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Tackling obesity in children

As the problem of obesity grows, so does the research on interventions to help tackle it. This makes it important that systematic reviews are kept up-to-date to keep pace. This has happened with the Cochrane review of strategies for children, which has just been updated to bring together the research up to 2008.

The review covers various types of intervention - lifestyle, drug and surgical - for children and adolescents. Although no trials were found of surgery, there were over 60 trials, with more than 5200 participants, of other approaches. This is a jump of 46 included studies over the previous version of the review, from 2003. The extra research has allowed the authors of the review to draw some conclusions, which were not possible before.

Most of the trials were of lifestyle interventions, tackling issues around diet, physical activity and behaviour. The latter sought to change the thinking patterns and actions of the children and their families. The trials tended to vary in subtle, or major, ways; making it difficult to combine them in meta-analyses but some important findings emerged.

Family-based lifestyle interventions which include behaviour therapy programmes and seek to modify diet and physical activity were found to help overweight and obese children under 12 to lose weight, and they kept this weight off for at least 6 months. In the older children and adolescents aged between 12 and 18, these interventions were also found to be effective, and the weight loss lasted for at least 12 months.

The ten drug trials were all done with adolescents and tested metformin, orlistat or sibutramine. The data available from the two trials of metformin were not adequate for a pooled analysis, but the combinations of two of the three trials of orlistat and four of the five trials of sibutramine found that adding either to behaviour change programs produced significant additional benefits.

This Cochrane review is available in full at www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD001872/frame.html

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February 2 2009

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