Maternal obesity, excessive gestational weight gain (GWG) and post-partum weight retention (PPWR) constitute new public health challenges, due to the association with negative short- and long-term ...maternal and neonatal outcomes. The aim of this evidence review was to identify effective lifestyle interventions to manage weight and improve maternal and infant outcomes during pregnancy and postpartum.
A review of systematic reviews and meta-analyses investigating the effects of lifestyle interventions on GWG or PPWR was conducted (Jan 2009-2018) via electronic searches in the databases Medline, Pubmed, Web of Science and Cochrane Library using all keywords related to obesity/weight gain/loss, pregnancy or postpartum and lifestyle interventions;15 relevant reviews were selected.
In healthy women from all BMI classes, diet and physical activity interventions can decrease: GWG (mean difference -1.8 to -0.7 kg, high to moderate-quality evidence); the risks of GWG above the IOM guidelines (risk ratio RR 0.72 to 0.80, high to low-quality evidence); pregnancy-induced hypertension (RR 0.30 to 0.66, low to very low-quality evidence); cesarean section (RR 0.91 to 0.95; high to moderate-quality evidence) and neonatal respiratory distress syndrome (RR 0.56, high-quality evidence); without any maternal/fetal/neonatal adverse effects. In women with overweight/obesity, multi-component interventions can decrease: GWG (-0.91 to -0.63 kg, moderate to very low-quality evidence); pregnancy-induced hypertension (RR 0.30 to 0.66, low-quality evidence); macrosomia (RR 0.85, 0.73 to 1.0, moderate-quality evidence) and neonatal respiratory distress syndrome (RR 0.47, 0.26 to 0.85, moderate-quality evidence). Diet is associated with greater reduction of the risks of GDM, pregnancy-induced hypertension and preterm birth, compared with any other intervention. After delivery, combined diet and physical activity interventions reduce PPWR in women of any BMI (-2.57 to -2.3 kg, very low quality evidence) or with overweight/obesity (-3.6 to -1.22, moderate to very low-quality-evidence), but no other effects were reported.
Multi-component approaches including a balanced diet with low glycaemic load and light to moderate intensity physical activity, 30-60 min per day 3-5 days per week, should be recommended from the first trimester of pregnancy and maintained during the postpartum period. This evidence review should help inform recommendations for health care professionals and women of child-bearing age.
Children and adolescents with overweight and obesity are a global health concern. This is an integrative overview of six Cochrane systematic reviews, providing an up-to-date synthesis of the evidence ...examining interventions for the treatment of children and adolescents with overweight or obesity. The data extraction and quality assessments for each review were conducted by one author and checked by a second. The six high quality reviews provide evidence on the effectiveness of behaviour changing interventions conducted in children <6 years (7 trials), 6-11 years (70 trials), adolescents 12-17 years (44 trials) and interventions that target only parents of children aged 5-11 years (20 trials); in addition to interventions examining surgery (1 trial) and drugs (21 trials). Most of the evidence was derived from high-income countries and published in the last two decades. Collectively, the evidence suggests that multi-component behaviour changing interventions may be beneficial in achieving small reductions in body weight status in children of all ages, with low adverse event occurrence were reported. More research is required to understand which specific intervention components are most effective and in whom, and how best to maintain intervention effects. Evidence from surgical and drug interventions was too limited to make inferences about use and safety, and adverse events were a serious consideration.
Background
Child and adolescent overweight and obesity has increased globally, and can be associated with significant short‐ and long‐term health consequences. This is an update of a Cochrane review ...published first in 2003, and updated previously in 2009. However, the update has now been split into six reviews addressing different childhood obesity treatments at different ages.
Objectives
To assess the effects of diet, physical activity and behavioural interventions (behaviour‐changing interventions) for the treatment of overweight or obese children aged 6 to 11 years.
Search methods
We searched CENTRAL, MEDLINE, Embase, PsycINFO, CINAHL, LILACS as well as trial registers ClinicalTrials.gov and ICTRP Search Portal. We checked references of studies and systematic reviews. We did not apply any language restrictions. The date of the last search was July 2016 for all databases.
Selection criteria
We selected randomised controlled trials (RCTs) of diet, physical activity, and behavioural interventions (behaviour‐changing interventions) for treating overweight or obese children aged 6 to 11 years, with a minimum of six months' follow‐up. We excluded interventions that specifically dealt with the treatment of eating disorders or type 2 diabetes, or included participants with a secondary or syndromic cause of obesity.
Data collection and analysis
Two review authors independently screened references, extracted data, assessed risk of bias, and evaluated the quality of the evidence using the GRADE instrument. We contacted study authors for additional information. We carried out meta‐analyses according to the statistical guidelines in the Cochrane Handbook for Systematic Reviews of Interventions.
Main results
We included 70 RCTs with a total of 8461 participants randomised to either the intervention or control groups. The number of participants per trial ranged from 16 to 686. Fifty‐five trials compared a behaviour‐changing intervention with no treatment/usual care control and 15 evaluated the effectiveness of adding an additional component to a behaviour‐changing intervention. Sixty‐four trials were parallel RCTs, and four were cluster RCTs. Sixty‐four trials were multicomponent, two were diet only and four were physical activity only interventions. Ten trials had more than two arms. The overall quality of the evidence was low or very low and 62 trials had a high risk of bias for at least one criterion. Total duration of trials ranged from six months to three years. The median age of participants was 10 years old and the median BMI z score was 2.2.
Primary analyses demonstrated that behaviour‐changing interventions compared to no treatment/usual care control at longest follow‐up reduced BMI, BMI z score and weight. Mean difference (MD) in BMI was ‐0.53 kg/m2 (95% confidence interval (CI) ‐0.82 to ‐0.24); P < 0.00001; 24 trials; 2785 participants; low‐quality evidence. MD in BMI z score was ‐0.06 units (95% CI ‐0.10 to ‐0.02); P = 0.001; 37 trials; 4019 participants; low‐quality evidence and MD in weight was ‐1.45 kg (95% CI ‐1.88 to ‐1.02); P < 0.00001; 17 trials; 1774 participants; low‐quality evidence.
Thirty‐one trials reported on serious adverse events, with 29 trials reporting zero occurrences RR 0.57 (95% CI 0.17 to 1.93); P = 0.37; 4/2105 participants in the behaviour‐changing intervention groups compared with 7/1991 participants in the comparator groups). Few trials reported health‐related quality of life or behaviour change outcomes, and none of the analyses demonstrated a substantial difference in these outcomes between intervention and control. In two trials reporting on minutes per day of TV viewing, a small reduction of 6.6 minutes per day (95% CI ‐12.88 to ‐0.31), P = 0.04; 2 trials; 55 participants) was found in favour of the intervention. No trials reported on all‐cause mortality, morbidity or socioeconomic effects, and few trials reported on participant views; none of which could be meta‐analysed.
As the meta‐analyses revealed substantial heterogeneity, we conducted subgroup analyses to examine the impact of type of comparator, type of intervention, risk of attrition bias, setting, duration of post‐intervention follow‐up period, parental involvement and baseline BMI z score. No subgroup effects were shown for any of the subgroups on any of the outcomes. Some data indicated that a reduction in BMI immediately post‐intervention was no longer evident at follow‐up at less than six months, which has to be investigated in further trials.
Authors' conclusions
Multi‐component behaviour‐changing interventions that incorporate diet, physical activity and behaviour change may be beneficial in achieving small, short‐term reductions in BMI, BMI z score and weight in children aged 6 to 11 years. The evidence suggests a very low occurrence of adverse events. The quality of the evidence was low or very low. The heterogeneity observed across all outcomes was not explained by subgrouping. Further research is required of behaviour‐changing interventions in lower income countries and in children from different ethnic groups; also on the impact of behaviour‐changing interventions on health‐related quality of life and comorbidities. The sustainability of reduction in BMI/BMI z score and weight is a key consideration and there is a need for longer‐term follow‐up and further research on the most appropriate forms of post‐intervention maintenance in order to ensure intervention benefits are sustained over the longer term.
Background
Adolescent overweight and obesity has increased globally, and can be associated with short‐ and long‐term health consequences. Modifying known dietary and behavioural risk factors through ...behaviour changing interventions (BCI) may help to reduce childhood overweight and obesity. This is an update of a review published in 2009.
Objectives
To assess the effects of diet, physical activity and behavioural interventions for the treatment of overweight or obese adolescents aged 12 to 17 years.
Search methods
We performed a systematic literature search in: CENTRAL, MEDLINE, Embase, PsycINFO, CINAHL, LILACS, and the trial registers ClinicalTrials.gov and ICTRP Search Portal. We checked references of identified studies and systematic reviews. There were no language restrictions. The date of the last search was July 2016 for all databases.
Selection criteria
We selected randomised controlled trials (RCTs) of diet, physical activity and behavioural interventions for treating overweight or obesity in adolescents aged 12 to 17 years.
Data collection and analysis
Two review authors independently assessed risk of bias, evaluated the overall quality of the evidence using the GRADE instrument and extracted data following the guidelines of the Cochrane Handbook for Systematic Reviews of Interventions. We contacted trial authors for additional information.
Main results
We included 44 completed RCTs (4781 participants) and 50 ongoing studies. The number of participants in each trial varied (10 to 521) as did the length of follow‐up (6 to 24 months). Participants ages ranged from 12 to 17.5 years in all trials that reported mean age at baseline. Most of the trials used a multidisciplinary intervention with a combination of diet, physical activity and behavioural components. The content and duration of the intervention, its delivery and the comparators varied across trials. The studies contributing most information to outcomes of weight and body mass index (BMI) were from studies at a low risk of bias, but studies with a high risk of bias provided data on adverse events and quality of life.
The mean difference (MD) of the change in BMI at the longest follow‐up period in favour of BCI was ‐1.18 kg/m2 (95% confidence interval (CI) ‐1.67 to ‐0.69); 2774 participants; 28 trials; low quality evidence. BCI lowered the change in BMI z score by ‐0.13 units (95% CI ‐0.21 to ‐0.05); 2399 participants; 20 trials; low quality evidence. BCI lowered body weight by ‐3.67 kg (95% CI ‐5.21 to ‐2.13); 1993 participants; 20 trials; moderate quality evidence. The effect on weight measures persisted in trials with 18 to 24 months' follow‐up for both BMI (MD ‐1.49 kg/m2 (95% CI ‐2.56 to ‐0.41); 760 participants; 6 trials and BMI z score MD ‐0.34 (95% CI ‐0.66 to ‐0.02); 602 participants; 5 trials).
There were subgroup differences showing larger effects for both BMI and BMI z score in studies comparing interventions with no intervention/wait list control or usual care, compared with those testing concomitant interventions delivered to both the intervention and control group. There were no subgroup differences between interventions with and without parental involvement or by intervention type or setting (health care, community, school) or mode of delivery (individual versus group).
The rate of adverse events in intervention and control groups was unclear with only five trials reporting harms, and of these, details were provided in only one (low quality evidence). None of the included studies reported on all‐cause mortality, morbidity or socioeconomic effects.
BCIs at the longest follow‐up moderately improved adolescent's health‐related quality of life (standardised mean difference 0.44 ((95% CI 0.09 to 0.79); P = 0.01; 972 participants; 7 trials; 8 comparisons; low quality of evidence) but not self‐esteem.
Trials were inconsistent in how they measured dietary intake, dietary behaviours, physical activity and behaviour.
Authors' conclusions
We found low quality evidence that multidisciplinary interventions involving a combination of diet, physical activity and behavioural components reduce measures of BMI and moderate quality evidence that they reduce weight in overweight or obese adolescents, mainly when compared with no treatment or waiting list controls. Inconsistent results, risk of bias or indirectness of outcome measures used mean that the evidence should be interpreted with caution. We have identified a large number of ongoing trials (50) which we will include in future updates of this review.
Background
Child and adolescent obesity has increased globally, and can be associated with significant short‐ and long‐term health consequences.
Objectives
To assess the efficacy of drug ...interventions for the treatment of obesity in children and adolescents.
Search methods
We searched CENTRAL, MEDLINE, Embase, PubMed (subsets not available on Ovid), LILACS as well as the trial registers ICTRP (WHO) and ClinicalTrials.gov. Searches were undertaken from inception to March 2016. We checked references and applied no language restrictions.
Selection criteria
We selected randomised controlled trials (RCTs) of pharmacological interventions for treating obesity (licensed and unlicensed for this indication) in children and adolescents (mean age under 18 years) with or without support of family members, with a minimum of three months' pharmacological intervention and six months' follow‐up from baseline. We excluded interventions that specifically dealt with the treatment of eating disorders or type 2 diabetes, or included participants with a secondary or syndromic cause of obesity. In addition, we excluded trials which included growth hormone therapies and pregnant participants.
Data collection and analysis
Two review authors independently assessed trial quality and extracted data following standard Cochrane methodology. Where necessary we contacted authors for additional information.
Main results
We included 21 trials and identified eight ongoing trials. The included trials evaluated metformin (11 trials), sibutramine (six trials), orlistat (four trials), and one trial arm investigated the combination of metformin and fluoxetine. The ongoing trials evaluated metformin (four trials), topiramate (two trials) and exenatide (two trials). A total of 2484 people participated in the included trials, 1478 participants were randomised to drug intervention and 904 to comparator groups (91 participants took part in two cross‐over trials; 11 participants not specified). Eighteen trials used a placebo in the comparator group. Two trials had a cross‐over design while the remaining 19 trials were parallel RCTs. The length of the intervention period ranged from 12 weeks to 48 weeks, and the length of follow‐up from baseline ranged from six months to 100 weeks.
Trials generally had a low risk of bias for random sequence generation, allocation concealment and blinding (participants, personnel and assessors) for subjective and objective outcomes. We judged approximately half of the trials as having a high risk of bias in one or more domain such as selective reporting.
The primary outcomes of this review were change in body mass index (BMI), change in weight and adverse events. All 21 trials measured these outcomes. The secondary outcomes were health‐related quality of life (only one trial reported results showing no marked differences; very low certainty evidence), body fat distribution (measured in 18 trials), behaviour change (measured in six trials), participants' views of the intervention (not reported), morbidity associated with the intervention (measured in one orlistat trial only reporting more new gallstones following the intervention; very low certainty evidence), all‐cause mortality (one suicide in the orlistat intervention group; low certainty evidence) and socioeconomic effects (not reported).
Intervention versus comparator for mean difference (MD) in BMI change was ‐1.3 kg/m2 (95% confidence interval (CI) ‐1.9 to ‐0.8; P < 0.00001; 16 trials; 1884 participants; low certainty evidence). When split by drug type, sibutramine, metformin and orlistat all showed reductions in BMI in favour of the intervention.
Intervention versus comparator for change in weight showed a MD of ‐3.9 kg (95% CI ‐5.9 to ‐1.9; P < 0.00001; 11 trials; 1180 participants; low certainty evidence). As with BMI, when the trials were split by drug type, sibutramine, metformin and orlistat all showed reductions in weight in favour of the intervention.
Five trials reported serious adverse events: 24/878 (2.7%) participants in the intervention groups versus 8/469 (1.7%) participants in the comparator groups (risk ratio (RR) 1.43, 95% CI 0.63 to 3.25; 1347 participants; low certainty evidence). A total 52/1043 (5.0%) participants in the intervention groups versus 17/621 (2.7%) in the comparator groups discontinued the trial because of adverse events (RR 1.45, 95% CI 0.83 to 2.52; 10 trials; 1664 participants; low certainty evidence). The most common adverse events in orlistat and metformin trials were gastrointestinal (such as diarrhoea, mild abdominal pain or discomfort, fatty stools). The most frequent adverse events in sibutramine trials included tachycardia, constipation and hypertension. The single fluoxetine trial reported dry mouth and loose stools. No trial investigated drug treatment for overweight children.
Authors' conclusions
This systematic review is part of a series of associated Cochrane reviews on interventions for obese children and adolescents and has shown that pharmacological interventions (metformin, sibutramine, orlistat and fluoxetine) may have small effects in reduction in BMI and bodyweight in obese children and adolescents. However, many of these drugs are not licensed for the treatment of obesity in children and adolescents, or have been withdrawn. Trials were generally of low quality with many having a short or no post‐intervention follow‐up period and high dropout rates (overall dropout of 25%). Future research should focus on conducting trials with sufficient power and long‐term follow‐up, to ensure the long‐term effects of any pharmacological intervention are comprehensively assessed. Adverse events should be reported in a more standardised manner specifying amongst other things the number of participants experiencing at least one adverse event. The requirement of regulatory authorities (US Food and Drug Administration and European Medicines Agency) for trials of all new medications to be used in children and adolescents should drive an increase in the number of high quality trials.
Background
Child overweight and obesity has increased globally, and can be associated with short‐ and long‐term health consequences.
Objectives
To assess the effects of diet, physical activity, and ...behavioural interventions for the treatment of overweight or obesity in preschool children up to the age of 6 years.
Search methods
We performed a systematic literature search in the databases Cochrane Library, MEDLINE, EMBASE, PsycINFO, CINAHL, and LILACS, as well as in the trial registers ClinicalTrials.gov and ICTRP Search Portal. We also checked references of identified trials and systematic reviews. We applied no language restrictions. The date of the last search was March 2015 for all databases.
Selection criteria
We selected randomised controlled trials (RCTs) of diet, physical activity, and behavioural interventions for treating overweight or obesity in preschool children aged 0 to 6 years.
Data collection and analysis
Two review authors independently assessed risk of bias, evaluated the overall quality of the evidence using the GRADE instrument, and extracted data following the Cochrane Handbook for Systematic Reviews of Interventions. We contacted trial authors for additional information.
Main results
We included 7 RCTs with a total of 923 participants: 529 randomised to an intervention and 394 to a comparator. The number of participants per trial ranged from 18 to 475. Six trials were parallel RCTs, and one was a cluster RCT. Two trials were three‐arm trials, each comparing two interventions with a control group. The interventions and comparators in the trials varied. We categorised the comparisons into two groups: multicomponent interventions and dietary interventions. The overall quality of the evidence was low or very low, and six trials had a high risk of bias on individual 'Risk of bias' criteria. The children in the included trials were followed up for between six months and three years.
In trials comparing a multicomponent intervention with usual care, enhanced usual care, or information control, we found a greater reduction in body mass index (BMI) z score in the intervention groups at the end of the intervention (6 to 12 months): mean difference (MD) ‐0.3 units (95% confidence interval (CI) ‐0.4 to ‐0.2); P < 0.00001; 210 participants; 4 trials; low‐quality evidence, at 12 to 18 months' follow‐up: MD ‐0.4 units (95% CI ‐0.6 to ‐0.2); P = 0.0001; 202 participants; 4 trials; low‐quality evidence, and at 2 years' follow‐up: MD ‐0.3 units (95% CI ‐0.4 to ‐0.1); 96 participants; 1 trial; low‐quality evidence.
One trial stated that no adverse events were reported; the other trials did not report on adverse events. Three trials reported health‐related quality of life and found improvements in some, but not all, aspects. Other outcomes, such as behaviour change and parent‐child relationship, were inconsistently measured.
One three‐arm trial of very low‐quality evidence comparing two types of diet with control found that both the dairy‐rich diet (BMI z score change MD ‐0.1 units (95% CI ‐0.11 to ‐0.09); P < 0.0001; 59 participants) and energy‐restricted diet (BMI z score change MD ‐0.1 units (95% CI ‐0.11 to ‐0.09); P < 0.0001; 57 participants) resulted in greater reduction in BMI than the comparator at the end of the intervention period, but only the dairy‐rich diet maintained this at 36 months' follow‐up (BMI z score change in MD ‐0.7 units (95% CI ‐0.71 to ‐0.69); P < 0.0001; 52 participants). The energy‐restricted diet had a worse BMI outcome than control at this follow‐up (BMI z score change MD 0.1 units (95% CI 0.09 to 0.11); P < 0.0001; 47 participants). There was no substantial difference in mean daily energy expenditure between groups. Health‐related quality of life, adverse effects, participant views, and parenting were not measured.
No trial reported on all‐cause mortality, morbidity, or socioeconomic effects.
All results should be interpreted cautiously due to their low quality and heterogeneous interventions and comparators.
Authors' conclusions
Muticomponent interventions appear to be an effective treatment option for overweight or obese preschool children up to the age of 6 years. However, the current evidence is limited, and most trials had a high risk of bias. Most trials did not measure adverse events. We have identified four ongoing trials that we will include in future updates of this review.
The role of dietary interventions is more equivocal, with one trial suggesting that dairy interventions may be effective in the longer term, but not energy‐restricted diets. This trial also had a high risk of bias.
Summary
Behavioural weight management interventions in research studies and clinical practice differ in length, advice, frequency of meetings, staff, and cost. Few real‐world programmes have ...published patient outcomes and those that have used different ways of reporting information, making it impossible to compare interventions and develop the evidence base. To address this issue, we have developed a core outcome set for behavioural weight management intervention programmes for adults with overweight and obesity. Outcomes were identified via systematic review of the literature. A representative expert group was formed comprising people with experience of adult weight management services. An online Delphi process was employed to reach consensus as to which outcomes should be measured and reported and which definitions/instruments should be utilised. The expert group identified eight core outcomes and 12 core processes for reporting by weight management services. Eleven outcomes and five processes were identified as optional. The most appropriate definitions/instruments for measuring each outcome/process were also agreed. Our core outcome set will ensure consistency of reporting. This will allow behavioural weight management interventions to be compared, revealing which interventions work best for which members of the population and helping inform development of adult behavioural weight management interventions.
Aims
NHS England commissioned independent service providers to deliver the NHS Low‐Calorie Diet Programme pilot. Previous research has illustrated a drift in the fidelity of behaviour change ...techniques (BCTs) during the delivery of the programme provided through face‐to‐face group or one‐to‐one behavioural support. The aim of this study was to assess the delivery fidelity of the BCT content in the digital delivery of the programme.
Methods
Online, app chat and phone call support content was coded using The Behaviour Change Technique Taxonomy. BCTs delivered by each service provider (N = 2) were calculated and compared to the BCTs specified in the NHS service specification and those specified in the providers' programme plans.
Results
Between 78% and 83% of the BCTs identified in the NHS service specification were delivered by the service providers. The fidelity of BCT delivery to those specified in providers' programme plans was 60%–65% for provider A, and 82% for provider B.
Conclusions
The BCT content of the digital model used in the NHS‐LCD programme adhered well to the NHS service specification and providers' plans. It surpassed what has been previously observed in face‐to‐face services provided through group or one‐on‐one behavioural support models.
Background
Child and adolescent overweight and obesity have increased globally and are associated with significant short‐ and long‐term health consequences.
Objectives
To assess the effects of ...surgery for treating obesity in childhood and adolescence.
Search methods
For this update, we searched Cochrane Central Register of Controlled Trials, MEDLINE, Latin American and Caribbean Health Science Information database (LILACS), World Health Organization International Clinical Trials Registry Platform (ICTRP)and ClinicalTrials.gov on 20 August 2021 (date of the last search for all databases). We did not apply language restrictions. We checked references of identified studies and systematic reviews.
Selection criteria
We selected randomised controlled trials (RCTs) of surgical interventions for treating obesity in children and adolescents (age < 18 years) with a minimum of six months of follow‐up. We excluded interventions that specifically dealt with the treatment of eating disorders or type 2 diabetes, or which included participants with a secondary or syndromic cause of obesity, or who were pregnant.
Data collection and analysis
We used standard methodological procedures expected by Cochrane. Two review authors independently extracted data and assessed the risk of bias using the Cochrane Risk of Bias 2.0 tool. Where necessary, we contacted authors for additional information.
Main results
With this update, we did not find any new RCTs. Therefore, this updated review still includes a single RCT (a total of 50 participants, 25 in both the intervention and comparator groups). The intervention focused on laparoscopic adjustable gastric banding surgery, which was compared to a control group receiving a multi‐component lifestyle programme. The participating population consisted of Australian adolescents (a higher proportion of girls than boys) aged 14 to 18 years, with a mean age of 16.5 and 16.6 years in the gastric banding and lifestyle groups, respectively. The trial was conducted in a private hospital, receiving funding from the gastric banding manufacturer. For most of the outcomes, we identified a high risk of bias, mainly due to bias due to missing outcome data.
Laparoscopic gastric banding surgery may reduce BMI by a mean difference (MD) of ‐11.40 kg/m2 (95% CI ‐13.22 to ‐9.58) and weight by ‐31.60 kg (95% CI ‐36.66 to ‐26.54) compared to a multi‐component lifestyle programme at two years follow‐up. The evidence is very uncertain due to serious imprecision and a high risk of bias. Adverse events were reported in 12/25 (48%) participants in the intervention group compared to 11/25 (44%) in the control group. A total of 28% of the adolescents undergoing gastric banding required revisional surgery. The evidence is very uncertain due to serious imprecision and a high risk of bias. At two years of follow‐up, laparoscopic gastric banding surgery may increase health‐related quality of life in the physical functioning scores by an MD of 16.30 (95% CI 4.90 to 27.70) and change in health scores by an MD of 0.82 (95% CI 0.18 to 1.46) compared to the lifestyle group. The evidence is very uncertain due to serious imprecision and a high risk of bias. No data were reported for all‐cause mortality, behaviour change, participants’ views of the intervention and socioeconomic effects.
Finally, we have identified three ongoing RCTs that are evaluating the efficacy and safety of metabolic and bariatric surgery in children and adolescents.
Authors' conclusions
Laparoscopic gastric banding led to greater body weight loss compared to a multi‐component lifestyle program in one small study with 50 participants. These results have very limited application, primarily due to more recent recommendations derived from observation studies to avoid the use of banding in youth due to long‐term reoperation rates. This systematic review update still highlights the lack of RCTs in this field. The authors are concerned that there may be ethical barriers to RTCs in this field, despite the lack of other effective therapies for severe obesity in children and adolescents and the significant morbidity and premature mortality caused by childhood obesity. Nevertheless, future studies, whether pre‐registered and planned non‐randomised or pragmatic randomised trials, should assess the impact of the surgical procedure and post‐operative care to minimise adverse events, including the need for post‐operative adjustments and revisional surgery. Long‐term follow‐up is also critical to comprehensively assess the impact of surgery as participants enter adulthood.
International evidence shows that severe paediatric obesity results in an increased risk of ill health and may require specialised weight management strategies, yet there remains a lack of data on ...the extent of the problem.
To examine the prevalence of severe obesity in children aged 4-5 and 10-11 years, attending English schools between 2006/2007 and 2012/2013.
A retrospective analysis of National Child Measurement Programme (NCMP) data.
Maintained schools in England.
All children aged 4-5 and 10-11 years included in the NCMP dataset.
Prevalence of severe childhood obesity, defined using the 99.6th centile of the British 1990 (UK90) growth reference for body mass index (BMI), analysed by sex, geography, ethnic group and deprivation.
The key findings show that in 2012/2013, severe obesity (BMI ≥UK90 99.6th centile) was found in 1.9% of girls and 2.3% of boys aged 4-5 years, and 2.9% of girls and 3.9% of boys aged 10-11 years. Severe obesity prevalence varies geographically and is more prevalent in children from deprived areas, and among those from black ethnic groups.
The findings from this study should help to raise awareness of the prevalence of severe obesity and support the provision of adequate treatment and prevention services both to support children who are already severely obese and reduce the prevalence of extreme weight in the future.
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