Household Chaos in Pediatric Obesity Prevention and Treatment: A Systematic Review

Family-based pediatric obesity prevention and treatment programs require sustained organization within the home, yet the role of household chaos in intervention implementation and response has not been synthesized. We evaluated whether household chaos predicts engagement, adherence, or response and whether interventions reduce household chaos.

PubMed, Embase, Scopus, Web of Science, PsycINFO, and CINAHL were searched through April 2026, with citation and targeted Google Scholar searches. Eligible quantitative studies examined household chaos within pediatric obesity prevention or treatment as a predictor, moderator, mediator, or intervention outcome. Risk of bias was assessed using QUIPS or RoB 2, and findings were synthesized narratively.

Six reports met eligibility criteria. Among three predictor studies, the FACES-IV Chaotic subscale, a related but distinct family-system measure, was not significantly associated with treatment attendance. Greater household chaos assessed using Confusion, Hubbub, and Order Scale-based measures was associated with higher odds of a low-decreasing rather than high-consistent parental dietary self-monitoring trajectory and less favorable early body mass index (BMI) change in adolescents. Three randomized trials assessed household chaos as an intervention outcome. A routines-focused obesity-prevention pilot reduced household chaos at 12 weeks, whereas two broader obesity interventions did not. No study was judged at low overall risk of bias.

Evidence is sparse and heterogeneous. Household chaos was associated with less sustained parental dietary self-monitoring and less favorable early BMI response, but causal effects remain uncertain. Prospective studies and adequately powered trials are needed to determine whether household organization reflects broader structural and family burden, represents a potentially modifiable implementation target, or both.