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Pediatric Overweight/Obesity: Prevention (2021)

Intervention
In pediatric individuals 2-5 years of age, what is the efficacy nutrition interventions, with or without physical activity, compared to no intervention, on BMI measures or prevalence of pediatric overweight or obesity?
- Conclusion
  Nutrition and physical activity interventions to prevent pediatric overweight or obesity resulted in a slight reduction in BMI z-score for participants 5 years of age or younger. Obesity prevention programs that were multi-component, multi-level and/or in multiple settings reduced overweight and obesity prevalence in pediatric individuals <18 years of age.
- Grade: Moderate (B)
  - Grade I means there is Good/Strong evidence supporting the statement;
  - Grade II is Fair;
  - Grade III is Limited/Weak;
  - Grade IV is Expert Opinion Only;
  - Grade V is Not Assignable.
  - High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
  - Moderate (B) means we are moderately confident in the effect estimate;
  - Low (C) means our confidence in the effect estimate is limited;
  - Very Low (D) means we have very little confidence in the effect estimate.
  - Ungraded means a grade is not assignable.
- Evidence Summary: In pediatric individuals 2-5 years of age, what is the efficacy nutrition interventions, with or without physical activity, compared to no intervention, on BMI measures or prevalence of pediatric overweight or obesity?
- Search Plan and Results: PWM: Pediatric Overweight and Obesity Prevention (2021)
In pediatric individuals (6-12 years and 13-17 years), what is the efficacy nutrition interventions, with or without physical activity, compared to no intervention, on BMI measures or prevalence of pediatric overweight or obesity?
- Conclusion
  Nutrition and physical activity interventions to prevent pediatric overweight or obesity resulted in a slight reduction in BMI z-score for participants <18 years of age. Interventions were more effective for individuals ≤12 years of age, and evidence for interventions targeting adolescents 13-18 years of age was highly heterogeneous. Obesity prevention programs that were multi-component, multi-level and/or in multiple settings reduced overweight and obesity prevalence.
- Grade: Low (C)
  - Grade I means there is Good/Strong evidence supporting the statement;
  - Grade II is Fair;
  - Grade III is Limited/Weak;
  - Grade IV is Expert Opinion Only;
  - Grade V is Not Assignable.
  - High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
  - Moderate (B) means we are moderately confident in the effect estimate;
  - Low (C) means our confidence in the effect estimate is limited;
  - Very Low (D) means we have very little confidence in the effect estimate.
  - Ungraded means a grade is not assignable.
- Evidence Summary: In pediatric individuals (6-12 years and 13-17 years), what is the efficacy nutrition interventions, with or without physical activity, compared to no intervention, on BMI measures or prevalence of pediatric overweight or obesity?
- Search Plan and Results: PWM: Pediatric Overweight and Obesity Prevention (2021)
In pediatric individuals 2-5 years, what is the efficacy nutrition interventions in the home & family setting, with or without physical activity, compared to no intervention or exposure, on BMI measures or prevalence of pediatric overweight or obesity?
- Conclusion
  Nutrition and physical activity interventions in the home setting significantly reduced BMI in children 0-5 years of age. However, evidence with less certainty described no effect on the outcome of BMI z-score.
- Grade: Moderate (B)
  - Grade I means there is Good/Strong evidence supporting the statement;
  - Grade II is Fair;
  - Grade III is Limited/Weak;
  - Grade IV is Expert Opinion Only;
  - Grade V is Not Assignable.
  - High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
  - Moderate (B) means we are moderately confident in the effect estimate;
  - Low (C) means our confidence in the effect estimate is limited;
  - Very Low (D) means we have very little confidence in the effect estimate.
  - Ungraded means a grade is not assignable.
- Evidence Summary: In pediatric individuals 2-5 years, what is the efficacy nutrition interventions in the home & family setting, with or without physical activity, compared to no intervention or exposure, on BMI measures or prevalence of pediatric overweight or obesity?
- Search Plan and Results: PWM: Pediatric Overweight and Obesity Prevention (2021)
In pediatric individuals (6-12 years and 13-17 years), what is the efficacy nutrition interventions in the home & family setting, with or without physical activity, compared to no intervention or exposure, on BMI measures or prevalence of pediatric overweight or obesity?
- Conclusion
  Limited evidence suggests no overall effect of home-based nutrition and physical activity interventions on BMI outcomes in children and adolescents 6-18 years of age.
- Grade: Low (C)
  - Grade I means there is Good/Strong evidence supporting the statement;
  - Grade II is Fair;
  - Grade III is Limited/Weak;
  - Grade IV is Expert Opinion Only;
  - Grade V is Not Assignable.
  - High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
  - Moderate (B) means we are moderately confident in the effect estimate;
  - Low (C) means our confidence in the effect estimate is limited;
  - Very Low (D) means we have very little confidence in the effect estimate.
  - Ungraded means a grade is not assignable.
- Evidence Summary: In pediatric individuals (6-12 years and 13-17 years), what is the efficacy nutrition interventions in the home & family setting, with or without physical activity, compared to no intervention or exposure, on BMI measures or prevalence of pediatric overweight or obesity?
- Search Plan and Results: PWM: Pediatric Overweight and Obesity Prevention (2021)
In pediatric individuals (2-5 years, 6-12 years and 13-17 years), what is the efficacy nutrition interventions in the healthcare setting, with or without physical activity, compared to no intervention or exposure, on BMI measures or prevalence or incidence of pediatric overweight or obesity?
- Conclusion
  Nutrition and physical activity interventions delivered in the healthcare setting reduced BMI z-scores in children 0-5 years of age. Results in older children and adolescents were lacking and more heterogeneous, with some research suggesting a beneficial effect and some demonstrating no effect on BMI z-scores and percentiles. There was little-to-no evidence available reporting the effects of healthcare obesity prevention interventions on the prevalence of overweight or obesity.
- Grade: Low (C)
  - Grade I means there is Good/Strong evidence supporting the statement;
  - Grade II is Fair;
  - Grade III is Limited/Weak;
  - Grade IV is Expert Opinion Only;
  - Grade V is Not Assignable.
  - High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
  - Moderate (B) means we are moderately confident in the effect estimate;
  - Low (C) means our confidence in the effect estimate is limited;
  - Very Low (D) means we have very little confidence in the effect estimate.
  - Ungraded means a grade is not assignable.
- Evidence Summary: In pediatric individuals (2-5 years, 6-12 years and 13-17 years), what is the efficacy nutrition interventions in the healthcare setting, with or without physical activity, compared to no intervention or exposure, on BMI measures or prevalence or incidence of pediatric overweight or obesity?
- Search Plan and Results: PWM: Pediatric Overweight and Obesity Prevention (2021)
In pediatric individuals (2-5 years, 6-12 years and 13-17 years), what is the efficacy nutrition interventions or longitudinal exposures in the school setting, with or without physical activity, compared to no intervention or exposure, on BMI measures or prevalence or incidence of pediatric overweight or obesity?
- Conclusion
  Nutrition and physical activity interventions to prevent pediatric obesity resulted in non-significant reduction in BMI measures for children in the childcare or preschool settings. Interventions in school settings resulted in a significant reduction in BMI z-score and obesity prevalence for children 6-12 years of age. There was no overall effect of school-based interventions in adolescents 13-18 years of age on BMI outcomes, but results were very heterogeneous. School meals and fruit and vegetable interventions, implementing policies for reducing competitive snacks and beverages and improving access to water decreased odds of overweight and/or obesity.
- Grade: Moderate (B)
  - Grade I means there is Good/Strong evidence supporting the statement;
  - Grade II is Fair;
  - Grade III is Limited/Weak;
  - Grade IV is Expert Opinion Only;
  - Grade V is Not Assignable.
  - High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
  - Moderate (B) means we are moderately confident in the effect estimate;
  - Low (C) means our confidence in the effect estimate is limited;
  - Very Low (D) means we have very little confidence in the effect estimate.
  - Ungraded means a grade is not assignable.
- Evidence Summary: In pediatric individuals (2-5 years, 6-12 years and 13-17 years), what is the efficacy nutrition interventions or longitudinal exposures in the school setting, with or without physical activity, compared to no intervention or exposure, on BMI measures or prevalence or incidence of pediatric overweight or obesity?
- Search Plan and Results: PWM: Pediatric Overweight and Obesity Prevention (2021)
In pediatric individuals (2-5 years, 6-12 years and 13-17 years), what is the efficacy nutrition interventions or longitudinal exposures in the community setting, with or without physical activity, compared to no intervention or exposure, on BMI measures or prevalence or incidence of pediatric overweight or obesity?
- Conclusion
  Nutrition and physical activity interventions in the community setting resulted in decreased BMI, but not BMI z-score, in children 0-5 years of age. While there was no effect of community interventions on BMI outcomes in children 6-12 years of age, limited evidence demonstrated that a multi-setting intervention including community components reduced the prevalence of overweight/obesity.
- Grade: Low (C)
  - Grade I means there is Good/Strong evidence supporting the statement;
  - Grade II is Fair;
  - Grade III is Limited/Weak;
  - Grade IV is Expert Opinion Only;
  - Grade V is Not Assignable.
  - High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
  - Moderate (B) means we are moderately confident in the effect estimate;
  - Low (C) means our confidence in the effect estimate is limited;
  - Very Low (D) means we have very little confidence in the effect estimate.
  - Ungraded means a grade is not assignable.
- Evidence Summary: In pediatric individuals (2-5 years, 6-12 years and 13-17 years), what is the efficacy nutrition interventions or longitudinal exposures in the community setting, with or without physical activity, compared to no intervention or exposure, on BMI measures or prevalence or incidence of pediatric overweight or obesity?
- Search Plan and Results: PWM: Pediatric Overweight and Obesity Prevention (2021)
In pediatric individuals (2-5 years, 6-12 years and 13-17 years), what is the effect of electronic media, marketing and device exposure and interventions, compared to no intervention or exposure, on BMI measures or prevalence or incidence of pediatric overweight or obesity?
- Conclusion
  Increased exposure to a screen and fewer caregiver rules on screen time may result in greater risk of overweight or obesity in children 6-12 years of age. Mobile phone interventions reduced BMI in adolescents, but results were not significant.
- Grade: Low (C)
  - Grade I means there is Good/Strong evidence supporting the statement;
  - Grade II is Fair;
  - Grade III is Limited/Weak;
  - Grade IV is Expert Opinion Only;
  - Grade V is Not Assignable.
  - High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
  - Moderate (B) means we are moderately confident in the effect estimate;
  - Low (C) means our confidence in the effect estimate is limited;
  - Very Low (D) means we have very little confidence in the effect estimate.
  - Ungraded means a grade is not assignable.
- Evidence Summary: In pediatric individuals (2-5 years, 6-12 years and 13-17 years), what is the effect of electronic media, marketing and device exposure and interventions, compared to no intervention or exposure, on BMI measures or prevalence or incidence of pediatric overweight or obesity?
- Search Plan and Results: PWM: Pediatric Overweight and Obesity Prevention (2021)
In pediatric individuals (2-5 years, 6-12 years and 13-17 years), with low socioeconomic status, what is the efficacy nutrition interventions or longitudinal exposures, with or without physical activity, compared to no intervention or exposure, on BMI measures or prevalence or incidence of pediatric overweight or obesity?
- Conclusion
  Limited evidence suggests a relationship between lower socioeconomic status (SES) and a higher risk of obesity in adolescents. Nutrition interventions delivered to individuals with lower SES, both on an individual and policy level, may improve BMI/z-score and risk of obesity in individuals 6-18 years of age.
- Grade: Low (C)
  - Grade I means there is Good/Strong evidence supporting the statement;
  - Grade II is Fair;
  - Grade III is Limited/Weak;
  - Grade IV is Expert Opinion Only;
  - Grade V is Not Assignable.
  - High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
  - Moderate (B) means we are moderately confident in the effect estimate;
  - Low (C) means our confidence in the effect estimate is limited;
  - Very Low (D) means we have very little confidence in the effect estimate.
  - Ungraded means a grade is not assignable.
- Evidence Summary: In pediatric individuals (2-5 years, 6-12 years and 13-17 years), with low socioeconomic status, what is the efficacy nutrition interventions or longitudinal exposures, with or without physical activity, compared to no intervention or exposure, on BMI measures or prevalence or incidence of pediatric overweight or obesity?
- Search Plan and Results: PWM: Pediatric Overweight and Obesity Prevention (2021)
In pediatric individuals (2-5 years, 6-12 years and 13-17 years), who identify as racial or ethnic minorities, what is the efficacy nutrition interventions or longitudinal exposures, with or without physical activity, compared to no intervention or exposure, on BMI measures or prevalence or incidence of pediatric overweight or obesity?
- Conclusion
  In a systematic review targeting adolescents 13-18 year olds who identified as racial or ethnic minorities, there was no effect of obesity prevention interventions on BMI measures, though one study demonstrated improvements in risk of overweight or obesity for a multi-component intervention targeting adolescents who were African-American.
- Grade: Low (C)
  - Grade I means there is Good/Strong evidence supporting the statement;
  - Grade II is Fair;
  - Grade III is Limited/Weak;
  - Grade IV is Expert Opinion Only;
  - Grade V is Not Assignable.
  - High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
  - Moderate (B) means we are moderately confident in the effect estimate;
  - Low (C) means our confidence in the effect estimate is limited;
  - Very Low (D) means we have very little confidence in the effect estimate.
  - Ungraded means a grade is not assignable.
- Evidence Summary: In pediatric individuals (2-5 years, 6-12 years and 13-17 years) who identify as racial or ethnic minorities, what is the efficacy nutrition interventions or longitudinal exposures, with or without physical activity, compared to no intervention or exposure, on BMI measures or prevalence or incidence of pediatric overweight or obesity?
- Search Plan and Results: PWM: Pediatric Overweight and Obesity Prevention (2021)
In pediatric individuals (2-5 years, 6-12 years and 13-17 years), what is the effect of federal food assistance programs and policies, compared to no intervention or exposure, on BMI measures or prevalence or incidence of pediatric overweight or obesity?
- Conclusion
  Limited evidence suggests that a USDA program providing fresh fruits and vegetables outside of the school setting may result in reduced BMI z-score and BMI in elementary-aged children. However, the effect of the SNAP program was heterogeneous, with some evidence suggesting increased risk of overweight or obesity with use of SNAP benefits in certain sub-populations, including girls 5-18 years of age. There was no information available on the impact on overweight or obesity prevalence in relation to participation in food assistance programs in any age group.
- Grade: Very Low (D)
  - Grade I means there is Good/Strong evidence supporting the statement;
  - Grade II is Fair;
  - Grade III is Limited/Weak;
  - Grade IV is Expert Opinion Only;
  - Grade V is Not Assignable.
  - High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
  - Moderate (B) means we are moderately confident in the effect estimate;
  - Low (C) means our confidence in the effect estimate is limited;
  - Very Low (D) means we have very little confidence in the effect estimate.
  - Ungraded means a grade is not assignable.
- Evidence Summary: In pediatric individuals (2-5 years, 6-12 years and 13-17 years), what is the effect of federal food assistance programs and policies, compared to no intervention or exposure, on BMI measures or prevalence or incidence of pediatric overweight or obesity?
- Search Plan and Results: PWM: Pediatric Overweight and Obesity Prevention (2021)
In pediatric individuals (2-5 years, 6-12 years and 13-17 years), what is the effect of charitable food systems (ex: food banks and pantries), compared to no intervention or exposure, on BMI measures or prevalence or incidence of pediatric overweight or obesity?
- Conclusion
  There were no systematic reviews identified that examined the influence of charitable food systems on BMI measures or prevalence of pediatric overweight or obesity.
- Grade: Ungraded
  - Grade I means there is Good/Strong evidence supporting the statement;
  - Grade II is Fair;
  - Grade III is Limited/Weak;
  - Grade IV is Expert Opinion Only;
  - Grade V is Not Assignable.
  - High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
  - Moderate (B) means we are moderately confident in the effect estimate;
  - Low (C) means our confidence in the effect estimate is limited;
  - Very Low (D) means we have very little confidence in the effect estimate.
  - Ungraded means a grade is not assignable.
- Search Plan and Results: PWM: Pediatric Overweight and Obesity Prevention (2021)
In pediatric individuals (2-5 years, 6-12 years and 13-17 years), what is the effect of dietary patterns and quality on BMI measures or prevalence or incidence of pediatric overweight or obesity?
- Conclusion
  In pediatric individuals ≤18 years of age, heterogeneous observational evidence suggests that “Western” or “Modern” dietary patterns are associated with higher BMI and higher risk of overweight or obesity compared to dietary patterns including fruits and vegetables, whole grains and low-fat dairy.
- Grade: Very Low (D)
  - Grade I means there is Good/Strong evidence supporting the statement;
  - Grade II is Fair;
  - Grade III is Limited/Weak;
  - Grade IV is Expert Opinion Only;
  - Grade V is Not Assignable.
  - High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
  - Moderate (B) means we are moderately confident in the effect estimate;
  - Low (C) means our confidence in the effect estimate is limited;
  - Very Low (D) means we have very little confidence in the effect estimate.
  - Ungraded means a grade is not assignable.
- Evidence Summary: In pediatric individuals (2-5 years, 6-12 years and 13-17 years), what is the effect of dietary patterns and quality on BMI measures or prevalence or incidence of pediatric overweight or obesity?
  - Detail
- Search Plan and Results: PWM: Pediatric Overweight and Obesity Prevention (2021)
In pediatric individuals (2-5 years, 6-12 years and 13-17 years), what is the cost-effectiveness of nutrition interventions or longitudinal exposures, with or without physical activity, compared to no intervention or exposures?
- Conclusion
  Obesity prevention programs including nutrition and physical activity are likely cost-effective for pediatric participants 2-18 years of age, but evidence is limited.
- Grade: Moderate (B)
  - Grade I means there is Good/Strong evidence supporting the statement;
  - Grade II is Fair;
  - Grade III is Limited/Weak;
  - Grade IV is Expert Opinion Only;
  - Grade V is Not Assignable.
  - High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
  - Moderate (B) means we are moderately confident in the effect estimate;
  - Low (C) means our confidence in the effect estimate is limited;
  - Very Low (D) means we have very little confidence in the effect estimate.
  - Ungraded means a grade is not assignable.
- Evidence Summary: In pediatric individuals (2-5 years, 6-12 years and 13-17 years), what is the cost-effectiveness of nutrition interventions or longitudinal exposures, with or without physical activity, compared to no intervention or exposures?
- Search Plan and Results: PWM: Pediatric Overweight and Obesity Prevention (2021)