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Review articles • J. Pediatr. (Rio J.) 95 (4) • Jul-Aug 2019 • https://doi.org/10.1016/j.jped.2018.07.009 copy

Overview of meta-analysis on prevention and treatment of childhood obesity^☆ ☆ Please cite this article as: Bahia L, Schaan CW, Sparrenberger K, Abreu GA, Barufaldi LA, Coutinho W, et al. Overview of meta-analysis on prevention and treatment of childhood obesity. J Pediatr (Rio J). 2019;95:385 -400.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objectives:

This study aimed to assess the quality of systematic reviews on prevention and non-pharmacological treatment of overweight and obesity in children and adolescents.

Data source:

A search was done in electronic databases (Medline via PubMed, Web of Science, Scopus, LILACS, the Cochrane Library, and Clinical Trials), including only systematic reviews with meta-analysis. Reviews were selected by two researchers, and a third one solved the divergences. PRISMA statement and checklist were followed.

Summary of data:

A total of 4574 records were retrieved, including 24 after selection. Six reviews were on obesity prevention, 17 on obesity treatment, and one on mixed interventions for prevention and treatment of obesity. The interventions were very heterogeneous and showed little or no effects on weight or body mass index. Mixed interventions that included dieting, exercise, actions to reduce sedentary behavior, and programs involving the school or families showed some short-term positive effects. Reviews that analyzed cardiovascular risk factors demonstrated significant improvements in the short-term.

Conclusion:

The systematic reviews of interventions to prevent or reduce obesity in children and adolescents generally showed little or no effects on weight or body mass index, although cardiovascular profile can be improved. Mixed interventions demonstrated better effects, but the long-term impact of obesity treatments of children and adolescents remains unclear.

KEYWORDS
Child; Adolescent; Obesity

Author/data	Date assessed as up to	Population	Interventions	Comparison interventions	Outcomes
O-Meara et al., 1998¹⁸18 O'Meara S, Glenny AM, Sheldon T, Melville A, Wilson C. Systematic review of the effectiveness of interventions used in the management of obesity. J Hum Nutr Diet. 1998;11:203-6.	Jan 1997	Children and adults^a a No information about the nutritional status at baseline.	Dietary, behavioral and exercise interventions	No intervention	Weight, fat content, and fat distribution
Snethen et al., 2006⁴²42 Snethen JA, Broome ME, Cashin SE. Effective weight loss for overweight children: a meta-analysis of intervention studies. J Pediatr Nurs. 2006;21:45-56.	1980 to 2002	Overweight/obesity (6 -16 y)	Any intervention with activity, instruction, training or program implemented for the purpose of assisting the overweight child to lose weight	No intervention or waiting list control	Weight
Atlantis et al., 2006¹⁴14 Atlantis E, Barnes EH, Singh MA. Efficacy of exercise for treating overweight in children and adolescents: a systematic review. Int J Obes (Lond). 2006;30:1027-40.	2004	Overweight/obese (<18 y)	At least one exercise or physical activity treatment arm was investigated either in isolation or as an adjunct to an alternative treatment simultaneously prescribed to the control/comparison group (e.g ., exercise plus caloric intake of 1000 kcal/days vs. caloric intake of 1000 kcal/days)	No exercise	Percent body fat, body weight, central obesity, waist girth
Collins et al., 2006²⁶26 Collins CE, Warren J, Neve M, McCoy P, Stokes BJ. Measuring effectiveness of dietetic interventions in child obesity: a systematic review of randomized trials. Arch Pediatr Adolesc Med. 2006;160:906-22.	1975 to 2003	Overweight/obese (<18 y)	Dietary intervention alone or in combination with lifestyle modifications and/or psychological therapies	No intervention	Weight
Young et al., 2007³⁴34 Young KM, Northern JJ, Lister KM, Drummond JA, O'Brien WH. A meta-analysis of family-behavioral weight-loss treatments for children. Clin Psychol Rev. 2007;27:240-9.	NA	Obese (5 -12 y)	Behavioral or cognitive -behavioral techniques with family involvement	No intervention	Percent overweight, weight, and BMI or BMI Z -score
McGovern et al., 2008⁴⁰40 McGovern L, Johnson JN, Paulo R, Hettinger A, Singhal V, Kamath C, et al. Clinical review Treatment of pediatric obesity: a systematic review and meta-analysis of randomized trials. J Clin Endocrinol Metab. 2008;93:4600-5.	Feb 2006	Overweight/obese (2 -18 y)	Pharmacological (sibutramine, orlistat, metformin), dietary intervention only, physical activity intervention only, dietary intervention and physical activity intervention	No intervention	BMI, percent overweight, percent fat-free mass, and visceral adiposity
Kamath et al., 2008²⁰20 Kamath CC, Vickers KS, Ehrlich A, McGovern L, Johnson J, Singhal V, et al. Clinical review: behavioral interventions to prevent childhood obesity: a systematic review and metaanalyses of randomized trials. J Clin Endocrinol Metab. 2008;93:4606-15.	Feb 2006	Children and adolescents (2 -18 y)	Increase physical activity or decrease sedentary activity or increase healthy dietary behavior or reduce unhealthy dietary behavior	No intervention	Dietary behavior and BMI
Katz et al., 2008²¹21 Katz DL, O'Connell M, Njike VY, Yeh MC, Nawaz H. Strategies for the prevention and control of obesity in the school setting: systematic review and meta-analysis. Int J Obes (Lond). 2008;32:1780-9.	1966 to Oct 2004	Overweight/obese (3 -18 y)	Nutrition and physical activity intervention	No intervention	BMI
Harris et al., 2009³⁶36 Harris KC, Kuramoto LK, Schulzer M, Retallack JE. Effect of school-based physical activity interventions on body mass index in children: a meta-analysis. CMAJ. 2009;180:719-26.	Jan 1966 to Sept 2008	Eutrophic, overweight and obese (5 -18 y)	School-based physical activity	No intervention	BMI and anthropometric measures (percent body fat, waist circumference, waist-to-hip ratio, triceps skin-fold thickness, and subscapular skin-fold thickness)
Kanekar et al., 2008⁴¹41 Kanekar A, Sharma M. Meta-analysis of school-based childhood obesity interventions in the U.K. and U.S.. Int Q Community Health Educ. 2008;29:241-56.	2000 to 2007	Overweight/obese (<18 y)	School-based childhood obesity interventions	No intervention or usual school activity or writing materials	BMI
Kesten et al., 2011²²22 Kesten JM, Griffiths PL, Cameron N. A systematic review to determine the effectiveness of interventions designed to prevent overweight and obesity in pre-adolescent girls. Obes Rev. 2011;12:997-1021.	1990 to Feb 2010	Overweight/obese girls (7 -11 y)	Physical activity, dietary or lifestyle modification within the school, family or community setting	No intervention	BMI, physical activity, and nutrition behavior
Luckner et al., 2012²³23 Luckner H, Moss JR, Gericke CA. Effectiveness of interventions to promote healthy weight in general populations of children and adults: a meta-analysis. Eur J Public Health. 2012;22:491-7.	Nov 2008	Overweight (≤18 y)	Physical activity, education, nutrition and reduction of TV viewing	No intervention	BMI
Lavelle et al., 2012³¹31 Lavelle HV, Mackay DF, Pell JP. Systematic review and meta-analysis of school-based interventions to reduce body mass index. J Public Health. 2012;34:360-9.	Feb 2011	Overweight/obese (≤18 y)	Physical activity and/or nutrition and/or sedentary behavior in school setting	No intervention	BMI
Friedrich et al., 2012²⁸28 Friedrich RR, Schuch I, Wagner MB. Effect of interventions on the body mass index of school-age students. Rev Saude Publica. 2012;46:551-60.	1998 to Aug 2010	Children and adolescents (4 -19 y)^a a No information about the nutritional status at baseline.	Physical activity and/or nutrition education	No intervention	BMI
Ho et al., 2012³⁰30 Ho M, Garnett SP, Baur L, Burrows T, Stewart L, Neve M, et al. Effectiveness of lifestyle interventions in child obesity: systematic review with meta-analysis. Pediatrics. 2012;130:e1647-71.	1975 to 2010	Overweight/obese (≤18 y)	Lifestyle intervention programs incorporating a nutrition or dietary component	No treatment or wait-list control, usual care, or minimal advice or written dietary and physical activity education materials	BMI, BMI Z -score, lipids, glucose, insulin, and blood pressure
Sbruzzi et al., 2013²⁴24 Sbruzzi G, Eibel B, Barbiero SM, Petkowicz RO, Ribeiro RA, Cesa CC, et al. Educational interventions in childhood obesity: a systematic review with meta-analysis of randomized clinical trials. Prev Med. 2013;56:254-64.	May 2012	Eutrophic, overweight or obese (6 -12 y)	Educational interventions (intervention strategy performed in the school and/or family) during at least 6 months	Usual care or no intervention for prevention or treatment of childhood obesity	BMI, BMI Z -score, weight, waist circumference (cm), blood pressure, total cholesterol, and high-density lipoprotein cholesterol
Ho et al., 2013³⁷37 Ho M, Garnett SP, Baur LA, Burrows T, Stewart L, Neve M, et al. Impact of dietary and exercise interventions on weight change and metabolic outcomes in obese children and adolescents: a systematic review and meta-analysis of randomized trials. JAMA Pediatr. 2013;167:759-68.	1975 to 2010	Overweight/obese (≤18 y)	Dietary intervention programs, dietary plus exercise or an exercise-only intervention	Dietary-only vs. dietary plus exercise intervention; dietary-only vs. exercise-only intervention	BMI, body fat percentage, lean body mass, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triglycerides, glucose, and insulin
Ajie et al., 2014¹³13 Ajie WN, Chapman-Novakofski KM. Impact of computer-mediated, obesity-related nutrition education interventions for adolescents: a systematic review. J Adolesc Health. 2014;54:631-45.	Jan 2002 to Aug 2013	Adolescents (12 -18 y)^a a No information about the nutritional status at baseline.	Internet-based education or behavioral intervention via a stationary or laptop computer	No intervention	Dietary composition, nutrition knowledge, BMI, BMI Z -score, weight, and sedentary behavior
Gow et al., 2014²⁹29 Gow ML, Ho M, Burrows TL, Baur LA, Stewart L, Hutchesson MJ, et al. Impact of dietary macronutrient distribution on BMI and cardiometabolic outcomes in overweight and obese children and adolescents: a systematic review. Nutr Rev. 2014;72:453-70.	1975 to 2013	Overweight/obese (≤18 y)	Dietary interventions of varying macronutrient content	Low carbohydrate dietary vs. low fat dietary; Increased protein dietary vs. standard protein dietary; increased fat dietary vs. standard fat dietary	BMI, BMI Z -score
van Hoek et al., 2014³³33 van Hoek E, Feskens EJ, Bouwman LI, Janse AJ. Effective interventions in overweight or obese young children: systematic review and meta-analysis. Child Obes. 2014;10:448-60.	April 15, 2012	Overweight/obese (3 -8 y)	Multicomponent treatment program, including dietary and physical activity education and behavioral therapy or treatment programs with combined dietary and physical activity education only	Some studies with control groups (no intervention) and others without control groups	BMI Z -score
Kelishadi et al., 2014¹⁶16 Kelishadi R, Azizi-Soleiman F. Controlling childhood obesity: a systematic review on strategies and challenges. J Res Med Sci. 2014;19:993-1008.	2000 to 2012	Overweight/obese (2 -18 y)	Community, family, school, and clinic interventions or a combination of them	No intervention	Weight, BMI, BMI Z -score
Liao et al., 2014 ³⁸38 Liao Y, Liao J, Durand CP, Dunton GF. Which type of sedentary behaviour intervention is more effective at reducing body mass index in children? A meta-analytic review. Obes Rev. 2014;15:159-68.	July 2012	Eutrophic, overweight or obese (≤18 y)	Reduce sedentary behavior (reduce TV/DVD/VCR, playing sedentary video/computer games, and sitting time in general) and/or increase physical activity and/or improving dietary habits	Control: some non-obesity prevention-related information; usual-programming; assessment-only	BMI
Martin et al., 2014 ³⁹39 Martin A, Saunders DH, Shenkin SD, Sproule J. Lifestyle intervention for improving school achievement in overweight or obese children and adolescents. Cochrane Database Syst Rev. 2014;:CD009728.	May 2013	Overweight/obese (3 -18 y)	Lifestyle interventions	Standard care, waiting list control, no treatment or attention control	School achievement, BMI, BMI Z -scores, BMI-SDs, and measures of body fatness by DXA and BIA
Ruotsalainen et al., 2015³²32 Ruotsalainen H, Kyngas H, Tammelin T, Kaariainen M. Systematic review of physical activity and exercise interventions on body mass indices, subsequent physical activity and psychological symptoms in overweight and obese adolescents. J Adv Nurs. 2015;71:2461-77.	Jan 1950 to Aug 2013	Overweight/obesity (≤ 18 y)	Physical activity or exercise along with counseling or dietary practices	Control with standard care - no treatment related to physical activity	Physical activity level, BMI, or psychological symptoms
Hung et al., 2015¹⁹19 Hung LS, Tidwell DK, Hall ME, Lee ML, Briley CA, Hunt BP. A meta-analysis of school-based obesity prevention programs demonstrates limited efficacy of decreasing childhood obesity. Nutr Res. 2015;35:229-40.	NA	Children and adolescents (6 -18 y)^a a No information about the nutritional status at baseline.	School-based childhood obesity prevention programs (nutrition component and/or physical activity component and/or parental involvement and/or specialist involvement)	NA	BMI and skinfold thickness
Foster et al., 2015¹⁵15 Foster BA, Farragher J, Parker P, Sosa ET. Treatment interventions for early childhood obesity: a systematic review. Acad Pediatr. 2015;15:353-61.	July 1948 to July 2014	Overweight/obese (0-6y)	Dietary advice, physical activities, behavioral management, and a motivational interview	Educational sessions	BMI, BMI percentile, or some iteration of percentage, overweight, or obese using height, weight, and waist circumference
Ling et al., 2016¹⁷17 Ling J, Robbins LB, Wen F. Interventions to prevent and manage overweight or obesity in preschool children: a systematic review. Int J Nurs Stud. 2016;53:270-89.	1966 to Feb 2015	Preschool children (2 -5 y)^a a No information about the nutritional status at baseline.	Lifestyle intervention (any intervention that aimed to improve behaviors, including screen time, sedentary activity, physical activity, dietary, and/or sleep)	30-min structured physical activity per day; usual care; wait-list	BMI, waist circumference, skinfold, body fat
Colquitt et al., 2016²⁷27 Colquitt JL, Loveman E, O'Malley C, Azevedo LB, Mead E, Al-Khudairy L, et al. Diet, physical activity, and behavioural interventions for the treatment of overweight or obesity in preschool children up to the age of 6 years. Cochrane Database Syst Rev. 2016;:CD012105.	Mar 2015	Overweight/obesity (0 -6 y)	Dietary, physical activity, and behavioral interventions	No intervention or usual care	BMI, BMI Z -score
Murray et al., 2017³⁵35 Murray M, Dordevic AL, Bonham MP. Systematic review and meta-analysis: the impact of multicomponent weight management interventions on self-esteem in overweight and obese adolescents. J Pediatr Psychol. 2017;42:379-94.	Dec 2014	Overweight/obese (10 -19 y)	Multicomponent weight management interventions (behavioral, dietary, and physical activity components)	No treatment control	Self esteem and BMI Z -score
Kim et al., 2017²⁵25 Kim K, Ok G, Jeon S, Kang M, Lee S. Sport-based physical activity intervention on body weight in children and adolescents: a meta-analysis. J Sports Sci. 2017;35:369-76.	April 2015	Children and adolescents (6 -18 y)	Sport-based intervention	Control	Weight

Prevention studies	Intervention duration (months)	Participants (age/number)	Number of studies included	Results
				BMI SMD (95% CI)	BMI Z -score SMD (95% CI)	Weight SMD (95% CI)	BMI Percentile
Kamath et al., 2008 ²⁰20 Kamath CC, Vickers KS, Ehrlich A, McGovern L, Johnson J, Singhal V, et al. Clinical review: behavioral interventions to prevent childhood obesity: a systematic review and metaanalyses of randomized trials. J Clin Endocrinol Metab. 2008;93:4606-15.	≥6	2 -18 y (NA)	34
Physical activity				0.01 (-0.06; 0.08)
Diet				-0.04 (-0.16; 0.08)
Combined lifestyle				-0.03 (-0.07; 0.01)
Katz et al., 2008 ²¹21 Katz DL, O'Connell M, Njike VY, Yeh MC, Nawaz H. Strategies for the prevention and control of obesity in the school setting: systematic review and meta-analysis. Int J Obes (Lond). 2008;32:1780-9.	NA	3 -18 y (13,029)	8
Control group						-0.29 (-0.45; -0.14)
Nutritional education vs . control						-0.39
TV reduction vs . control						- 0.35
Physical activity vs . control						1.87
Family involvement + nutritional education + physical activity vs . control						-0.20 (-0.41;0.00)
Family involvement +environmental component + nutritional education + physical activity vs . control						-0.16 (-0.32; 0.00)
Girls only: physical activity vs . control						-0.38 (-0.74; -0.02)
Girls only: nutritional education + physical activity vs . control						-0.53 (-1.37; 0.30)
Boys only: nutritional education + physical activity vs . control						-0.22 (-0.32; -0.12)
Girls only: physical activity vs . nutritional education + physical activity						-0.53 (-1.37; 0.30)
Boys only: physical activity vs . nutritional education + physical activity						-0.14 (-0.17; 0.44)
Luckner et al., 2012 ²³23 Luckner H, Moss JR, Gericke CA. Effectiveness of interventions to promote healthy weight in general populations of children and adults: a meta-analysis. Eur J Public Health. 2012;22:491-7.	NA	0 -18 y (NA)	68
Physical activity				-0.15 (-0.33; -0.03)		-0.7 (-1.05; -0.31)
Education				-0.15 (-0.24; -0.07)		0.13 (-0.04; 0.3)
Nutrition				-0.14 (-0.55; -0.27)
Physical activity + education				-0.19 (-0.37; -0.02)		-1.07 (-2.27; 0.13)
Physical activity + education + nutrition				-0.1 (-0.77; -0.04)		0.78 (-0.29; 1.86)
Reduced sedentary behavior				-0.27 (-0.4; -0.13)		0.08 (-0.68; 0.84)
Sbruzzi et al., 2013 ²⁴24 Sbruzzi G, Eibel B, Barbiero SM, Petkowicz RO, Ribeiro RA, Cesa CC, et al. Educational interventions in childhood obesity: a systematic review with meta-analysis of randomized clinical trials. Prev Med. 2013;56:254-64.	≥6	6 -12 y (23,617)	8
Educational intervention vs . usual care or no intervention				-0.86 (-1.59; -0.14)	-0.06 (-0.16; 0.03)

Prevention studies	Intervention duration (months)	Participants (age/number)	Number of studies included	Outcomes/results
Kesten et al., 2011²²22 Kesten JM, Griffiths PL, Cameron N. A systematic review to determine the effectiveness of interventions designed to prevent overweight and obesity in pre-adolescent girls. Obes Rev. 2011;12:997-1021. Physical activity, diet or lifestyle modification within the school, family or community setting with a qualitative, quantitative or mixed methods approach	3	7 -11 y (NA) Girls	30	Physical activity, nutrition, knowledge and attitudes, physical measures (BMI, weight) Effect sizes ranged from 0.01 to 1.45 66 less than 0.2, 56 low (0.2), 16 medium (0.5) and two high (0.8)^a a Majority of results failed to produce medium to large effect sizes.
Hung et al., 2015¹⁹19 Hung LS, Tidwell DK, Hall ME, Lee ML, Briley CA, Hunt BP. A meta-analysis of school-based obesity prevention programs demonstrates limited efficacy of decreasing childhood obesity. Nutr Res. 2015;35:229-40. School-based childhood obesity prevention programs	<12 or ≥12	6 -18 y (26,114)	27	BMI Summary effect size: 0.039 (95% CI: -0.013 to 0.092, p = 0.145)
Kim et al., 2017²⁵25 Kim K, Ok G, Jeon S, Kang M, Lee S. Sport-based physical activity intervention on body weight in children and adolescents: a meta-analysis. J Sports Sci. 2017;35:369-76. Sport-based physical activity intervention on body weight in children and adolescents	<3; 3 -6; or >6	6 -18 y (1777)	18	Body weight Effect sizes: 0.52 (95% CI: 0.08 to 0.95, p = 0.021)

Treatment studies	Intervention duration (months)	Participants (age/number)	Number of studies included	Results
				BMI SMD (95% CI)	BMI Z -score SMD (95% CI)	Weight SMD (95% CI)	BMI Percentile
Collins et al., 2006 ²⁶26 Collins CE, Warren J, Neve M, McCoy P, Stokes BJ. Measuring effectiveness of dietetic interventions in child obesity: a systematic review of randomized trials. Arch Pediatr Adolesc Med. 2006;160:906-22.	NA	≤18 y (2262)	8
Dietary intervention vs . control						-1.82 (-2.40; -1.23)
Dietary intervention vs . control at follow-up						-0.64 (-0.89; -0.39)
Young et al., 2007 ³⁴34 Young KM, Northern JJ, Lister KM, Drummond JA, O'Brien WH. A meta-analysis of family-behavioral weight-loss treatments for children. Clin Psychol Rev. 2007;27:240-9.	≥2.5	5 -12 y (666)	16
Family behavioral						-0.62 (-0.79; -0.44)
Other treatments						-0.52 (-1.49; 0.44)
Control group						-0.18 (-0.75; -0.38)
McGovern et al., 2008 ⁴⁰40 McGovern L, Johnson JN, Paulo R, Hettinger A, Singhal V, Kamath C, et al. Clinical review Treatment of pediatric obesity: a systematic review and meta-analysis of randomized trials. J Clin Endocrinol Metab. 2008;93:4600-5.	NA	2 -18 y (NA)	61
Dietary intervention vs . control				-0.22 (-0.56; 0.11)
Physical activity intervention vs . control				-0.02 (-0.21; 0.18)
Reduced sedentary behavior vs . control				0.02 (-0.35; 0.39)
Combined lifestyle interventions vs . control				-0.17 (-0.40; 0.05)
Harris et al., 2009 ³⁶36 Harris KC, Kuramoto LK, Schulzer M, Retallack JE. Effect of school-based physical activity interventions on body mass index in children: a meta-analysis. CMAJ. 2009;180:719-26.	≥6	5 -18 y (18,141)	15
Physical activity vs . control				-0.05 (-0.19;0.10)
Friedrich et al., 2012 ²⁸28 Friedrich RR, Schuch I, Wagner MB. Effect of interventions on the body mass index of school-age students. Rev Saude Publica. 2012;46:551-60.	≥3	≤19 y (9997)	23
Physical activity				-0.02 (-0.08; 0.04)
Nutritional education				-0.03 (-0.10; 0.04)
Physical activity + nutritional education				-0.37 (-0.63; -0.12)
Ho et al., 2012 ³⁰30 Ho M, Garnett SP, Baur L, Burrows T, Stewart L, Neve M, et al. Effectiveness of lifestyle interventions in child obesity: systematic review with meta-analysis. Pediatrics. 2012;130:e1647-71.	1 -24	≤18 y (NA)	32
Lifestyle intervention vs . control (A)				-1.25 (-2.18; -0.32)	-0.10 (-0.18; -0.02)
Lifestyle interventions vs . usual care (B)				-1.30 (-1.58; -1.03)
Lifestyle intervention vs . usual care (C)				-0.92 (-1.31; -0.54)
Lifestyle intervention vs . written education (B)				-2.52 (-5.95;0.91)	-0.06 (-0.10; -0.02)
Lavelle et al., 2012 ³¹31 Lavelle HV, Mackay DF, Pell JP. Systematic review and meta-analysis of school-based interventions to reduce body mass index. J Public Health. 2012;34:360-9.	≥6 -72	≤18 y (36,579)	43
School based education vs . control				-0.17 (-0.26; -0.08)
Girls only: school based education vs . control				-0.28 (-0.50; -0.06)
Boys only: school based education vs . control				-0.17 (-0.26; -0.08)
Physical activity promotion in school vs . control				-0.13 (-0.22; -0.44)
Nutritional education + physical activity promotion in school vs . control				-0.17 (-0.29; -0.08)
Ho et al., 2013 ³⁷37 Ho M, Garnett SP, Baur LA, Burrows T, Stewart L, Neve M, et al. Impact of dietary and exercise interventions on weight change and metabolic outcomes in obese children and adolescents: a systematic review and meta-analysis of randomized trials. JAMA Pediatr. 2013;167:759-68.	6 weeks-6 m	≤18 y (NA)	12
Dietary interventions + exercise vs . diet only				-0.24 (-0.62; 0.14)
Resistance training				0.40 (0.08; 0.71)
Resistance training + aerobic training				-0.10 (-0.45; 0.26)
Sbruzzi et al., 2013 ²⁴24 Sbruzzi G, Eibel B, Barbiero SM, Petkowicz RO, Ribeiro RA, Cesa CC, et al. Educational interventions in childhood obesity: a systematic review with meta-analysis of randomized clinical trials. Prev Med. 2013;56:254-64.	≥6	6 -12 y (23,617)	18
Educational interventions vs . usual care or no intervention				-0.86 (-1.59; -0.14)	-0.06 (-0.16; 0.03)
Gow et al., 2014 ²⁹29 Gow ML, Ho M, Burrows TL, Baur LA, Stewart L, Hutchesson MJ, et al. Impact of dietary macronutrient distribution on BMI and cardiometabolic outcomes in overweight and obese children and adolescents: a systematic review. Nutr Rev. 2014;72:453-70.	≥2	≤18 y	14
Low-carbohydrate diet vs . standard low-fat diet (A)				1.46 (-2.48; -0.44)	-0.25 (-0.44; -0.06)
Low-carbohydrate diet vs . standard low-fat diet (B)				0.57 (-1.44; 2.58)
Increased-protein diet vs . standard-protein diet (A)				-0.18 (-0.78; 0.42)	-0.01 (-0.06; 0.04)
Increased-protein diet vs . standard-protein diet (B)					-0.06 (-0.15; 0.02)
van Hoek et al., 2014 ³³33 van Hoek E, Feskens EJ, Bouwman LI, Janse AJ. Effective interventions in overweight or obese young children: systematic review and meta-analysis. Child Obes. 2014;10:448-60.	≥6	3 -8 y (1015)	11
Multicomponent intervention very low intensity vs . control					-0.08 (-0.15; 0.02)
Multicomponent intervention moderate or high intensity vs . control					-0.46 (-0.53; -0.39)
Nutritional education combined with either behavioral therapy or physical activity education - very low intensity vs . control					-0.31 (-0.51; 0.02)
Nutritional education very low intensity vs. control					-0.46 (-0.94; 0.02)
Physical activity education high intensity vs . control					-0.31 (-0.88; 0.27)
Liao et al., 2014 ³⁸38 Liao Y, Liao J, Durand CP, Dunton GF. Which type of sedentary behaviour intervention is more effective at reducing body mass index in children? A meta-analytic review. Obes Rev. 2014;15:159-68.	NA	≤18 y (NA)	25
Physical activity vs . control				-0.15 (-0.35; 0.04)
Physical activity + Reduced sedentary behavior				-0.08 (-0.20; 0.02)
Physical activity + Reduced sedentary behavior + diet				-0.06 (-0.15; 0.03)
Martin et al., 2014 ³⁹39 Martin A, Saunders DH, Shenkin SD, Sproule J. Lifestyle intervention for improving school achievement in overweight or obese children and adolescents. Cochrane Database Syst Rev. 2014;:CD009728.	NA	3 -18 y (792)	6
Lifestyle interventions vs . standard care					0.03 (-0.15; 0.21)
Colquitt et al., 2016 ²⁷27 Colquitt JL, Loveman E, O'Malley C, Azevedo LB, Mead E, Al-Khudairy L, et al. Diet, physical activity, and behavioural interventions for the treatment of overweight or obesity in preschool children up to the age of 6 years. Cochrane Database Syst Rev. 2016;:CD012105.	6 -24	0 -6 y (923)	5
Multicomponent intervention vs . control (A)					-0.26 (-0.37; -0.16)	-1.18 (-1.91; -0.45)	-1.54 (-2.82; -0.26)
Multicomponent intervention vs . control (B)					-0.38 (-0.58; -0.19)	-2.81 (-4.39; -1.22)	-3.47 (-5.11; -1.82)
Ruotsalainen et al., 2015 ³²32 Ruotsalainen H, Kyngas H, Tammelin T, Kaariainen M. Systematic review of physical activity and exercise interventions on body mass indices, subsequent physical activity and psychological symptoms in overweight and obese adolescents. J Adv Nurs. 2015;71:2461-77.	3 -6	12 -18 y (NA)	14
Supervised exercise vs . control				-0.36 (-0.64; -0.08)
Physical activity promotion vs . control				-0.10 (-0.24; 0.04)
Supervised exercise + physical activity promotion vs . control				-0.18 (-0.40; 0.03)

NA, not available.Collins et al.²⁶26 Collins CE, Warren J, Neve M, McCoy P, Stokes BJ. Measuring effectiveness of dietetic interventions in child obesity: a systematic review of randomized trials. Arch Pediatr Adolesc Med. 2006;160:906-22.: control group received usual care or no intervention.Young et al.³⁴34 Young KM, Northern JJ, Lister KM, Drummond JA, O'Brien WH. A meta-analysis of family-behavioral weight-loss treatments for children. Clin Psychol Rev. 2007;27:240-9.: Family behavioral = use of at least one named behavioral or cognitive-behavioral technique to encourage children to pursue and maintain healthy physical and/or eating habits; Other treatments = behavioral treatments analogous to the family-behavioral groups without the direct involvement of the parents, Control group = not defined.McGovern et al.⁴⁰40 McGovern L, Johnson JN, Paulo R, Hettinger A, Singhal V, Kamath C, et al. Clinical review Treatment of pediatric obesity: a systematic review and meta-analysis of randomized trials. J Clin Endocrinol Metab. 2008;93:4600-5.: Dietary interventions = reduced-glycemic-load diet, protein-sparing modified diet, low-carbohydrate diet, high-protein diet, and hypocaloric diet; combination lifestyle interventions = physical activity and dietary modification.Harris et al.³⁶36 Harris KC, Kuramoto LK, Schulzer M, Retallack JE. Effect of school-based physical activity interventions on body mass index in children: a meta-analysis. CMAJ. 2009;180:719-26.: Physical activity: intervention took place during regular class time; Control group = continued with the existing physical education curriculum of school.Ho et al.³⁰30 Ho M, Garnett SP, Baur L, Burrows T, Stewart L, Neve M, et al. Effectiveness of lifestyle interventions in child obesity: systematic review with meta-analysis. Pediatrics. 2012;130:e1647-71.: A = at latest point of follow-up, B = at the end of active treatment. C = at follow up. Lifestyle intervention = program incorporating a nutrition or dietary component; control = no treatment; usual care = minimal advice; written education = written diet and physical activity education materials.Lavelle et al.³¹31 Lavelle HV, Mackay DF, Pell JP. Systematic review and meta-analysis of school-based interventions to reduce body mass index. J Public Health. 2012;34:360-9.: School based education = physical activity promotion and/or sedentary behavior reduction and/or nutritional education.Ho et al.³⁷37 Ho M, Garnett SP, Baur LA, Burrows T, Stewart L, Neve M, et al. Impact of dietary and exercise interventions on weight change and metabolic outcomes in obese children and adolescents: a systematic review and meta-analysis of randomized trials. JAMA Pediatr. 2013;167:759-68.: Dietary interventions = calorie restriction approach, with energy levels ranging from 900 to 1800 kcal/d and with varied macronutrient combinations. Others either used the Traffic Light Diet, aimed at limiting added sugar consumption and increasing dietary fiber intake or provided general dietary advice.Sbruzzi et al.²⁴24 Sbruzzi G, Eibel B, Barbiero SM, Petkowicz RO, Ribeiro RA, Cesa CC, et al. Educational interventions in childhood obesity: a systematic review with meta-analysis of randomized clinical trials. Prev Med. 2013;56:254-64.: Educational intervention = school-based program defined as an intervention strategy performed in the school and/or family based program.Gow et al.²⁹29 Gow ML, Ho M, Burrows TL, Baur LA, Stewart L, Hutchesson MJ, et al. Impact of dietary macronutrient distribution on BMI and cardiometabolic outcomes in overweight and obese children and adolescents: a systematic review. Nutr Rev. 2014;72:453-70.: A = end of intervention; B = 2-year follow up.Van Hoek et al.³³33 van Hoek E, Feskens EJ, Bouwman LI, Janse AJ. Effective interventions in overweight or obese young children: systematic review and meta-analysis. Child Obes. 2014;10:448-60.: multicomponent intervention = dietary, physical education and behavioral therapy; Intensity of treatment (duration over the course of the intervention period) was categorized as very low (<10 hours), low (10 -25 hours), moderate (26 -75 hours), or high (>75 hours).Liao et al.³⁸38 Liao Y, Liao J, Durand CP, Dunton GF. Which type of sedentary behaviour intervention is more effective at reducing body mass index in children? A meta-analytic review. Obes Rev. 2014;15:159-68.: Sedentary behaviors = watching TV/DVD/VCR, playing sedentary video/computer games and sitting time in general.Martin et al.³⁹39 Martin A, Saunders DH, Shenkin SD, Sproule J. Lifestyle intervention for improving school achievement in overweight or obese children and adolescents. Cochrane Database Syst Rev. 2014;:CD009728.: lifestyle intervention (physical activity promotion, sedentary behavior reduction, nutritional education, psychological interventions).Colquitt et al.²⁷27 Colquitt JL, Loveman E, O'Malley C, Azevedo LB, Mead E, Al-Khudairy L, et al. Diet, physical activity, and behavioural interventions for the treatment of overweight or obesity in preschool children up to the age of 6 years. Cochrane Database Syst Rev. 2016;:CD012105.: multicomponent intervention (nutritional, physical activity, and behavioral interventions); A = end of intervention (6 -12 months); B = 12 -18 months follow-up (6 -8 months post intervention);Ruotsalainen et al.³²32 Ruotsalainen H, Kyngas H, Tammelin T, Kaariainen M. Systematic review of physical activity and exercise interventions on body mass indices, subsequent physical activity and psychological symptoms in overweight and obese adolescents. J Adv Nurs. 2015;71:2461-77.: control = standard care.

Treatment studies	Intervention duration (months)	Participants (age/number)	Number of studies included	Outcomes/results
Snethen et al., 2006⁴²42 Snethen JA, Broome ME, Cashin SE. Effective weight loss for overweight children: a meta-analysis of intervention studies. J Pediatr Nurs. 2006;21:45-56. Some form of the weight-loss intervention: dietary, physical activity, behavioral changes, and parental involvement	NA	6 -16 y Overweight/obese children and adolescents	7	Weight loss In seven studies, there were 14 interventions^a a Exercise, nutrition, dietary, and/or a combination of them. with effect size d = 0.95 (95% CI: 0.79 to 1.11) In four studies, there were seven interventions^a a Exercise, nutrition, dietary, and/or a combination of them. with effect size d = 1.70 (0.74 to 3.33)
Kanekar et al., 2008⁴¹41 Kanekar A, Sharma M. Meta-analysis of school-based childhood obesity interventions in the U.K. and U.S.. Int Q Community Health Educ. 2008;29:241-56. School-based childhood obesity interventions^b b Promoting physical activity, and/or dietary modifications.	NA	Students	5	BMI reduction Pooled estimate - Effect size: 0.0649 (95% CI: -0.29 to 0.16) Random effects model - Effect size: 0.179 (95% CI: -0.38 to 0.72)
Murray et al., 2017³⁵35 Murray M, Dordevic AL, Bonham MP. Systematic review and meta-analysis: the impact of multicomponent weight management interventions on self-esteem in overweight and obese adolescents. J Pediatr Psychol. 2017;42:379-94. Multicomponent^c c Lifestyle, health education, nutrition, physical activity, and/or a combination of them. weight management interventions on self-esteem	2.2 to 6	10 -19 y (217) Overweight/obese adolescents	5	BMI Z -score Effect size: -0.17 (95% CI: -0.22 to -0.11)

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