005). Not only are the origins of weight-related health problems altered more effectively in childhood, behaviors are simply more easily changed in children (Seidell et al.). Further, parental involvement in weight-related health interventions for children and adolescents may be a key contributor to their successes (Avenell and Goode, 2008, Bowman, 2005, Peterson and Fox, 2007, Philippas and Lo, 2005). Many intervention studies have indicated that changes in parents' dietary and physical activity behaviors influence their children's changes in dietary and physical activity behaviors (Blom-Hoffman et al., 2008, Chen et al., 2008, Haire-Joshu et al., 2008, Hunter et al., 2008, McCallum et al., 2007, Talpade, 2010). Parents model behaviors for their children, and they also control the availability of foods and activities in their households (Chen et al.; Haire-Joshu et al., 2008, Hunter et al., 2008, Springer et al., 2010, Talpade, 2010).
The influence of parental involvement in child and adolescent weight-related interventions has been reviewed previously (Hingle et al., 2010, Skouteris et al., 2011). Although noteworthy, the focus of these reviews has been on interventions that target specific behavior patterns (i.e. dietary behaviors) (Hingle et al.) or that aim to reduce obesity rates in a narrow preschool age range (Skouteris et al.).
The purpose of this study was to systematically review and investigate the potential parental influence of a more comprehensive collection of child and adolescent weight-related health interventions according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement (Moher et al., 2009). Studies reviewed included reports of dietary, physical activity, and behavioral interventions, group and family therapies, peer influence, incentive activities, and others. Interventions that required parent participation were examined, as were those interventions that provided only an option for parents to participate and those that did not include parent participation at all. An analysis of intervention success among the three groups was conducted. In addition, considerations were made for intervention types (treatment vs. preventive), participant age groups and ranges, intervention durations, and whether interventions included single or multiple components.
Section snippets
Searching
In January-2011, the EBSCOhost database platform was used to search multiple databases, including Academic Search Premier, Alt Health Watch, EBSCO MegaFILE, MasterFILE Premier, ERIC, Health Source: Consumer Edition, Health Source: Nursing/Academic Edition, MEDLINE, Professional Development Collection, PsycARTICLES, PsycINFO, Science Reference Center, CINAHL Plus, and others. The following three layers of terms were utilized to search the titles of manuscripts: (child or children or childhood or
Results
The study selection process is illustrated in Fig. 1. After duplicate articles were removed, a total of 1590 studies were screened, and reports of 42 interventions among 36 research articles met the selection criteria and were included in this review. Six of the research articles reported on multiple interventions, and each intervention was reviewed separately. Study samples ranged from n = 6 to n = 1029, and the participant total was n = 7455.
Sample sizes of interventions were considered, as one
Discussion
BMI reductions and weight loss have been associated with reduced insulin sensitivity, reduced rates of metabolic syndrome, and improved cardiovascular health in obese children (Birkebaek et al., 2010, Pedrosa et al., 2011, Reinehr et al., 2004, Reinehr et al., 2005) and obese adolescents (⁎Ford et al., 2010, Reinehr et al., 2005, Wickham et al., 2009). It is therefore critical to identify factors that contribute to effective children's and adolescents' weight-related health interventions.
In the
Study limitations and strengths
A limitation that should be noted in this study is in the lack of ability to clearly distinguish between participant age groups. It is likely that intervention approaches differ between children and adolescents; however, although limited age-group categorization was possible, differences between them did not emerge. It is unclear whether the lack of significant differences between the two age groups was related to the absence of success rate differences or the unclear differentiation of the age
Conclusions
A remarkable opportunity for long-term health behavior change exists during childhood and adolescence (Seidell et al., 2005). Because child and adolescent weight-related health behaviors along with the associated health consequences typically persist into adulthood (Heath and Panaretto, 2005, Serdula et al., 1993, United States Department of Health and Human Services, 2010, Yancey and Kumanyika, 2007), success of children's and adolescents' weight-related health behavior interventions is
Conflict of interest statement
The authors declare that there are no conflicts of interest.
References1 (90)
- et al.
Positive changes of dietary habits after an outpatient training program for overweight children
Nutr. Res.
(2006) - et al.
Lifestyle intervention in primary care settings improves obesity parameters among Mexican youth
J. Am. Diet. Assoc.
(2010) - et al.
Physical Activity Across the Curriculum (PAAC): a randomized controlled trial to promote physical activity and diminish overweight and obesity in elementary school children
Prev. Med.
(2009) Childhood obesity: a school-based approach to increase nutritional knowledge and activity levels
Nurs. Clin. N. Am.
(2005)- et al.
Two-year follow-up results for Hip-Hop to Health Jr.: a randomized controlled trial for overweight prevention in preschool minority children
J. Pediatr.
(2005) - et al.
High 5 for kids: the impact of a home visiting program on fruit and vegetable intake of parents and their preschool children
Prev. Med.
(2008) - et al.
Parental involvement in interventions to improve child dietary intake: a systematic review
Prev. Med.
(2010) - et al.
The COPE Healthy Lifestyles TEEN program: feasibility, preliminary efficacy, & lessons learned from an after school group intervention with overweight adolescents
J. Pediatr. Health Care
(2007) - et al.
Engaging parents and children in designing child health research
Prev. Med.
(2010) - et al.
An effective lifestyle intervention in overweight children: findings from a randomized controlled trial on “Obeldicks light”
Clin. Nutr.
(2010)
High-sensitive C-reactive protein, tumor necrosis factor alpha, and cardiovascular risk factors before and after weight loss in obese children
Metabolism
Do obese children become obese adults? A review of the literature
Am. J. Prev. Med.
A one-year intervention has modest effects on energy and macronutrient intakes of overweight and obese Swedish children
J. Nutr.
Health and economic burden of the projected obesity trends in the USA and the UK
Lancet
Childhood obesity: concept, feasibility, and interim results of a local group-based, long-term treatment program
J. Nutr. Educ. Behav.
Assessing the evidence base for interventions to prevent the further increase in obesity
Aust. Econ. Rev.
Effectiveness of interventions in the prevention of childhood obesity
Eur. J. Epidemiol.
Effect of weight reduction on insulin sensitivity, sex hormone-binding globulin, sex hormones and gonadotrophins in obese children
Eur. J. Endocrinol.
Challenge! Health promotion/obesity prevention mentorship model among urban, black adolescents
Pediatrics
Family involvement in school-based health promotion: bringing nutrition information home
Sch. Psychol. Rev.
Pediatrician's office: a solution in the prevention of childhood obesity
Acta Paediatr.
Role of television in childhood obesity prevention
Int. J. Obes.
Improvement of fitness, body composition, and insulin sensitivity in overweight children in a school-based exercise program: a randomized, controlled study
Arch. Pediatr. Adolesc. Med.
Pilot study of an individually tailored educational program by mail to promote healthy weight in Chinese American children
J. Spec. Pediatr. Nurs.
Statistical Power Analysis for the Behavioral Sciences
What is the best measure of adiposity change in growing children: BMI, BMI %, BMI z-score, or BMI centile?
Eur. J. Clin. Nutr.
Parent diet modification, physical activity, or both in obese children: an RCT
Pediatrics
Effects of aerobic exercise on overweight children's cognitive functioning: a randomized controlled trial
Res. Q. Exerc. Sport
Randomized control trial to improve adiposity and insulin resistance in overweight Latino adolescents
Obesity
Treatment of Childhood Obesity by Retraining Eating Behaviour: Randomised Controlled Trial
What reduction in BMI SDS is required in obese adolescents to improve body composition and cardiometabolic health?
Arch. Dis. Child.
The contribution of childhood obesity to adult carotid intima-media thickness: the Bogalusa Heart Study
Int. J. Obes.
Childhood obesity: political developments in Europe and related perspectives for future action on prevention
Obes. Rev.
Evaluation of a Multiple Ecological Level Child Obesity Prevention Program: Switch® What You Do, View, and Chew
Effects of Open-Loop Feedback on Physical Activity and Television Viewing in Overweight and Obese Children: A Randomized, Controlled Trial
Interventions that involve parents to improve children's weight-related nutrition intake and activity patterns: what activity and nutrition targets and behaviour change techniques are associated with intervention effectiveness?
Obes. Rev.
School-based prevention: effects on obesity and physical performance after four years
J. Sport Sci.
Data from the StEP TWO programme showing the effect on blood pressure and different parameters for obesity in overweight and obese primary school children
Cardiol. Young
Nutrition status of primary school children in Townsville
Aust. J. Rural Health
Family-based treatment for pediatric overweight: parental weight loss as a predictor of children's treatment success
Child. Health Care
The effects of a 3-year obesity intervention in schoolchildren in Beijing
Child Care Health Dev.
Randomized, controlled trial of an Internet-facilitated intervention for reducing binge eating and overweight in adolescents
Pediatrics
Two-year controlled effectiveness trial of a school-based intervention to prevent obesity in Chilean children
Public Health Nutr.
Family-based treatment of severe pediatric obesity: randomized, controlled trial
Pediatrics
Clinical efficacy of group-based treatment for childhood obesity compared with routinely given individual counseling
Int. J. Obes.
Cited by (108)
PCIT-Health: Preventing Childhood Obesity by Strengthening the Parent–Child Relationship
2022, Cognitive and Behavioral PracticeEvery cockroach is beautiful to his mother’s eyes”? A multicentric study on the perception of child’s health status according to the parent
2023, Journal of Preventive Medicine and Hygiene
- 1
*Included in systematic review and meta-analysis.