Deep Dive: Comparing the efficacy of diet, exercise, and lifestyle modifications for controlling childhood obesity

Body mass index (BMI) is used to define childhood overweight and obesity. However, BMI works a little differently in children than in adults. In adults, BMI is calculated by dividing weight in kilograms by height in meters squared. In comparison, the status of a child’s weight is determined using an age- and gender-specific percentile for BMI (referred to as BMI-for-age) because child body composition varies by age and sex. Overweight for a child is defined^[1] as a BMI-for-age equal to or greater than the 85th percentile and less than the 95th percentile. Obesity for a child is defined as a BMI-for-age equal to or greater than the 95th percentile. The details of BMI-for-age for both boys and girls is shown in Figure 1.

Figure 1: BMI-for-age for girls and boys ages 2–18

Reference: CDC. 2000 CDC Growth Charts for the United States: Methods and Development. 2002 May.

The World Health Organization reports that childhood obesity has been steadily increasing throughout the world. In 2019, 38 million children younger than 5 years old were overweight or obese. Childhood overweight and obesity ^[2]adversely affect^[2] many organ systems and can lead to complications, including high blood pressure, adverse changes in blood lipid levels, insulin resistance, fatty liver disease, physical limitations, and psychosocial difficulties. This is why it is imperative to find effective ways to prevent and reverse childhood overweight and obesity.

Several ^[3]studies have investigated^[3] the beneficial effects of individual interventions such as diet, exercise, and lifestyle to control childhood overweight and obesity. However, there are no systematic reviews that rank interventions to determine which work best for controlling childhood overweight and obesity. Through the use of a network meta-analysis, this study was designed to compare and evaluate the results of pertinent interventions in order to identify the most effective method(s) of intervention to control childhood overweight and obesity.

The prevalence and consequences associated with childhood overweight and obesity make these conditions a serious issue that needs to be addressed. Although there are studies that have examined the beneficial effects of various interventions individually, there are no systematic reviews that compare the efficacy of several interventions or combinations of interventions (e.g., diet, exercise, lifestyle, multicomponent) both with and without parental involvement. The researchers conducting this study used a network meta-analysis to compare the efficacy of these interventions both with and without parental involvement.