Childhood Obesity Evidence Base Project: A Systematic Review and Meta-Analysis of a New Taxonomy of Intervention Components to Improve Weight Status in Children 2-5 Years of Age, 2005-2019

Abstract

Objective: To evaluate the efficacy of childhood obesity interventions and conduct a taxonomy of intervention components that are most effective in changing obesity-related health outcomes in children 2-5 years of age. Methods: Comprehensive searches located 51 studies from 18,335 unique records. Eligible studies: (1) assessed children aged 2-5, living in the United States; (2) evaluated an intervention to improve weight status; (3) identified a same-aged comparison group; (4) measured BMI; and (5) were available between January 2005 and August 2019. Coders extracted study, sample, and intervention characteristics. Effect sizes [ESs; and 95% confidence intervals (CIs)] were calculated by using random-effects models. Meta-regression was used to determine which intervention components explain variability in ESs. Results: Included were 51 studies evaluating 58 interventions (N = 29,085; mean age = 4 years; 50% girls). Relative to controls, children receiving an intervention had a lower BMI at the end of the intervention (g = 0.10, 95% CI = 0.02-0.18; k = 55) and at the last follow-up (g = 0.17, 95% CI = 0.04-0.30; k = 14; range = 18-143 weeks). Three intervention components moderated efficacy: engage caregivers in praise/encouragement for positive health-related behavior; provide education about the importance of screen time reduction to caregivers; and engage pediatricians/health care providers. Conclusions: Early childhood obesity interventions are effective in reducing BMI in preschool children. Our findings suggest that facilitating caregiver education about the importance of screen time reduction may be an important strategy in reducing early childhood obesity.

Keywords: BMI; intervention; meta-analysis; prevention; taxonomy.

Conflict of interest statement

No competing financial interests exist.

Figures

Figure 1.

Childhood Obesity Evidence Base Systematic Review and Meta-Analysis Study Search and Selection Process.

Figure 2.

Childhood Obesity Evidence Base Project Forest Plot of the Impact of Child Obesity Interventions on BMI at the Immediate Post-intervention Assessment (k = 55).*aaRandom effects (full information maximum likelihood) model. The size of the square representing the standardized mean difference for each study is proportional to its weight in the analysis and the line running through the square represents the 95% CI. The diamond represents the overall standardized mean difference and the width of the diamond represents the 95% CI. Heterogeneity: I2 = 20% (95% CI = 0–43); τ2 = 0.0303; Q (54) = 67.08, p = 0.109. CI, confidence interval.

Figure 3.

Childhood Obesity Evidence Base Project Forest Plot of the Impact of Child Obesity Interventions on BMI at the Final Post-Intervention Assessment (k = 14).aaRandom effects (full information maximum likelihood) model. The size of the square representing the standardized mean difference for each study is proportional to its weight in the analysis, and the line running through the square represents the 95% CI. The diamond represents the overall standardized mean difference, and the width of the diamond represents the 95% CI. Heterogeneity: I2 = 0% (95% CI = 0–74); τ2 = 0.0297; Q (13) = 11.91, p = 0.535.