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Lifestyle Interventions in Preschool Children: A Meta-analysis of Effectiveness
Jiying Ling1, Lorraine B Robbins1, Fujun Wen2
1Michigan State University College of Nursing, East Lansing, Michigan.
Insights
Lifestyle interventions effectively reduce BMI in preschool children. Targeting parents with skill training and children with nutrition education shows the most promise for long-term healthy weight.
Area of Science:
- Pediatric obesity prevention
- Lifestyle intervention research
- Public health
Background:
- Establishing healthy behaviors in preschool is critical for long-term weight management.
- Early lifestyle interventions can prevent childhood obesity.
- Optimizing intervention design requires understanding effective strategies.
Purpose of the Study:
- To meta-analyze the effects of lifestyle interventions on Body Mass Index (BMI) in preschool children.
- To identify moderators that influence intervention effectiveness.
- To inform future intervention designs for healthy weight maintenance.
Main Methods:
- Systematic search of multiple databases (PubMed, CINAHL, EMBASE, PsycINFO, ERIC, Cochrane) up to October 2015.
- Inclusion of 52 eligible articles with 42 randomized controlled trials (31 prevention, 11 treatment).
- Calculation of weighted standardized mean differences for BMI using random-effects models.
Main Results:
- Lifestyle interventions showed significant reductions in BMI for both prevention (-0.19 kg/m²) and treatment (-0.28 kg/m²).
- Sustained effects were observed for prevention (-0.21 kg/m²) and treatment (-0.23 kg/m²) interventions.
- Parental intervention sessions, child age, and ethnicity were significant moderators. Interventions focusing on parenting skills and general nutrition education for children yielded greater effects.
Conclusions:
- Parenting skill training and behavioral change strategies are promising for parents.
- General health and nutrition education are recommended for children.
- Publication bias may limit the generalizability of findings, necessitating cautious interpretation.
Context:
With healthy behaviors becoming established in the preschool years, intervening with preschool children to assist them in establishing a healthy lifestyle and maintaining a long-term healthy weight is critical. To optimize future intervention designs, this meta-analysis aimed to estimate the effects of lifestyle interventions on BMI among preschool children and explore potential intervention moderators.
Evidence Acquisition:
In October 2015, a search of PubMed, CINAHL, EMBASE, PsycINFO, ERIC, and Cochrane library databases yielded 52 eligible articles with 42 randomized intervention-control comparisons (31 prevention and 11 treatment). In 2016, weighted standardized mean differences for BMI were calculated using random-effects models to estimate effect sizes.
Evidence Synthesis:
The effect sizes were -0.19 (95% CI=-0.28, -0.09) and -0.28 (95% CI=-0.48, -0.09) kg/m2 for prevention and treatment interventions, with sustained effect sizes of -0.21 (95% CI=-0.35, -0.08) and -0.23 (95% CI=-0.43, -0.04) kg/m2, respectively. Child mean age, percentage Hispanic, and parental intervention sessions were common significant moderators. School-based or prevention interventions with active parental involvement did not yield better outcomes. Interventions targeting parents with parenting skill training and behavioral change strategies, and children with general health and nutrition education, resulted in greater effects.
Conclusions:
Although publication bias limits the validity of the study findings, the meta-analysis results highlight the promising intervention approaches of parenting skill training and behavioral change strategies to target parents. However, for children, general health and nutrition education should be employed.
