Scolaris Content Display Scolaris Content Display

Intervencije za sprječavanje pretilosti u djece

Esta versión no es la más reciente

Background

Prevention of childhood obesity is an international public health priority given the significant impact of obesity on acute and chronic diseases, general health, development and well‐being. The international evidence base for strategies that governments, communities and families can implement to prevent obesity, and promote health, has been accumulating but remains unclear.

Objectives

This review primarily aims to update the previous Cochrane review of childhood obesity prevention research and determine the effectiveness of evaluated interventions intended to prevent obesity in children, assessed by change in Body Mass Index (BMI). Secondary aims were to examine the characteristics of the programs and strategies to answer the questions "What works for whom, why and for what cost?"

Search methods

The searches were re‐run in CENTRAL, MEDLINE, EMBASE, PsychINFO and CINAHL in March 2010 and searched relevant websites. Non‐English language papers were included and experts were contacted.

Selection criteria

The review includes data from childhood obesity prevention studies that used a controlled study design (with or without randomisation). Studies were included if they evaluated interventions, policies or programs in place for twelve weeks or more. If studies were randomised at a cluster level, 6 clusters were required.

Data collection and analysis

Two review authors independently extracted data and assessed the risk of bias of included studies.  Data was extracted on intervention implementation, cost, equity and outcomes. Outcome measures were grouped according to whether they measured adiposity, physical activity (PA)‐related behaviours or diet‐related behaviours.  Adverse outcomes were recorded. A meta‐analysis was conducted using available BMI or standardised BMI (zBMI) score data with subgroup analysis by age group (0‐5, 6‐12, 13‐18 years, corresponding to stages of developmental and childhood settings).

Main results

This review includes 55 studies (an additional 36 studies found for this update). The majority of studies targeted children aged 6‐12 years.  The meta‐analysis included 37 studies of 27,946 children and demonstrated that programmes were effective at reducing adiposity, although not all individual interventions were effective, and there was a high level of observed heterogeneity (I2=82%). Overall, children in the intervention group had a standardised mean difference in adiposity (measured as BMI or zBMI) of ‐0.15kg/m2 (95% confidence interval (CI): ‐0.21 to ‐0.09). Intervention effects by age subgroups were ‐0.26kg/m2 (95% CI:‐0.53 to 0.00) (0‐5 years), ‐0.15kg/m2 (95% CI ‐0.23 to ‐0.08) (6‐12 years), and ‐0.09kg/m2 (95% CI ‐0.20 to 0.03) (13‐18 years). Heterogeneity was apparent in all three age groups and could not explained by randomisation status or the type, duration or setting of the intervention.  Only eight studies reported on adverse effects and no evidence of adverse outcomes such as unhealthy dieting practices, increased prevalence of underweight or body image sensitivities was found.  Interventions did not appear to increase health inequalities although this was examined in fewer studies.

Authors' conclusions

We found strong evidence to support beneficial effects of child obesity prevention programmes on BMI, particularly for programmes targeted to children aged six to 12 years. However, given the unexplained heterogeneity and the likelihood of small study bias, these findings must be interpreted cautiously. A broad range of programme components were used in these studies and whilst it is not possible to distinguish which of these components contributed most to the beneficial effects observed, our synthesis indicates the following to be promising policies and strategies:

·         school curriculum that includes healthy eating, physical activity and body image

·         increased sessions for physical activity and the development of fundamental movement skills throughout the school week

·         improvements in nutritional quality of the food supply in schools

·         environments and cultural practices that support children eating healthier foods and being active throughout each day

·         support for teachers and other staff to implement health promotion strategies and activities (e.g. professional development, capacity building activities)

·         parent support and home activities that encourage children to be more active, eat more nutritious foods and spend less time in screen based activities

However, study and evaluation designs need to be strengthened, and reporting extended to capture process and implementation factors, outcomes in relation to measures of equity, longer term outcomes, potential harms and costs.

Childhood obesity prevention research must now move towards identifying how effective intervention components can be embedded within health, education and care systems and achieve long term sustainable impacts.  

PICO

Population
Intervention
Comparison
Outcome

El uso y la enseñanza del modelo PICO están muy extendidos en el ámbito de la atención sanitaria basada en la evidencia para formular preguntas y estrategias de búsqueda y para caracterizar estudios o metanálisis clínicos. PICO son las siglas en inglés de cuatro posibles componentes de una pregunta de investigación: paciente, población o problema; intervención; comparación; desenlace (outcome).

Para saber más sobre el uso del modelo PICO, puede consultar el Manual Cochrane.

Intervencije za sprječavanje pretilosti u djece

Pretilost u dječjoj dobi može uzrokovati društvene, psihološke i zdravstvene teškoće, i povezana je s pretilošću i lošijim zdravstvenim ishodima u odrasloj dobi.  Razvoj pretilosti je povezan s tjelesnom aktivnošću i prehranom. Cochrane sustavni pregled analizirao je literaturu o sprječavanju pretilosti u djece te je pronađeno 55 međunarodnih istraživanja je proučavalo programe koji unaprjeđuju tjelesnu aktivnost, prehranu ili obe navedene navike  Iako su mnogi programi uspjeli donekle unaprijediti prehrambene navike ili tjelesnu aktivnost djece, samo su neka istraživanja pokazala učinak takvih programa na debljinu. Prilikom kombiniranja navedenih istraživanja, vidljivo je da ovi programi imaju pozitivan utjecaj, ali razlike između rezultata istraživanjani su objašnjenje. Čini se također da su rezultati pristrani jer u literaturi nisu pronađene male studije s negativnim rezultatima. Autori su također pokušali objasniti zašto neki programi djeluju bolje od drugih, i postoji li ikakav štetan utjecaj na djeci uključenoj u navedene programe.  Iako je samo nekoliko istraživanja pratilo eventualnu štetnost programa, rezultati ukazuju na to da programi sprječavanja pretilosti ne uzrokuju iskrivljenu sliku o sebi, nezdrave prehrambene navike udjece, pothranjenost ili nezdrav odnos prema tjelesnoj masi, te da sva djeca mogu imati koristi od takvih programa.  Važno je provesti istraživanja na vrlo maloj djeci i adolescentima kako bise otkrilo više o prevenciji pretilosti u ovim dobnim skupinama, i kako bi se saznalo koliko traju učinci takvih intervencija.  Također je potrebno razviti načine da rezultati ovih istraživanja koriste svoj djeci uključivanjem aktivnosti iz programa u svakodnevnom životu kod kuće, školama, vrtićima, zdravstvenom sustavu i širem društvu.