Review
Parent participation in weight-related health interventions for children and adolescents: A systematic review and meta-analysis

https://doi.org/10.1016/j.ypmed.2012.04.021Get rights and content

Abstract

Objective

To review child and adolescent weight-related health intervention characteristics, with a particular focus on levels of parental participation, and examine differences in intervention effectiveness.

Methods

Multiple social science, health, and medical databases were searched, and experimental randomized controlled studies of child and adolescent weight‐related health interventions, reported in January 2004 through December 2010, were collected. Intervention characteristics were reviewed, and pre- and post-measurement data, including body mass index, were extracted for analyses. Differences in effect sizes of experimental and control groups were used to evaluate effectiveness of interventions.

Results

Reports of 42 interventions were included. Intervention activities consisted of nutrition education, physical activity education, physical activity sessions, behavior education, behavior therapy, or a combination of these activities. Significant differences existed among levels of parent participation, p < 0.05. In addition, intervention duration positively predicted intervention effectiveness, p = 0.006, and the linear combination of parent participation and intervention duration significantly predicted intervention effectiveness, p = 0.001.

Conclusions

This study suggests that weight‐related health interventions that require parent participation more effectively reduce body mass indexes of child and adolescent participants. In addition, longer interventions that include parent participation appear to have greater success. Suggestions for future research and related interventions are provided.

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)

  • T. Reinehr et al.

    High-sensitive C-reactive protein, tumor necrosis factor alpha, and cardiovascular risk factors before and after weight loss in obese children

    Metabolism

    (2005)
  • M. Serdula et al.

    Do obese children become obese adults? A review of the literature

    Am. J. Prev. Med.

    (1993)
  • M. *Waling et al.

    A one-year intervention has modest effects on energy and macronutrient intakes of overweight and obese Swedish children

    J. Nutr.

    (2010)
  • Y.C. Wang et al.

    Health and economic burden of the projected obesity trends in the USA and the UK

    Lancet

    (2011)
  • C. *Weigel et al.

    Childhood obesity: concept, feasibility, and interim results of a local group-based, long-term treatment program

    J. Nutr. Educ. Behav.

    (2008)
  • A. Avenell et al.

    Assessing the evidence base for interventions to prevent the further increase in obesity

    Aust. Econ. Rev.

    (2008)
  • I. Bautista-Castaño et al.

    Effectiveness of interventions in the prevention of childhood obesity

    Eur. J. Epidemiol.

    (2004)
  • N.H. Birkebaek et al.

    Effect of weight reduction on insulin sensitivity, sex hormone-binding globulin, sex hormones and gonadotrophins in obese children

    Eur. J. Endocrinol.

    (2010)
  • M.M. *Black et al.

    Challenge! Health promotion/obesity prevention mentorship model among urban, black adolescents

    Pediatrics

    (2010)
  • J. Blom-Hoffman et al.

    Family involvement in school-based health promotion: bringing nutrition information home

    Sch. Psychol. Rev.

    (2008)
  • S.A. Bowman

    Pediatrician's office: a solution in the prevention of childhood obesity

    Acta Paediatr.

    (2005)
  • M. Caroli et al.

    Role of television in childhood obesity prevention

    Int. J. Obes.

    (2004)
  • A.L. *Carrel et al.

    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.

    (2005)
  • J. Chen et al.

    Pilot study of an individually tailored educational program by mail to promote healthy weight in Chinese American children

    J. Spec. Pediatr. Nurs.

    (2008)
  • J. Cohen

    Statistical Power Analysis for the Behavioral Sciences

    (1988)
  • T.J. Cole et al.

    What is the best measure of adiposity change in growing children: BMI, BMI %, BMI z-score, or BMI centile?

    Eur. J. Clin. Nutr.

    (2005)
  • C.E. Collins et al.

    Parent diet modification, physical activity, or both in obese children: an RCT

    Pediatrics

    (2011)
  • C.L. *Davis et al.

    Effects of aerobic exercise on overweight children's cognitive functioning: a randomized controlled trial

    Res. Q. Exerc. Sport

    (2007)
  • J.N. *Davis et al.

    Randomized control trial to improve adiposity and insulin resistance in overweight Latino adolescents

    Obesity

    (2009)
  • A.L. *Ford et al.

    Treatment of Childhood Obesity by Retraining Eating Behaviour: Randomised Controlled Trial

    (2010)
  • A.L. Ford et al.

    What reduction in BMI SDS is required in obese adolescents to improve body composition and cardiometabolic health?

    Arch. Dis. Child.

    (2010)
  • D.S. Freedman et al.

    The contribution of childhood obesity to adult carotid intima-media thickness: the Bogalusa Heart Study

    Int. J. Obes.

    (2008)
  • D. Fussenegger et al.

    Childhood obesity: political developments in Europe and related perspectives for future action on prevention

    Obes. Rev.

    (2007)
  • D.A. *Gentile et al.

    Evaluation of a Multiple Ecological Level Child Obesity Prevention Program: Switch® What You Do, View, and Chew

    (2009)
  • G.S. *Goldfield et al.

    Effects of Open-Loop Feedback on Physical Activity and Television Viewing in Overweight and Obese Children: A Randomized, Controlled Trial

    (2006)
  • R.K. Golley et al.

    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.

    (2011)
  • C. *Graf et al.

    School-based prevention: effects on obesity and physical performance after four years

    J. Sport Sci.

    (2008)
  • C. *Graf et al.

    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

    (2005)
  • D.L. Heath et al.

    Nutrition status of primary school children in Townsville

    Aust. J. Rural Health

    (2005)
  • H.L. Hunter et al.

    Family-based treatment for pediatric overweight: parental weight loss as a predictor of children's treatment success

    Child. Health Care

    (2008)
  • J. *Jiang et al.

    The effects of a 3-year obesity intervention in schoolchildren in Beijing

    Child Care Health Dev.

    (2007)
  • M. *Jones et al.

    Randomized, controlled trial of an Internet-facilitated intervention for reducing binge eating and overweight in adolescents

    Pediatrics

    (2008)
  • J. *Kain et al.

    Two-year controlled effectiveness trial of a school-based intervention to prevent obesity in Chilean children

    Public Health Nutr.

    (2008)
  • M.A. *Kalarchian et al.

    Family-based treatment of severe pediatric obesity: randomized, controlled trial

    Pediatrics

    (2009)
  • M.P. *Kalavainen et al.

    Clinical efficacy of group-based treatment for childhood obesity compared with routinely given individual counseling

    Int. J. Obes.

    (2007)
  • Cited by (108)

    View all citing articles on Scopus
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    *Included in systematic review and meta-analysis.

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