| Study ID | Primary Outcomes | Secondary Outcomes |
| Amaro 2006 | MEASURES: Height, weight OUTCOMES: No significant difference in zBMI between treated group and control group at post‐assessment controlling for baseline values. Adjusted means were 0.345 (95% CI 0.299 to 0.390) for the intervention group and 0.405 (95% CI 0.345 to 0.465) for the control group. MEASURES: Nutrition knowledge OUTCOMES: Intervention group had significant increase in nutrition knowledge (P < 0.05) compared to control. Adjusted means were 11.24 (95%CI 10.68 to 11.80) for the intervention group and 9.24 (95% CI 8.50 to 9.98) for the control group. MEASURES: Dietary Intake OUTCOMES: Intervention group had significant increase in weekly vegetable intake (P < 0.01) compared with control. Adjusted mean number of servings per week was 3.7 (95% CI 3.5 to 4.1) for the intervention group and 2.8 (95% CI 2.4 to 3.3) for the control group. | MEASURES: Physical activity OUTCOMES: No significant difference between groups post‐intervention |
| Baranowski 2003 | 1. Fatness assessed by repeat measures of height and weight (and calculated BMI) at baseline and end of pilot:
OUTCOME: No differences between intervention and control.
2. Waist circumference:
OUTCOME: No differences between intervention and control.
3. Dual X‐Ray Absorptiometry (DEXA) for % Body fat
OUTCOME: Not reported.
4. Physical activity: CSA accelerometer,
OUTCOME: No differences between I and C.
5. a modification of the Self‐Administered Physical Activity Checklist (SAPAC),
OUTCOME: No differences between intervention and control.
6. GEMS Activity Questionnaire (GAQ) computerised
OUTCOME: No differences between intervention and control.
7. Dietary intake measured by two 24 hour recalls using Nutrition Data System computer programme (NDS‐R).
OUTCOME: No differences between intervention and control. | 1. Participation in summer camp
OUTCOME: I: 91.5% and C: 80.5%
2. Monitoring website usage (log‐on rates).
OUTCOME: Intervention: child mean 48%, parent mean 47%; Control: child mean 25%, parent mean 16%. |
| Beech 2003 | 1. Fatness assessed by repeat measures of height and weight (and calculated BMI) at baseline and end of pilot:
OUTCOME: No differences between intervention and control.
2. Waist circumference:
OUTCOME: No differences between intervention and control.
3. Dual X‐Ray Absorptiometry (DEXA) for % Body fat
OUTCOME: Not reported.
4. Physical activity: accelerometer CSA,
OUTCOME: No differences between intervention and control.
5. a modification of the Self‐Administered Physical Activity Checklist (SAPAC),
OUTCOME: Not reported.
6. GEMS Activity Questionnaire(GAQ) computerised
OUTCOME: No differences between intervention and control.
7. Dietary intake measured by two 24 hour recalls using Nutrition Data System computer programme (NDS‐R).
OUTCOME: Intervention parent group significantly lower for sweetened drinks compared with intervention child group and controls. | 1. Psychological variables:
Body silhouettes McKnight Risk Factor Survey, and Stunkard et al. 1983.
OUTCOME: No differences between intervention and control
2. Over concern with weight or shape:
OUTCOME: Intervention significantly better than control.
3. Parental food preparation practices
OUTCOME: Intervention significantly better than control.
4. Self‐Perception Profile for Children
OUTCOME: No differences between intervention and control
5. Healthy Growth Study for physical activity expectations, and a self‐efficacy measure.
OUTCOME: No differences between intervention and control. |
| Caballero 2003 | 1. Fatness assessed by repeat measures of height and weight (and calculated BMI), at baseline and after 3 years (end of intervention):
OUTCOME: No differences between intervention and control
2. Triceps and subscapular Skinfolds.
OUTCOME: No differences between intervention and control
3. Bioelectrical impedance.
OUTCOME: No differences between intervention and control. | 1. Lunch Programme:
OUTCOME: Intervention school's lunches had significantly less energy from fat (4%), P = 0.005. 24 hour dietary records showed significant reduction in energy P = 0.003 and total fat P = 0.001.
2. Physical Activity
OUTCOME: Tri Trac R3D accelerometer showed no significant differences, but trends were in the desired direction. 24 hour recalls were significantly higher in I P = 0.001.
3. Knowledge, attitudes and beliefs:
OUTCOME: significant improvements were found in I, especially in the 3rd grade (8‐9 years), but Self efficacy to be physically active was higher in I schools but choosing healthy foods was not.
4. Family Programme
OUTCOME: families attending events was 58%. |
| Coleman 2005 | MEASURE: Risk of overweight and overweight OUTCOME: The rate of increase in the percentage of students at risk of overweight or overweight from 3rd to 5th grades was 13% in control girls compared with 2% in intervention girls and 9% in control boys compared with 1% in intervention boys. MEASURE: Anthropometry OUTCOME: No effect of intervention on height, weight, waist‐to‐hip ratio or BMI. All children had increases in these measures from year to year. MEASURE: Aerobic fitness OUTCOME: Results for passing Fitnessgram standards were similar between intervention and control schools for the 3rd grade. In the 4th grade, control schools had higher rates than intervention schools, while in the 5th grade, intervention schools had higher rates than control schools. | MEASURE: PE outcomes OUTCOME: For part of the 3rd and 4th grades, intervention schools had higher MVPA than control schools. By the end of the 4th grade, control schools had reached similar values to intervention schools, with a similar pattern for the 5th grade. Intervention schools has higher vigorous physical activity (VPA) than control schools in the fall of 4th grade and for both 5th grade semesters. MEASURE: Cafeteria outcomes OUTCOME: At the beginning and end of the 4th grade, intervention schools had a lower percentage of fat than control schools. This difference disappeared by the 5th grade. Intervention schools met programme goals for fat content in school lunches during the 2nd year of the programme, while control schools did not at any time. No schools reached programme sodium recommendations. |
| Donnelly 2009 | MEASURES: BMI OUTCOMES: No significant differences for change in BMI or BMI percentile (baseline to 3 year) for intervention vs control (not influenced by gender). Schools (n = 9) with ≥ 75min of PAAC/wk showed significantly less increase in BMI at 3 years compared to schools (n = 5) with < 75min (1.8 ± 1.8 vs 2.4 ± 2.0; P = 0.02) | MEASURES: Daily PA (accelerometer) OUTCOMES: Over a 4‐day average (consecutive), children in PAAC schools had greater levels of PA (13%>) compared to children in control schools (P = 0.007). Children in PAAC schools had greater levels of PA during the school day (12%>; 0.01) and on weekends (17%>; 0.001) compared with children in control schools. Children in PAAC schools exhibited 27% higher levels of moderate to vigorous intensity PA (?4 METS) compared with children in control schools (P = 0.001). MEASURES: Academic achievement measured using Weschler Individual Achievement Test 2nd edition. OUTCOMES: significant improvement in academic achievement from baseline to 3 years were observed in the PAAC compared with the control schools for the composite, reading, math and spelling scores (all P < 0.01) |
| Epstein 2001 | 1. Fatness assessed by percentage of overweight (established by comparing the BMI of the subject with the relevant 50th BMI percentile based on the gender and age of the subject) at baseline and at one year (end of intervention).
OUTCOME: Children showed no significant differences in percentage of overweight with either intervention: increase fruit and vegetable intervention (‐1.10 + 5.29) or decrease high fat/high sugar intervention (‐2.40 + 5.39).
2. Dietary intake:
OUTCOME: High fat/high sugar intake significantly decreased across all children independent of group. Children also showed trends toward greater increases in fruit and vegetable intake for the Increase Fruit and Vegetable group through the one year study. | |
| Fernandes 2009 | MEASURES: Nutritional status defined on the basis of BMI for age and sex. OUTCOMES: No significant changes from baseline in the prevalence of overweight/obesity (BMI?85th percentile) were observed in either group (both p=1.0) with no difference between groups. The percentage of overweight/obese children increased from 21.8 to 23.6% in the intervention group and from 33.7 to 35.0% in the no‐intervention group (P > 0.05). | MEASURES: Frequency of eating foods (either 0‐1 day or 2‐3 days) prohibited by School Canteens Act by self‐report for two 3‐day dietary recalls OUTCOMES: The percentage of children who ate foods prohibited by the Act on 2‐3 days decreased in both intervention and control groups (not significant) MEASURES: Distribution of children eating certain foods on the two 3‐day dietary recalls OUTCOMES: In the control group, the percentage eating mass‐produced snacks increased (P = 0.008), while in the intervention group, this decreased (p=0.016). In both groups, there was a significant reduction in the intake of artificial juice (P < 0.001) and chocolate (I: P < 0.001; C: P = 0.031). There was an increase in the percentage of children drinking soda in both intervention and control groups (P = 0.002 and P = 0.016). For the percentage of children eating yoghurt, there was an increase in the intervention group (P = 0.016) and a decrease in the control group (P = 0.016). There was a decrease in the percentage of children drinking natural juice in the control group (P < 0.001) and a numerical increase in the intervention group (P = 0.063). There was an increase in the percentage of children eating fruit in both groups, but this was only significant in the control group (P = 0.016 vs P = 0.25). |
| Foster 2008 | MEASURES: Incidence of overweight and obesity OUTCOMES: Fewer children in the intervention schools (7.5% [unadjusted mean]) than in the control schools (14.9% [unadjusted mean]) became overweight after 2 years (adjusted odds ratio: 0.67 [0.47 to 0.96]; P = 0.03 [adjusted for gender, race/ethnicity and age]). No differences between control and intervention groups in the incidence of obesity at 2 years (P = 0.99). The predicted odds of incidence of either overweight or obesity were 15% lower for the intervention group (odds ratio: 0.85 [0.74 to 0.99]; P <0.05) | MEASURES: Prevalence and remission of overweight and obesity OUTCOMES: After 2 years, the predicted odds of overweight prevalence were 35% lower for in the intervention group (odds ratio: 0.65 [0.54 to 0.79]; P < 0.0001 [adjusted for gender, race/ethnicity, age]). Effect was slightly greater in black students who, if receiving the intervention, were 41% less likely to be overweight than those in control schools after 2 years (after controlling for gender, age and baseline prevalence). No differences between intervention and control groups in the prevalence of obesity after 2 years (P = 0.48). No difference between intervention and control groups for combined prevalence of overweight and obesity (P = 0.07). No differences between groups with respect to the remission of overweight or obese after 2 years. MEASURES: Dietary intake and physical activity sedentary behaviours, potential adverse effects OUTCOMES: Reported decreases in both intervention and control schools in self‐reported consumption of energy, fat, and fruits and vegetables over 2 years with no differences between groups. Decreases in self‐reported amounts of physical activity in both intervention and control groups with no differences between groups. MEASURES: Sedentary behaviours OUTCOMES: Inactivity was 4% lower after 2 years in the intervention group compared with the control group after adjusting for gender, age, race/ethnicity and baseline inactivity (odds ratio: 0.96 [0.94 to 0.99]; P < 0.01). Weekday television watching was 5% lower in the intervention group than in the control group (odds ratio: 0.95 [0.93 to 0.97]; P < 0.0001) after 2 years. MEASURES: Potential adverse effects OUTCOMES: The intervention showed no evidence of an adverse impact with respect to a worsening body image or changes in incidence, prevalence and remission of underweight. |
| Gentile 2009 | MEASURES: Height and Weight OUTCOMES: No significant difference in BMI between groups post‐intervention or at 6 months follow‐up MEASURES: Screen time OUTCOMES: Child report (hours/week): No significant difference between groups post‐intervention or at 6 months follow‐up Parent report (hours/week) Significantly lower in intervention group post‐intervention (I: 22.8(0.7), C: 24.6(0.3), P <0.05) and at 6 months follow‐up (I: 23.7(0.5), C: 25.7(0.5), P <0.05) ) compared with control group MEASURES: Fruit and vegetable consumption OUTCOMES: Child report (servings/week): Significantly lower in intervention group post‐intervention (I: 4.4(0.2), C: 4.2(0.1), P < 0.05) and at 6 months follow‐up (I: 4.1(0.2), C: 4.0(0.1), P < 0.05) compared with control group Parent report (servings/week) Significantly lower in intervention group post‐intervention (I: 24.9(0.7), C: 22.6(0.4), P < 0.05) and at 6 months follow‐up (I: 22.5(0.7), C: 21.3(0.3), P < 0.05) ) compared with control group MEASURES: Physical activity (steps/day) OUTCOMES: No significant difference on pedometer measures of physical activity | |
| Gortmaker 1999a | 1. Fatness assessed by repeat measures of height, weight, (and calculated BMI), and triceps skinfold thickness, at baseline and after 18 months (end of intervention) :
OUTCOME: The prevalence of obesity among girls in intervention schools was reduced compared with controls, controlling for baseline obesity (odds ratio, 0.47; 95% confidence interval, 0.24‐0.93; P = 0.03), with no differences found among boys. There was greater remission of obesity among intervention girls vs control girls (odds ratio, 2.16; 95% confidence interval, 1.07‐4.35; P = 0.04). Reestimated regressions that excluded observations with missing data and got similar results with both approaches. | 1. Television viewing time:
OUTCOME: Both girls and boys in the intervention group spent less time viewing television.
2. Dietary intake:
OUTCOME: Intervention girls reported eating more fruit and vegetables and reduced their increase in dietary energy over the two years of the intervention.
Behavioural variables as explanations for intervention effect: Regression indicated that only change in television viewing mediated the intervention effect. |
| Gutin 2008 (see Notes in Included Studies table) | MEASURES: Percent body fat (%BF) OUTCOMES: 1 year: %BF decreased in intervention participants with no change in control participants (adjusted change: ‐0.76 [‐1.42, ‐0.09]; P = 0.027). No significant differences between groups for ITT analysis. Significant relationship between level of programme attendance and change in %BF in intervention group, with greater decreases in %BF observed with higher programme attendance (P = 0.0004). 3 year: Significant group by time interaction (P < 0.05). Intervention group reduced their body fat during school months and this returned to levels similar to those of the control group after the summer months (school vacation). | MEASURES: Bone Mineral Density (BMD) OUTCOMES: 1 year: Compared with control, intervention participants showed significantly greater gains in BMD (adjusted change: 0.008 [0.001, 0.015]; P = 0.023). In intervention group greater increases in BMD were observed with higher programme attendance (P = 0.029). 3 year: Significant group by time interaction in favour of intervention participants (P < 0.01). MEASURES: Fat mass OUTCOMES: 1 year: No significant differences between groups post‐intervention. In intervention group greater decreases in fat mass were observed with higher programme attendance (P = 0.0004). 3 year: No significant differences between groups post‐intervention (data not reported). MEASURES: Fat‐free soft tissue (FFST) OUTCOMES: 1 year: No significant differences between groups post‐intervention. 3 year: Significant group by time interaction in favour of intervention participants (P < 0.01). MEASURES: cardiovascular fitness (CVF) OUTCOMES: 1 year: Compared with control, intervention participants showed significantly greater gains in CVF (adjusted change: ‐4.4 [‐8.2 to ‐0.6]; P = 0.025). In intervention group greater increases in CVF were observed with higher programme attendance (P = 0.029). 3 year: Significant group by time interactions in favour of intervention participants (P < 0.01). The intervention group improved in fitness during school months and this returned to levels similar to those of the control group after the summer months. MEASURES: BMI OUTCOMES: 1 year: No significant differences between groups post‐intervention. 3 year: Significant group by time interaction, with the increase in BMI being greater in the intervention group than in the control group (P < 0.05). MEASURES: waist circumference OUTCOMES: 1 year: No significant differences between groups post‐intervention. MEASURES: CV risk factors OUTCOMES: 1 year: No significant differences between groups post‐intervention. |
| Hamelink‐Basteen 2008 | MEASURES: Height, weight OUTCOMES: BMI increase did not differ between groups post‐intervention MEASURES: Obesity OUTCOMES: Prevalence of obesity did not differ between groups post‐intervention | MEASURES: Nutrition knowledge OUTCOMES: Higher level of knowledge about importance of vegetables and fruit and a healthy diet MEASURES: Lifestyle and behaviours OUTCOMES: Intervention group walked more frequently to school, watched less television, drank less soft drinks and ate less sweets than control group. |
| Harrison 2006 | MEASURES: Height, weight OUTCOMES: No significant difference between groups post‐intervention MEASURES: Physical activity OUTCOMES: MVPA in 30 min blocks was significantly higher (by 0.84 blocks; 95%CI 0.11, 1.57) in the intervention group post‐intervention (P = 0.03) MEASURES: Screen time OUTCOMES: No significant difference between groups post‐intervention MEASURES: Physical activity self‐efficacy OUTCOMES: Significantly higher self efficacy (by 0.86 units; 95%CI: 0.16, 1.56) post‐intervention (P = 0.03) MEASURES: Aerobic fitness (20m shuttle test) OUTCOMES: No significant difference between groups post‐intervention | |
| James 2004 | MEASURE: BMI at 1 year (end of intervention) and 3 years post‐baseline (or 2‐year follow‐up)
OUTCOME: No differences between intervention and control in the change in BMI from baseline MEASURE: Proportion of children overweight or obese at 1 year (end of intervention) and 3 years post‐baseline (or 2‐year follow‐up), based on proportion above 91st centile
OUTCOME: At 1 year, the mean percentage of overweight and obese children increased in the control clusters by 7.5%, compared with a decrease in the intervention group of 0.2% (mean difference 7.7%, 95%CI: 2.2% to 13.1%). At 3 years, this difference was smaller and no longer significant (Odds ratio: 0.79 (95%CI: 0.52 to 1.21)). | MEASURE: Carbonated drink consumption at 1 year (end of intervention):
OUTCOME: Children in intervention classes reported fewer carbonated drinks (0.6 glasses fewer compared with an increase in controls of 0.2 (95% CI: 0.1 to 1.3).
MEASURE: Water consumption at 1 year (end of intervention)
OUTCOME: No differences between intervention and control. |
| Kain 2004 | Fatness assessed by repeat measures of height and weight (and calculated BMI) at baseline and after 1 year (end of intervention):
OUTCOME: No differences between intervention and control.
Skinfolds:
OUTCOME: No differences between intervention and control.
Waist circumference:
OUTCOME: decreased significantly in intervention group by a mean of 0.9cm and increased in controls by same amount.
Physical Fitness:
OUTCOME: Shuttle run test and lower back flexibility both improved for boys and girls in the intervention group compared with controls. | 1. Dietary assessment: food frequency questionnaire of 16 key items:
OUTCOME: Not reported.
2. Attitudes and behaviours (14 questions about physical activity and some about fruit and vegetable consumption):
OUTCOME: Not reported. |
| Kipping 2008 | MEASURES: Time spent doing screen‐based activities OUTCOMES: No statistically significant differences between intervention and control groups. | MEASURES: BMI OUTCOMES: No statistically significant differences between intervention and control groups. MEASURES: Obesity (BMI > 95th percentile) OUTCOMES: No statistically significant differences between intervention and control groups. However, subgroup analysis by gender showed that the odds of being overweight post‐intervention were higher in females (1.52; 95%CI: 0.37 to 6.25) than males (0.28; 95% CI: 0.06 to 1.33) MEASURES: Walks/cycles to and from school OUTCOMES: No statistically significant differences between intervention and control groups. |
| Lazaar 2007 | MEASURES: Obesity status OUTCOMES: A larger proportion of obese children (BMI > 97th percentile) became overweight (90th <BMI <97th percentile) in the intervention group compared with control (16.3%, P < 0.05 versus 9.3%, P < 0.05). The proportion of non obese children becoming obese or overweight was greater in controls than in the intervention group (14.8%, P < 0.05 versus 2.6%, P= ns) MEASURES OUTCOMES | MEASURES: BMI OUTCOMES: Average BMI remained unchanged over time in both groups overall. In girls, there was a significant group*time interaction (P < 0.01) and a significant effect of PA intervention between intervention and control in obese (‐1.4% vs 0.9%; P < 0.05) and non obese (‐0.2% vs 2.1%; P < 0.001) girls. MEASURES: BMI z‐score OUTCOMES: In boys, BMI z‐score declined significantly over time only in the intervention group and was significantly different compared with controls (P < 0.001). In boys, there was also a significant difference between intervention and control groups in both obese (‐2.8% vs 1.5%; P < 0.05) and non obese boys (‐2.4% vs 2.6%; P < 0.01). In girls, BMI z‐score declined significantly in all groups except for obese controls. The decrease was higher in the intervention groups compared with control groups for both obese (‐6.8% vs ‐2.4%; P < 0.001) and non obese (‐3.1% vs ‐1.8%; P < 0.01) girls. Changes were greater in obese compared with non obese girls (P < 0.001). MEASURES: Waist circumference OUTCOMES: In girls, waist circumference was affected over time, decreasing in the intervention group and increasing in the control group (‐3.3% vs 2.8%; P < 0.001). In boys, waist circumference was not significantly affected over time. MEASURES: Skinfold thickness OUTCOMES: In girls, the sum of skinfolds was significantly decreased over time in the intervention groups in both obese (‐4.4%, P < 0.05) and non obese (‐3.2%, P < 0.001) girls, with a significant difference between obese and non obese girls (P < 0.05) and no significant changes in controls. In boys, the sum of skinfolds was not significantly altered over time. MEASURES: Fat‐free mass OUTCOMES: In girls, fat‐free mass increased over time, with greater increases in intervention children compared with controls for both obese (5.2% vs 2.4%, P < 0.001) and non obese (4.0% vs 0.6%, P < 0.05) girls. In boys, fat‐free mass improved over time with higher changes in the intervention groups (obese = 6.4%, P < 0.001 and non obese = 3.4%, P < 0.001) compared with control groups (obese = 1.3%, P = ns and non obese = 0.7%, P = ns), and a higher increases in obese boys compared with non obese boys (P < 0.01) |
| Macias‐Cervantes 2009 | MEASURES: Anthropometric measurements: height, weight, BMI, waist circumference, triceps skinfold OUTCOMES: Differences between groups post‐intervention were not tested MEASURES: Glucose, triglycerides, cholesterol, HDL‐C, LDL‐C, HOMA‐IR OUTCOMES: Intervention group decreased insulin (P < 0.001) and HOMA index (4.36 vs. 2.39, P <0.001) from baseline to follow‐up, but no difference in control group. No other differences were reported. Differences between groups post‐intervention were not tested MEASURES: Physical activity (steps/day, by pedometer) OUTCOMES: Intervention group increased their median daily steps from baseline to follow‐up (15,329 to 19,910). Differences between groups post‐intervention were not tested | MEASURES: Food intake OUTCOMES: Not reported |
| Marcus 2009 | MEASURES: Height and weight OUTCOMES: Prevalence of overweight/obesity decreased by 3.2% (from 20.3 to 17.1) in intervention schools compared with an increase of 2.8% (from 16.1 to 18.9) in control schools (P < 0.05). No difference between intervention and control groups in change in zBMI (BMIsds) post‐intervention A larger proportion of the children who were initially overweight reached normal weight in the intervention group (14%) compared with the control group (7.5%), P < 0.017 | MEASURES: Physical activity measured by accelerometry OUTCOMES: No significant differences between groups post‐intervention MEASUREs: Eating habits at home measured by parental report. OUTCOMES: Post‐intervention eating habits at home were healthier among intervention families. Significant differences between children in intervention and control schools were found for high‐fat dairy products (P < 0.001), sweetened cereals (P<0.02) and sweet products (P < 0.002). MEASURES: Eating disorders measured by self‐report. OUTCOMES: No significant differences between groups post‐intervention |
| Müller 2001 | 1. Fatness assessed by repeat measures of height and weight.
OUTCOME: No significant difference between I and C from BMI data available at baseline and 1 year. The median of the BMI was 15.2 (intervention school) and 15.4 for children in control schools. At one‐year follow‐up the corresponding data were 16.1 and 16.3 respectively.
2. Triceps skinfold thickness
OUTCOME: Significant difference in favour of the intervention group at one‐year follow‐up (age‐dependent increases in median triceps skinfolds of the whole group (from 10.9 to 11.3mm in ‘intervention schools’ vs from 10.7 to 13.0mm in ‘control schools’, P < 0.01). Also positive intervention impacts on percentage fat mass of overweight children (increase by 3.6 vs 0.4% per year without and with intervention, respectively; P < 0.05). | 1. Nutrition knowledge
OUTCOME: significant increase from 48% to 60% of the children.
2. Daily physical activities
OUTCOME: significant increase from 58 to 65% of the children.
3. Daily fruit and vegetable consumption
OUTCOME: significant increase from 40 to 60% of the children.
4. Daily intake of low fat food
OUTCOME: significant increase in frequency of daily intake of low fat food from 20 to 50%.
5. Decrease in TV watching
OUTCOME: significant decrease from 1.9 to 1.6 h/day. |
| Paineau 2008 | MEASURES: Nutritional intake OUTCOMES: Compared with controls, participants in the intervention groups achieved their nutritional targets for fat intake and for sugar and complex carbohydrate intake, leading to a decrease in energy intake (children, P<0.001; parents, P = 0.02). MEASURES: height and weight OUTCOMES: No significant differences were found between groups in BMI or zBMI, with a trend toward negative changes in zBMI in all 3 groups. BMI differed in parents (group A, +0.13, 95% CI, ?0.01, 0.27; group B, ?0.02, 95% CI, ?0.14, 0.11; control group,+ 0.24, 95% CI, 0.13, 0.34; P =.001), with a significant difference between group B and the control group (P = 0.01) | MEASURES: Physical activity OUTCOMES: In children, changes in physical activity throughout the study did not differ between groups, either for daily screen viewing or for activities in clubs MEASURES: Food‐related quality of life OUTCOMES: In parents, food‐related quality of life did not change differently between groups throughout the study |
| Pangrazi 2003 | 1. Fatness assessed by repeat measures of height and weight (and calculated BMI) at baseline and end of pilot:
OUTCOME: No differences between intervention and control.
2. Physical activity: accelerometer CSA,
OUTCOME: All students: PLAY & PE, and PLAY only groups were significantly more active than C. Girls: PLAY & PE, and PE only groups were significantly more active than controls. | None reported. |
| Reed 2008 | MEASURES: Cardiovascular fitness (measured by 20‐m shuttle run test) OUTCOMES: The intervention group demonstrated a significantly greater increase (20%) in fitness (20‐m shuttle run) compared with the control group (P <0.05). MEASURES: Blood pressure (systolic and diastolic) OUTCOMES: Systolic blood pressure in the intervention group decreased significantly compared with an increase in the control group (5.7% smaller increase; P < 0.05). There was no difference for change in diastolic blood pressure. | MEASURES: Total cholesterol, HDL, LDL, Apo B, C‐reactive protein and fibrinogen OUTCOMES: Although all serum variables in the intervention group decreased more than these same variables for the control group changes failed to reach significance MEASURES: Weight, height OUTCOMES: BMI not different between groups post‐intervention |
| Robbins 2006 | MEASURES: Physical activity variables (frequency, intensity, duration, and readiness) OUTCOMES: No significant differences between groups MEASURES: Physical activity determinants (interpersonal influences, physical activity enjoyment, self efficacy, and perceived benefits and barriers of physical activity) OUTCOMES: The intervention group had significantly greater social support across time (P = 0.019). No other significant differences between groups. No other significant differences between groups | |
| Robinson 2003 | 1. Fatness assessed by repeat measures of height and weight (and calculated BMI) at baseline and end of pilot:
OUTCOME: No differences between intervention and control.
2. Waist circumference:
OUTCOME: No differences between intervention and control.
3. Dual X‐Ray Absorptiometry (DEXA) for % Body fat
OUTCOME: Not done
4. Physical activity: accelerometer CSA,
OUTCOME: No differences between intervention and control.
5. a modification of the Self‐Administered Physical Activity Checklist (SAPAC):
OUTCOME: No differences between intervention and control.
6. GEMS Activity Questionnaire(GAQ) computerised
OUTCOME: Not reported
7. Dietary intake measured by two 24 hour recalls using Nutrition Data System computer programme (NDS‐R).
OUTCOME: No differences between intervention and control. | 1. TV usage: TV, videotape and video games:
OUTCOME: No differences between intervention and control.
2. Total household TV usage:
OUTCOME: Intervention significantly less than control.
3. Ate breakfast with TV on:
OUTCOME: No differences between intervention and control.
4. Ate dinner with TV on:
OUTCOME: Intervention significantly less than control.
5. Over concern with weight or shape:
OUTCOME: Intervention significantly better than control. |
| Rodearmel 2006 | MEASURES: Steps per day OUTCOMES: Steps per day increased in all members of intervention families but not in any members of the control families. Intervention target girls/boys, mums and dads, all took significantly more steps per day on average than their control counterparts (P < 0.05). Increases in steps/day over baseline in intervention groups approached the primary goal of the intervention (an additional 2000 steps/day) MEASURES: cereal consumption OUTCOMES: Intervention families consumed approximately 1 serving of cereal/day, double the amount consumed by control families (P < 0.05) MEASURES: Food Intake OUTCOMES: No significant changes in self‐reported total energy intake or in intake of any macronutrient in either group. MEASURES: Body weight/adiposity OUTCOMES: Significant between‐group differences (P < 0.05) were found pre‐ to post‐study in the difference in the mean change of all body weight/adiposity measures of primary importance for overweight target children (%BMI‐for‐age, % body fat) and their parents (weight, BMI and % body fat). All trends were in favour of the intervention group. When analysed by gender, significant between‐group differences were found in the difference in the mean change of both the child‐ and adult‐specific body weight/adiposity measures between intervention and control for target girls and mums, but not for target boys and dads. | |
| Sahota 2001 | 1. Fatness assessed by repeat measures of height and weight (and calculated BMI) at baseline and after 1 year (end of intervention) OUTCOME: No differences between groups overall (weighted mean difference between intervention and control of 0 (95% CI: ‐0.1 to 0.1) overall, or when analysed by weight status for overweight (WMD: ‐0.07, 95% CI ‐0.22 to 0.08) or obese (WMD: ‐0.05; 95% CI: ‐0.22 to 0.11) children separately. 2. Dietary intake: OUTCOME: Vegetable consumption by 24 hour recall was higher in children in the intervention group than the control group (weighted mean difference 0.3 portions/day, 95% CI 0.2 to 0.4). Fruit consumption was lower in obese children in the intervention group ( ‐ 1.0, ‐ 1.8 to ‐ 0.2) than those in the control group. The three‐day diary showed higher consumption of high sugar foods (0.8, 0.1 to 1.6)) among overweight children in the intervention group than the control
group. 3. Physical activity: OUTCOME: Sedentary behaviour was higher in overweight children in the intervention group (0.3, 0.0 to 0.7). 4. Psychological measures: OUTCOME: small increase in global self‐worth for obese children in the intervention schools. | 1. Nutrition knowledge:OUTCOME: Focus groups indicated higher levels of self‐reported behaviour change, understanding and knowledge. |
| Sallis 1993 | 1. Fatness assessed by weight, height, BMI, calf and triceps skinfold at baseline and 6, 12, 18 months.
OUTCOME: Little difference in BMI for boys and girls between specialist and teacher led intervention conditions (statistical significance not addressed) at 6, 12 and 18 months.
Small differences in BMI for boys and girls between specialist‐led, teacher‐led conditions and usual physical education control. (statistical significance not addressed) at 6, 12 and 18 months. | None reported |
| Salmon 2008 | MEASURES: BMI OUTCOMES: Significant reduction in BMI post‐intervention in the BM/FMS group compared with control (average ‐1.88 BMI units less than control; P < 0.01). This was maintained at 6 and 12 month follow‐up. MEASURES: Weight status OUTCOMES: On average, those in the BM/FMS group were over 60% less likely to be overweight or obese compared with control (P < 0.05). This was maintained at 6 and 12 month follow‐up. | MEASURES: Physical activity (accelerometer) OUTCOMES: Compared with controls, FMS group children recorded higher levels and greater enjoyment of PA; and BM children
recorded higher levels of PA across all four time points.Significant average effects over time in favour of the BM and FMS groups compared with control (P < 0.05). This was maintained at 6 and 12 month follow‐up. Gender was a significant moderator, with boys showing greater increases. MEASURES: Self‐reported screen behaviours OUTCOMES: Children in the BM group reported 229 min/week more in TV viewing on overage over time compared with control (P < 0.05). These effects were maintained with inclusion of 6 and 12 month follow‐up data. MEASURES: Self‐reported enjoyment of physical activity (five‐point Likert scale) OUTCOMES: Children in the FMS group reported higher average enjoyment scores over time compared with those in the control group (P < 0.05). MEASURES: Mastery of fundamental movement skills OUTCOMES: No significant intervention effects on FMS z‐scores between baseline and any of the post‐intervention time points. In girls, there was a significant effect, with those in the BM (P < 0.05) and FMS (P < 0.01) groups recording higher average FMS z‐scores compared with those in the control group. MEASURES: Body Image (five‐point Likert scale) OUTCOMES: No effects on children’s happiness with their body shape and body weight, or eating to gain weight or lose weight in the last month. When stratified by gender, boys in the FMS group (P = 0.003) and BM/FMS group (P = 0.014) recorded significantly higher satisfaction with their body shape between baseline and all post‐intervention time points compared with control. |
| Sanigorski 2008 | MEASURES: Body weight OUTCOMES: Children in intervention population gained less weight than in the comparison population (‐0.92kg [‐1.74 to ‐0.11], P = 0.03). MEASURES: Waist circumference OUTCOMES: Children in intervention population showed lower increases in waist circumference than in the comparison population (‐3.14cm [‐5.07 to ‐1.22], P = 0.01). MEASURES: BMI‐z score OUTCOMES: Children in intervention population showed lower increases in BMI‐z score than in the comparison population (‐0.11 [‐0.21 to ‐0.01], P = 0.04). MEASURES: Relationship between baseline indicators of children’s household SES and changes in children’s anthropometry. OUTCOMES: In the comparison population, lower SES was associated with a greater weight gain (statistically significant relationship in 19 of 20 analyses). In the intervention population, no statistically significant relationships were observed. | MEASURES: BMI OUTCOMES: No significant difference between intervention and comparison populations (P = 0.20). MEASURES: waist/height ratio OUTCOMES: Children in intervention population showed lower increases in waist/height ratio than in the comparison population (‐0.02 [‐0.03, ‐0.004], P = 0.01). MEASURES: Prevalence and incidence of ow/ob OUTCOMES: Prevalence of overweight/obesity increased in both groups, and the incidence of overweight/obesity was not significantly different between groups. |
| Sichieri 2009 | MEASURES: change in BMI OUTCOMES: BMI and weight increased in both groups with no statistically significant differences between groups. Among students overweight at baseline, the intervention group showed greater BMI reduction and this difference was statistically significant among girls (P = 0.009). MEASURES: carbonated SSB and juice intake OUTCOMES: Mean intake of sodas per class was reduced in both groups, with reduction being about four times greater in the intervention compared with the control group (‐69ml vs ‐13ml). Carbonated beverage intake was significantly reduced in the intervention group compared with the control group (p=0.03), but fruit juice consumption was slightly increased in the intervention group (P = 0.08). | MEASURES: overweight and obesity OUTCOMES: For both groups, obesity changed from about 4 to 4.5% with no statistically significant difference between groups. |
| Simon 2008 | MEASURES: BMI OUTCOMES: intervention students showed a lower increase in BMI (P = 0.01) over time than control students. The differences across groups of the adjusted (by baseline weight status) BMI changes were ‐0.33 (‐0.55 to ‐0.12) at 3 years and ‐0.36 (‐0.60 to ‐0.11) at 4 years. Cumulative incidence of overweight was lower in the intervention group than in the control group (4.2% vs 9.8% at 4 years; P < 0.01). Sensitvity analyses conducted using intention to treat population to compare this with analysis using data from only those participants who completed the study and similar results were observed. | MEASURES: Self‐reported leisure physical activity OUTCOMES: At 4 years, 79% of intervention students practised at least one supervised physical activity outside school PE classes, compared with 47% of control students (P < 0.001). Supervised leisure physical activity increased in intervention students, whereas it slightly decreased in controls, with a difference across groups of the 4‐year within‐group changes of 66min (95%CI: 34 to 98) per week (P < 0.0001). MEASURES: TV/video viewing time OUTCOMES: Intervention students had a greater reduction over time of TV/video viewing than controls (P < 0.01), with a difference in the 4‐year changes of ‐16min (95%CI: ‐29, ‐2) per day. MEASURES: Active commuting to/from school OUTCOMES: Slight increase in active commuting observed across both groups. MEASURES: Self‐efficacy and intention towards physical activity OUTCOMES: Intervention associated with an increase of self‐efficacy during the first 2 years (P < 0.0001 and 0.01 at 1 and 2 years respectively) and a sustained improvement of intention toward physical activity (P < 0.05). MEASURES: Cardiovascular risk factors OUTCOMES: Compared with controls, intervention participants had a higher increase of high‐density lipoprotein‐cholesterol concentration at 4 years and a slight decrease in blood pressure at 2 years. Other biological cardiovascular risk factors were similar between groups over time. |
| Spiegel 2006 | MEASURES: Height, weight OUTCOMES: There were significant shifts in BMI in the intervention group, with a 2% reduction in overweight (BMI > 85% for age and sex) in the intervention group. There was a significant correlation at the 0.01 level between the intervention and a reduced BMI and BMI‐for‐age data showed that 39.4% of the comparison group and 36.4% of the intervention group were either overweight or at risk for overweight when measured at the baseline interval. Significant shifts in BMI were noted in the intervention group, with a 2% reduction in overweight (BMI _ 85% for age and sex) youth in the intervention group. Student’s t test and Pearson correlations were used to evaluate the significance of the BMI shift. Both analyses showed a significant correlation at the 0.01 level between the intervention and a reduced BMI. Student’s t test mean for the comparison group was 0.5210 (N _ 479; SD _ 1.01610, SE _ 0.04643) and for the intervention group was 0.1606 (N _ 534, SD _ 0.89446, SE _ 0.03871). The Pearson correlation for change in BMI baseline to post‐data measure with treatment (r _ _0.186; N _ 1013) was significant at the 0.01 level (two‐tailed). BMI‐for‐age data showed that 39.4% of the comparison group and 36.4% of the intervention group were either overweight or at risk for overweight when measured at the baseline interval. There was no significant shift in the comparison group, but there was a notable reduction in the intervention group in overweight and at risk for overweight classification, which was most significant at the at risk for overweight (BMI‐for‐age between 85% to 95%) level. There was a 16.2% attrition rate in the comparison group (N _ 479 matched measures between baseline to post‐data) and a 13.7% attrition rate in the intervention group (N _ 534 matched). There was no significant shift in the comparison group, but there was a reduction in the intervention group in overweight and at risk for overweight classification, which was most significant at the ‘at risk for overweight’ (BMI‐for‐age between 85% to 95%) level. MEASURES: Fruits and Vegetable Consumption OUTCOMES: Post‐intervention, there was an increase in fruit and vegetable consumption in both groups from baseline levels, with a higher increase in the intervention group. MEASURES: Physical activity levels OUTCOMES: Physical activity levels in the intervention group increased in both school and home settings. Post‐intervention, intervention students reported an average of 102.5 min/wk of physical activity during the school day (up from 59min/wk at baseline) and a mean level of 37.42 min/d outside of the school day (up from 22.34 min/d at baseline). Physical activity levels increased slightly in the comparison group in reported levels of light exercise | |
| Stolley 1997 | 1. Fatness assessed by weight and height at baseline and at 12 weeks (end of the intervention):
OUTCOME: No statistically significant change between intervention and control. | 1. Dietary Intake:
OUTCOME: Significant reductions found in intervention mothers' daily saturated fat intakes and percentage of energy from fat when compared to controls. Also intervention girls had statistically significant reductions for percentage energy from fat when compared to controls. |
| Story 2003a | 1. Fatness assessed by repeat measures of height and weight (and calculated BMI) at baseline and end of pilot:
OUTCOME: No differences between intervention and control.
2. Waist circumference:
OUTCOME: No differences between intervention and control.
3. Dual X‐Ray Absorptiometry (DEXA) for % Body fat
OUTCOME: Not done.
4. Physical activity: CSA accelerometer,
OUTCOME: No differences between intervention and control.
5. a modification of the Self‐Administered Physical Activity Checklist (SAPAC),
OUTCOME: Not reported.
6. GEMS Activity Questionnaire(GAQ) computerised
OUTCOME: No differences between intervention and control.
7. Dietary intake measured by two 24 hour recalls using Nutrition Data System computer programme (NDS‐R).
OUTCOME: No differences between intervention and control. | Psychological variables:
1. Over concern with weight or shape:
OUTCOME: Intervention significantly better than control.
2. Diet: Healthy choice Behavioural Intentions:
OUTCOME: Intervention significantly better than control.
3. Self‐Efficacy for Healthy Eating
OUTCOME: No differences between intervention and control.
4. Diet knowledge:
OUTCOME: Intervention significantly better than control.
5. Physical Activity Outcomes Expectations, and a self‐efficacy measure.
OUTCOME: No differences between intervention and control (except physical activity preference).
6. Parental reported diet
OUTCOME: Significant differences with intervention better than control: % energy from fat and low fat food practices.
7. Parental reported physical activity:
OUTCOME: No differences between intervention and control. |
| Taylor 2008 | MEASURES: Weight, Height OUTCOMES:
Post‐intervention: Adjusted mean BMI Z‐score was lower in intervention relative to control children by ‐0.12 units (95% CI: ‐0.22 to ‐0.02). Follow‐Up: Mean BMI z score (and 95% CI) remained significantly lower in intervention children in the whole group (n = 554, ‐0.17; ‐0.25 to ‐0.08) and in the group who underwent at least 1 (n = 389;‐0.19;‐0.24 to ‐0.13) or 2 (n = 256;‐0.21;‐0.29 to ‐0.14) full years of intervention. MEASURES: Prevalence Overweight and obesity OUTCOMES:
Post‐intervention: Although the risk of being overweight or obese (18) at year‐end in intervention compared with control children (odds ratio 0.55; 95% CI: 0.19 to 1.48) did not achieve statistical significance, more intervention children who were overweight at baseline tended to be classified as normal weight at year‐end (12 of 49, 24%) than control children (10 of 65, 15%). Furthermore, 10 of 158 (6%) intervention children became overweight during the year compared with 13 of 112 (12%) control children. Follow‐up: Intervention children were less likely to be overweight, but only in those who were present for the full intervention (n = 256; Relative Risk: 0.81; 95% CI: 0.69, 0.94). 9 (10%) intervention and 10 (14%) control children became overweight during the 2 yr after the cessation of the intervention project. 12 (30%) intervention and 14 (25%) control children who were overweight at baseline were not overweight at follow‐up. 13 (10%) intervention and 18 (17%) control children became overweight. 20 (30%) intervention and 20 (24%) control children became normal weight | MEASURES: Physical activity OUTCOMES: Post‐intervention average accelerometry counts at 1 year were 28% (95% CI: 11 to 47%) higher in intervention compared with control children after adjusting for age, sex, baseline values and school. Intervention children spent less time in sedentary activity (ratio 0.91, P = 0.007) and more time in moderate (1.07, P = 0.001) and moderate/vigorous (1.10, P = 0.01) activity. MEASURES: Waist circumference, blood pressure, pulse rate OUTCOME: No intervention effect was observed |
| Vizcaino 2008 | MEASURE: BMI OUTCOMES: No significant differences between intervention and control groups MEASURES: Triceps skin‐fold thickness (TST) OUTCOMES: Significant reduction in TST in intervention children compared with controls for both boys (‐1.14mm; 95%CI: ‐1.71, ‐0.57; p<0.001) and girls (‐1.55mm; 95%CI: ‐2.38, ‐0.73; p<0.001). MEASURES: Percentage body fat OUTCOMES: Significant reduction in % body fat in girls (‐0.58%; 95%CI: ‐1.04, ‐0.11; p=0.02). No significant differences between intervention and control for boys. | MEASURES: Blood pressure, total cholesterol, triglycerides, apo A and apo B OUTCOMES: Compared with controls, intervention children had lower apo B levels and higher apo A‐1 levels. Intervention was not associated with any significant changes in total cholesterol, triglycerides or blood pressure, with the exception of diastolic blood pressure, which rose in intervention versus control boys. |
| Warren 2003 | 1. Fatness assessed by repeat measures of height and weight.
OUTCOME: No significant changes in the rates of overweight and obesity were seen as a result of the 3 different interventions (Be Smart, Eat Smart, Play Smart). Post‐intervention, the change in prevalence of overweight from baseline was ‐1, +5, 0 for the Be Smart, Eat Smart, Play Smart groups, respectively. Post‐intervention, the change in prevalence of obesity from baseline was ‐1, ‐2, 0 for the Be Smart, Eat Smart, Play Smart groups, respectively. | 1. Nutrition knowledge:
OUTCOME: all conditions improved their knowledge, I vs C not reported. No gender differences.
2. Diet:
OUTCOME: significant increase in vegetable consumption (P<0.05) and fruit (P<0.01). However, 24h recall showed no significant differences between the groups or genders at base line or at follow‐up.
3. Physical activity:
OUTCOME: No intervention effect was found in either the children's or parents questionnaires. |
