Effectiveness of family-based weight management interventions for children with overweight and obesity: an umbrella review.
Effectiveness of family-based weight management interventions for children with overweight and obesity: an umbrella review.
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DOI：
10.11124/jbisrir-2017-003695
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发表时间：
2019-07-01
期刊：
影响因子：
--
通讯作者：
Burrows, Tracy
中科院分区：
文献类型：
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作者：
Chai, Li Kheng;Collins, Clare;Burrows, Tracy
目的：该审查的目的是综合的有效性和策略，在以家庭为基础的儿童肥胖行为干预措施，改善儿童体重相关outcomes.INTRODUCTION：以家庭为基础的干预措施是常见的做法，在治疗儿童肥胖症。研究表明，父母的直接参与可以改善儿童体重相关的结果。然而，由于缺乏高质量的项目和治疗策略的多样性，在评估以家庭为基础的干预措施对儿童体重和体重相关行为的影响方面仍然存在挑战。该综述包括对年龄≤18岁的超重和/或肥胖儿童进行基于家庭的行为干预的系统综述和/或荟萃分析，并报告了儿童体重相关结局，如体重指数（BMI）、体脂百分比和腰围。方法：检索1990年至2016年5月的7个数据库，以识别英文出版物。还检索了纳入综述的参考文献列表和相关登记簿，以查找其他综述。所有纳入的系统评价均由两名评价者独立进行批判性评价。提取的数据包括纳入的系统性综述和报告的体重相关结局的特征。数据合成涉及将干预措施分为七类，并以叙述和表格形式呈现调查结果。使用建议评估、开发和评价分级（GRADE）方法评估证据质量。结果：总体评价包括2004年至2015年期间发表的14篇系统性评价（低至中等方法学质量），其中包括47项独立试验，随访时间从1个月到7年不等，在超过16个国家进行。大多数综述（93%）报告了6至13岁儿童的体重结果。除一项研究外，所有研究都表明，以家庭为基础的干预措施在改善儿童体重和/或体重相关行为方面取得了成功。5篇综述强调，与亲子干预相比，仅家长干预的有效性相似（n = 4）或更高（n = 1）。 有效的干预措施采用家长为目标的战略，包括营养和体育活动的教育会议，积极的育儿技巧，角色塑造和儿童行为管理，以鼓励积极的健康饮食/锻炼行为的儿童和/或整个family.CONCLUSIONS：以家庭为基础的干预措施，针对父母，单独或与他们的孩子，是有效的儿童体重管理。由于缺乏高质量的证据，特别是在新兴的家长干预，进一步的研究是必要的。卫生从业人员可以与父母合作，作为变革的推动者，并专注于培养积极的育儿技能，如监测，强化，角色塑造，并提供一个养育环境，以支持他们的孩子的健康行为。未来的研究需要探讨仅父母干预是否比亲子干预更具成本效益，并包括更大的人群，更长的干预时间和随访。
OBJECTIVES: The objective of the review was to synthesize the effectiveness and strategies used in family-based behavioral childhood obesity interventions in improving child weight-related outcomes.INTRODUCTION: Family-based interventions are common practice in the treatment of childhood obesity. Research suggests that direct parental involvement can improve child weight-related outcomes. However, challenges remain in assessing the effects of family-based interventions on child weight and weight-related behavior due to the lack of quality programs and diversity of treatment strategies.INCLUSION CRITERIA: The review included systematic reviews and/or meta-analyses of family-based behavioral interventions in children aged ≤18 who were classified as overweight and/or obese, and which reported child weight related outcomes, such as body mass index (BMI), body fat percentage and waist circumferences.METHODS: Seven databases were searched from 1990 to May 2016 to identify English language publications. Reference lists of included reviews and relevant registers were also searched for additional reviews. All included systematic reviews were critically appraised by two reviewers independently. Data extracted included characteristics of included systematic reviews and weight-related outcomes reported. Data synthesis involved categorizing the interventions into seven categories and presented findings in narrative and tabular format. Quality of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach.RESULTS: The umbrella review included 14 systematic reviews (low to moderate methodological quality), published between 2004 and 2015, including 47 independent trials ranging from one month to seven years follow-up conducted in more than 16 countries. The majority of reviews (93%) reported weight outcomes of children aged six to 13 years. All reviews except one indicated that family-based interventions were successful in improving child weight and/or weight-related behavior. Five reviews highlighted that parent-only interventions had similar (n = 4) or greater (n = 1) effectiveness compared to parent-child interventions. Effective interventions employed parent-targeted strategies, including nutrition and physical activity education sessions, positive parenting skills, role modelling and child behavior management to encourage positive healthy eating/exercise behaviors in children and/or whole family.CONCLUSIONS: Family-based interventions targeting parents, alone or with their child, are effective for child weight management. Due to the lack of high quality evidence, especially in emerging parent-only interventions, further research is warranted. Health practitioners can work with parents as agents of change and focus on fostering positive parenting skills, such as monitoring, reinforcement, role modelling, and providing a nurturing environment, in order to support health behaviors in their children. Future research needs to explore whether parent-only interventions are more cost-effective compared to parent-child interventions, and to include larger populations, longer intervention duration and follow-up.