review

1. Childhood Obesity Prevention/Treatment Literature Review
Prevention
Caroli, M., Argentieri, L., Cardone, M., & Masi, A. (2004). Role of television in childhood
obesity prevention. International Journal of Obesity, 28(S3), S104-S108.
doi:10.1038/sj.ijo.0802802
De Barse, L. M., Tiemeier, H., Leermakers, E. T. M., Voortman, T., Jaddoe, V. W. V., Edelson,
L. R., … Jansen, P. W. (2015). Longitudinal association between preschool fussy eating
and body composition at 6 years of age: The Generation R Study. The International
Journal of Behavioral Nutrition and Physical Activity, 12, 153.
http://doi.org/10.1186/s12966-015-0313-2
The study attempted to determine whether or not fussy eating at 4 years of age is longitudinally
related to body mass index (BMI), fat mass index (FMI) and fat-free mass index (FFMI) at 6
years of age. The Children’s Eating Behaviour Questionnaire (CEBQ) was given to 4191
children at the age of 4 in order to classify them as fussy eaters or non-fussy eaters. The
researchers measured the height and weight of the children at age 6 years. Dual-energy-X-ray
absorptiometry was employed to measure body fat and fat-free mass. Age- and sex-specific
standard deviation scores (SDS) were used for all outcomes. The researchers found that having a
fussy eating profile was related to lower BMI-SDS, lower FMI-SDS and lower FFMI-SDS.
Fussy eaters also had an elevated risk of becoming underweight when compared to non-fussy
eater.

2. de Silva-Sanigorski, A., Prosser, L., Carpenter, L., Honisett, S., Gibbs, L., Moodie, M.. . Waters,
E. (2010). Evaluation of the childhood obesity prevention program kids--'go for your
life'. BMC Public Health, 10(1), 288-288. doi:10.1186/1471-2458-10-288
The program, Kids – ‘Go for your life’ (K-GFYL), is a health promotion intervention that seeks
to decrease the risk of childhood obesity by improving the socio-cultural, policy, and physical
environments related to physical activity and healthy eating. The researchers hypothesized that
obtaining award status increases children’s physical activity and healthy eating behaviors
through the formation of health promoting environments, capacity-building and community
engagement. The parents of the children will be surveyed using both the School Environment
Questionnaire and the Child Health Questionnaire. A knowledgeable school staff member will
be given the Economic Resource Questionnaire. A child lunch box survey will also be conducted
in pre-schools and the FDC services.
Hesketh, K., Campbell, K., Crawford, D., Salmon, J., Ball, K., McNaughton, S., & McCallum, Z.
(2011). cluster-randomised controlled trial of an early childhood obesity prevention
program: The melbourne infant feeding, activity and nutrition trial (infant)
program. Journal of Epidemiology and Community Health, 65, A15-A16.
doi:10.1136/jech.2011.142976a.36
The study assessed the effectiveness of the Melbourne InFANT program, which focuses healthy
diet, physical activity, and reduced sedentary behavior from 3 to 18 months of age. Upon
conclusion of the study, children’s objectively measured physical activity was similar among
control and intervention study participants. Mothers in the intervention group had more favorable

3. beliefs about television and diet and corresponding child behaviors than mothers in the control
group.
Marcus, C., Nyberg, G., Nordenfelt, A., Karpmyr, M., Kowalski, J., & Ekelund, U. (2009). A 4-
year, cluster-randomized, controlled childhood obesity prevention study:
STOPP.International Journal of Obesity,33(4), 408-417. doi:10.1038/ijo.2009.38
The study assessed the effectiveness of a school and after school care-based obesity prevention
program, STOPP, which is focused on healthy eating, including modifications of school lunches
and afternoon snacks, increased physical activity during school time and a reduction of sedentary
activities during time spent at after school care. Analysis of all children who participated in the
study for at least 1 school year showed no statistical difference in the change in BMIs between
intervention and control groups. However, after 4 years of intervention, the prevalence of
overweight and obesity in grades 2,3 and 4 children in the intervention schools was significantly
reduced compared with an increase in control schools.
Moreno, L. A., De Henauw, S., Swinburn, B., Romon, M., Raffin, S., Summerbell, C.. . EEN
Study Group. (2012). EPODE approach for childhood obesity prevention: Methods,
progress and international development. Obesity Reviews, 13(4), 299-315.
doi:10.1111/j.1467-789X.2011.00950.x
Nyberg, G., Norman, Å., Sundblom, E., Zeebari, Z., & Elinder, L. S. (2016). Effectiveness of a
universal parental support programme to promote health behaviours and prevent
overweight and obesity in 6-year-old children in disadvantaged areas, the healthy school
start study II, a cluster-randomised controlled trial. The International Journal of
Behavioral Nutrition and Physical Activity, 13(1), 4. doi:10.1186/s12966-016-0327-4

4. The researchers evaluated the effectiveness of a parental support program, Healthy School Start,
which promotes healthy dietary and physical activity habits and prevents overweight and obesity
in six-year-old children from families with low SES and a high proportion of foreign-born
citizens. A cluster-randomized controlled trial was implemented in disadvantaged areas in
Stockholm. Participants were randomly assigned to intervention and control groups. The
intervention continued for 6 months and consisted of: health information for parents,
motivational interviewing with parents, and teacher-led classroom activities with children.
Accelerometry was employed to measure physical activity, a questionnaire was used to assess
dietary intake and screen time, and BMI standard deviation scores were calculated from body
weight and height measurements. The above measurements were obtained at baseline, post-
intervention and at a 5-month follow-up. Group effects were observed using Mixed-effect
Regression analyses, which were adjusted for sex, parental education and baseline values. The
study found that there was a significant intervention effect on outcomes regarding consumption
of unhealthy foods and unhealthy drinks. There was no intervention effect on physical activity
and BMI sds for the whole group. However, BMI sds among obese children decreased
significantly. At 5 months follow-up, the decrease in intake of unhealthy foods among boys was
constant.
Rogers, V. W., Hart, P. H., Motyka, E., Rines, E. N., Vine, J., & Deatrick, D. A. (2013). Impact
of let's go! 5-2-1-0:A community-based, multisetting childhood obesity prevention
program.Journal of Pediatric Psychology,38(9), 1010.
The impact of Let’s Go!, a multisetting community-based childhood obesity prevention program,
was documented in this study. Awareness, knowledge, and healthy behaviors of adults and their
children and the extent of program implementation at the participating elementary schools, child

5. care programs, and afterschool programs were measured using telephone interviews. The extent
of the implementation of the 10 Let’s Go! strategies was also assessed through survey findings
from the three settings. Parent-survey data shows statistically significant increases in the number
of parents reporting awareness of Let’s Go! and its message, knowledge of the program’s
recommendations, and child adherence with two of the program’s healthy behaviors over the
five-year course. The results of the site-based implementation survey indicate wide-spread
implementation of the 10 strategies in child care programs, elementary schools, and afterschool
programs.
Salmon, J., Timperio, A., Telford, A., Carver, A., & Crawford, D. (2005). Association of family
environment with children's television viewing and with low level of physical activity.
Obesity, 13(11), 1939-1951. doi:10.1038/oby.2005.239
The study examined how the family environment influenced children’s television viewing and
the likelihood of being low-active. Parents and children from 19 primary schools in Melbourne,
Australia completed questionnaires. The children also wore an accelerometer for 8 days.
Movement counts were used to identify low-active children. The sample consisted of 878
children. The researchers used multiple logistic regression models to analysis the relationship
between television viewing and family environment. Factors that influence TV viewing among
children include: individual, family or social, and environmental influences. Authors recommend
reduction of sedentary behaviors and increasing physical activity. They suggest that parents may
be essential in mediating their child’s sedentary behavior.
Salsberry, P. J., & Reagan, P. B. (2005). Dynamics of early childhood overweight. Pediatrics,
116(6), 1329-1338. doi:10.1542/peds.2004-2583

6. The researchers conducted a secondary analysis of data from the National Longitudinal Survey
of Youth’s Child-Mother file to study the various processes that influence the development of
childhood overweight by examining the effects of prenatal characteristics and early-life feeding
on weight status through age 7 years. A total of 3,022 children were included in the sample.
Information on prenatal and birth characteristics, as well as, information on height and weight
was obtained during 3 consecutive interviews when the child was aged 24 to 95 months. The
data was analyzed using chi-squared analysis of bivariate association. The researchers found that
early development of childhood overweight is associated with race, ethnicity, maternal pre-
pregnancy obesity, maternal smoking during pregnancy, and later birth years. They suggest that
overweight prevention should begin before pregnancy and in early childhood.
Skinner, J. D., Carruth, B. R., Bounds, W., Ziegler, P., & Reidy, K. (2002). Do food-related
experiences in the first 2 years of life predict dietary variety in school-age children?
Journal of Nutrition Education and Behavior, 34, 310−315.
A total of 70 mother and child pairs were interviewed seven to eight times when the child was
between 2 and 24 months of age and then again when the child was 6,7, and 8 years old. Dietary
data was collected for 3 days at 6,7, and 8 years. The study found that vegetable variety in
school-aged children was predicted by the mother’s preference. Fruit variety in school-aged
children was predicted by breast-feeding duration and either early fruit variety or fruit exposure.
It emphasizes the importance of early food-related experiences in relation to school-age
acceptance of a variety of fruits and vegetables.

7. Zenzen, W., & Kridli, S. (2009). Integrative review of school-based childhood obesity
prevention programs. Journal of Pediatric Health Care, 23(4), 242-258.
doi:10.1016/j.pedhc.2008.04.008
The study examines the differences in the methodological approaches and theoretical
frameworks of 16 school-based obesity prevention programs. Each program employs one or
more of the following interventions: dietary, physical activity, healthy lifestyle education, and/or
parental involvement. The authors concluded that the most effective programs should be guided
by a theoretical framework and should include BMI as one of the outcome measures. In addition,
the authors noted that parental involvement is critical in reinforcing the patterns of healthy
dietary practices at home and encouraging daily physical activity for the child’s long-term
success.
Treatment
Aldrich, H., Gance-Cleveland, B., Schmiege, S., & Dandreaux, D. (2014). School-based health
center providers' treatment of overweight children. Journal of Pediatric Nursing-Nursing
Care of Children & Families, 29(6), 521-527. doi:10.1016/j.pedn.2014.05.007
The purpose of this study was to describe providers’ self-reported treatment practices of school-
based health centers (SBHCs) in six states before they received training on the current obesity
care guidelines. Researchers used the International Life Science Institute (ILSI) Research
Foundation Assessment of Overweight in Children and Adolescents survey to assess attitudes,
barriers, skills, approaches to assessment, and treatment methods.
Bloom, T., Sharpe, L., Mullan, B., & Zucker, N. (2013). A pilot evaluation of appetite‐awareness
training in the treatment of childhood overweight and obesity: A preliminary

8. investigation.International Journal of Eating Disorders, 46(1), 47-51.
doi:10.1002/eat.22041
The study evaluated Children’s Appetite Awareness Training (CAAT), which encourages
overweight children to eat in response to internal appetite cues. To do so, overweight children
(ages 6-12 years old) were randomized to either the CAAT treatment group to receive 1-h
treatment sessions over the course of 6 weeks, or a wait-list group. Height and weight data of
both the children and the parents in the two groups were obtained at pre- and post-treatment (or
equivalent time for wait-list control), as well as, at a 6-month follow-up for those included in the
CAAT group. Results show that the intervention had a significant, short-term effect on the BMI
of children who participated in the CAAT group compared to children in the control group. At
follow-up, children maintained treatment-related changes in BMI.
Cason-Wilkerson, R., Goldberg, S., Albright, K., Allison, M., & Haemer, M. (2015). Factors
influencing healthy lifestyle changes: A qualitative look at low-income families engaged
in treatment for overweight children.Childhood Obesity, 11(2), 17-176.
doi:10.1089/chi.2014.0147
Researchers used a qualitative approach to understand how low-income families living in the
Denver, Colorado, metropolitan area accepted the Healthy Living Program (HeLP), a
community-based, family-oriented childhood obesity treatment program, and how they
incorporated treatment goals into daily life. Focus groups were conducted with parents who
completed at least 2 of the 12 program sessions. Barrier themes that emerged include: time and
financial cost, parent’s lack of time and energy, influence of family members, and challenges
regarding physical environment. Facilitators to implementing diet and physical activity

9. recommendations include: skill building for healthy eating, skill building for parenting, family
involvement, and concerns about quality of life. Despite barriers to lifestyle changes in an effort
to manage obesity, the families made positive dietary changes and increased physical activity.
Collins, C., Watson, J., & Burrows, T. (2010). Measuring dietary intake in children and
adolescents in the context of overweight and obesity. International Journal of
Obesity, 34(7), 1103-1115. doi:10.1038/ijo.2009.241
The study reviews current dietary intake assessment methodologies for children, identifies their
biases and suggests ways to improve reporting of dietary intakes.
Delgado-Noguera, M., Tort, S., Bonfill, X., Gich, I., & Alonso-Coello, P. (2009). Quality
assessment of clinical practice guidelines for the prevention and treatment of childhood
overweight and obesity. European Journal of Pediatrics, 168(7), 789-799.
doi:10.1007/s00431-008-0836-5
Researchers assessed the quality of the available clinical practice guidelines (CPGs) in the field
of prevention and treatment of childhood overweight and obesity. The AGREE instrument was
used to evaluate the quality of current CPGs. Analysis showed that only 6 out of the 22
guidelines could be recommended and applied.
de Niet, J., Timman, R., Rokx, C., Jongejan, M., Passchier, J., & van Den Akker, E. (2011).
Somatic complaints and social competence predict success in childhood overweight
treatment. International Journal of Pediatric Obesity, 6(2-2), e472-e479.
doi:10.3109/17477166.2011.575145

10. The study identified baseline characteristics as predictors of treatment success in terms of Body
Mass Index-Standard Deviation Scores (BMI-SDS) during the Big Friends Club (BFC) for
children with overweight and obesity. The intervention appears to be more effective in
decreasing BMI-SDS for children with Caucasian parents, with a lower BMI-SDS, and with
higher social competence scores. In addition, children with non-overweight parents, younger
children, and children with less somatic complains accomplish greater BMI-SDS reductions over
the course of one year.
Ewald, H., Kirby, J., Rees, K., & Robertson, W. (2014). Parent-only interventions in the
treatment of childhood obesity: A systematic review of randomized controlled
trials. Journal of Public Health,36(3), 476-489. doi:10.1093/pubmed/fdt108
The study sought to determine whether parent-only interventions are effective in the treatment of
obesity in children aged 5 – 12 years compared with child-only or parent and child interventions.
A systematic review of published and ongoing studies until 2013 revealed that parent-only
groups are either more effective than or similarly effective as child-only or parent- child
interventions in terms of change in degree of overweight.
Foster, G. D., Sundal, D., Lent, M. R., McDermott, C., Jelalian, E., & Vojta, D. (2014). 18‐
month outcomes of a community‐based treatment for childhood obesity.Pediatric
Obesity, 9(3), e63-e67. doi:10.1111/j.2047-6310.2013.00197.x
The study evaluated weight and quality of life outcomes in children and adolescents 1 year after
participating in the JOIN for ME trial, a community-based 6-month behavioral treatment for
childhood obesity administered in YMCAs. The primary outcome was change in child percent
over BMI from 6 – 18 months and 0 – 18 months. Changes in secondary outcomes (BMI z-score,

11. guardian weight, health-related quality of life) were also examined from 6 – 18 to 0 – 8 months.
The primary finding was that changes in relative weight and health-related quality of life
observed after 6 months of treatment persisted 1 year later. The intervention effectively reduced
BMI z-score and obesity prevalence but did not reduce percent over BMI from 0 to 18 months.
Geer, B., Porter, R., Haemer, M., & Krajicek, M. (2014). Increasing patient attendance in a
pediatric obesity clinic: A quality improvement project. Journal of Pediatric Nursing-
Nursing Care of Children & Families, 29(6), 528-535. doi:10.1016/j.pedn.2014.09.001
A quality improvement project was conducted at the weight management clinic (WMC) in order
to increase the average monthly attendance rate of patients seen for follow-up in a hospital-based
pediatric weight management clinic by 10% over the course of one year.
O'Keeffe, N., Purtill, E., Hegarty, M., & Glennon, C. (2008). Activity confidence and eating; a
pilot group approach to management of childhood overweight and obesity: Dietetic
perspective in an interdisciplinary team.Proceedings of the Nutrition Society, 67(OCE7)
doi:10.1017/S0029665108009245
Perea, A., Lopez, G., Santamaria, C., Ynga, M., Lara, A., & Padron, M. (2014). PO-0086 clinical
utility of the conjugated linoleic acid as adyuvant on overweight and obesity treatment in
child and adolescent. Archives of Disease in Childhood, 99(Suppl 2), A277-A277.
doi:10.1136/archdischild-2014-307384.756
Sargent, G. M. (2011). Successful treatment of childhood overweight and obesity in primary
health care and appropriate outcome measures: Development of a logic model. Obesity
Research & Clinical Practice, 5, 22-22. doi:10.1016/j.orcp.2011.08.096

12. Wilfley, D. E., Tibbs, T. L., Buren, D. J. V., Reach, K. P., Walker, M. S., & Epstein, L. H.
(2007). Lifestyle interventions in the treatment of childhood overweight: A meta-analytic
review of randomized controlled trials.Health Psychology, 26(5), 521-532.
doi:10.1037/0278-6133.26.5.521