Abstract
Effective obesity prevention and treatment interventions targeting children and their families are needed to help curb the obesity epidemic. Pediatric primary care is a promising setting for these interventions, and a growing number of studies are set in this context. This review aims to identify randomized controlled trials of pediatric primary care-based obesity interventions. A literature search of 3 databases retrieved 2947 publications, of which 2899 publications were excluded after abstract (n = 2722) and full-text review (n = 177). Forty-eight publications, representing 31 studies, were included in the review. Eight studies demonstrated a significant intervention effect on child weight outcomes (e.g., BMI z-score, weight-for-length percentile). Effective interventions were mainly treatment interventions, and tended to focus on multiple behaviors, contain weight management components, and include monitoring of weight-related behaviors (e.g., dietary intake, physical activity, or sedentary behaviors). Overall, results demonstrate modest support for the efficacy of obesity treatment interventions set in primary care.
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Whitaker RC, Wright JA, Pepe MS, Seidel KD, Dietz WH. Predicting obesity in young adulthood from childhood and parental obesity. New Engl J Med. 1997;337(13):869–73.
Singh AS, Mulder C, Twisk JW, Van Mechelen W, Chinapaw MJ. Tracking of childhood overweight into adulthood: a systematic review of the literature. Obes Rev. 2008;9(5):474–88.
Daniels SR, Arnett DK, Eckel RH, et al. Overweight in children and adolescents pathophysiology, consequences, prevention, and treatment. Circulation. 2005;111(15):1999–2012.
Sorof J, Daniels S. Obesity hypertension in children a problem of epidemic proportions. Hypertension. 2002;40(4):441–7.
Kelsey MM, Zaepfel A, Bjornstad P, Nadeau KJ. Age-related consequences of childhood obesity. Gerontology. 2014;60(3):222–8.
Magnussen CG, Smith KJ, Juonala M. What the long term cohort studies that began in childhood have taught us about the origins of coronary heart disease. Current Cardiovascular Risk Reports. 2014;8(2):1–10.
Katz M, Rubino A, Collier J, Rosen J, Ehrich JH. Demography of pediatric primary care in Europe: delivery of care and training. Pediatrics. 2002;109(5):788–96.
Kuo AA, Inkelas M, Lotstein DS, Samson KM, Schor EL, Halfon N. Rethinking well-child care in the United States: an international comparison. Pediatrics. 2006;118(4):1692–702.
van Esso D, del Torso S, Hadjipanayis A, et al. Paediatric primary care in Europe: variation between countries. Arch Dis Child. 2010;95(10):791–5.
Stettler N. Comment: The global epidemic of childhood obesity: is there a role for the paediatrician? Obes Rev. 2004;5(s 1):1–3.
Barlow SE. Expert committee recommendations regarding the prevention, assessment, and treatment of child and adolescent overweight and obesity: summary report. Pediatrics. 2007;120 Suppl 4:S164–92.
National Health and Medical Research Council. Summary guide for the management of overweight and obesity in primary care. Melbourne: National Health and Medical Research Council; 2013.
Lau DC, Douketis JD, Morrison KM, Hramiak IM, Sharma AM, Ur E. 2006 Canadian clinical practice guidelines on the management and prevention of obesity in adults and children [summary]. Can Med Assoc J. 2007;176(8):S1–S13.
National Institute for Health and Clinical Excellence. Obesity: the prevention, identification, assessment and management of overweight and obesity in adults and children. London, United Kingdom: National Institute for Health and Clinical Excellence; 2006: www.nice.org.uk/guidance/cg43.
King LA, Loss JH, Wilkenfeld RL, Pagnini DL, Booth ML, Booth SL. Australian GPs’ perceptions about child and adolescent overweight and obesity: the Weight of Opinion study. Brit J Gen Pract. 2007;57(535):124–9.
Walker O, Strong M, Atchinson R, Saunders J, Abbott J. A qualitative study of primary care clinicians’ views of treating childhood obesity. BMC Fam Pract. 2007;8(1):50.
Story MT, Neumark-Stzainer DR, Sherwood NE, et al. Management of child and adolescent obesity: attitudes, barriers, skills, and training needs among health care professionals. Pediatrics. 2002;110(1):210–4.
Jelalian E, Boergers J, Alday CS, Frank R. Survey of physician attitudes and practices related to pediatric obesity. Clin Pediatr (Phila). 2003;42(3):235–45.
Kolagotla L, Adams W. Ambulatory management of childhood obesity. Obes Res. 2004;12(2):275–83.
Yarborough BJH, DeBar LL, Wu P, Pearson J, Stevens VJ. Responding to pediatric providers’ perceived barriers to adolescent weight management. Clin Pediatr (Phila). 2012;51(11):1063–70.
Perrin EM, Flower KB, Garrett J, Ammerman AS. Preventing and treating obesity: pediatricians’ self-efficacy, barriers, resources, and advocacy. Ambul Pediatr. 2005;5(3):150–6.
Spivack JG, Swietlik M, Alessandrini E, Faith MS. Primary care providers’ knowledge, practices, and perceived barriers to the treatment and prevention of childhood obesity. Obesity (Silver Spring). 2010;18(7):1341–7.
Sivertsen LM, Woolfenden SR, Woodhead HJ, Lewis D. Diagnosis and management of childhood obesity: a survey of general practitioners in South West Sydney. J Paediatr Child H. 2008;44(11):622–9.
Franc C, Van Gerwen M, Le Vaillant M, Rosman S, Pelletier-Fleury N. French pediatricians’ knowledge, attitudes, beliefs towards and practices in the management of weight problems in children. Health Policy. 2009;91(2):195–203.
Mazur A, Matusik P, Revert K, et al. Childhood obesity: knowledge, attitudes, and practices of European pediatric care providers. Pediatrics. 2013;132(1):e100–8.
He M, Piché L, Clarson CL, Callaghan C, Harris SB. Childhood overweight and obesity management: a national perspective of primary health care providers’ views, practices, perceived barriers and needs. Paediatr Child Healt. 2010;15(7):419.
Rausch JC, Perito ER, Hametz P. Obesity prevention, screening, and treatment: practices of pediatric providers since the 2007 expert committee recommendations. Clin Pediatr (Phila). 2011;50(5):434–41.
Lowenstein LM, Perrin EM, Campbell MK, Tate DF, Cai J, Ammerman AS. Primary care providers’ self-efficacy and outcome expectations for childhood obesity counseling. Childhood Obesity. 2013;9(3):208–15.
Sharifi M, Rifas-Shiman SL, Marshall R, et al. Evaluating the implementation of expert committee recommendations for obesity assessment. Clin Pediatr (Phila). 2013;52(2):131–8.
Liang L, Meyerhoefer C, Wang J. Obesity counseling by pediatric health professionals: an assessment using nationally representative data. Pediatrics. 2012;130(1):67–77. This article uses the Medical Expenditure Panel Survey (2001–2007) to calculate nationally representative rates of parent-reported health care provider screening and counseling of childhood obesity and weight-related behaviors.
Tanda R, Salsberry P. The impact of the 2007 expert committee recommendations on childhood obesity preventive care in primary care settings in the United States. J Pediatr Health Car. 2014;28(3):241–50.
Rurik I, Torzsa P, Ilyés I, et al. Primary care obesity management in Hungary: evaluation of the knowledge, practice and attitudes of family physicians. BMC Fam Pract. 2013;14(1):156.
Hiscock H, Roberts G, Efron D, et al. Children Attending Paediatricians Study: a national prospective audit of outpatient practice from the Australian Paediatric Research Network—what conditions are paediatricians seeing in outpatient settings? Med J Australia. 2011;194(8):392.
Goldman RD, Modan-Moses D, Bujanover Y, Glasser S, Meyerovitch J. Physicians’ attitude toward identification and management of childhood obesity in Israel. Clin Pediatr (Phila). 2004;43(8):737–41.
Klein JD, Sesselberg TS, Johnson MS, et al. Adoption of body mass index guidelines for screening and counseling in pediatric practice. Pediatrics. 2010;125(2):265–72.
Isma GE, Bramhagen A-C, Ahlstrom G, Östman M, Dykes A-K. Obstacles to the prevention of overweight and obesity in the context of child health care in Sweden. BMC Fam Pract. 2013;14(1):143.
Sargent G, Pilotto L, Baur L. Components of primary care interventions to treat childhood overweight and obesity: a systematic review of effect. Obes Rev. 2011;12(5):e219–35.
Marild S, Gronowitz E, Forsell C, Dahlgren J, Friberg P. A controlled study of lifestyle treatment in primary care for children with obesity. Pediatr Obes. 2013;8(3):207–17.
French SA, Mitchell NR, Hannan PJ. Decrease in television viewing predicts lower body mass index at 1-year follow-up in adolescents, but not adults. J Nutr Educ Behav. 2012;44(5):415–22.
Nicholson LM, Schwirian PM, Klein EG, et al. Recruitment and retention strategies in longitudinal clinical studies with low-income populations. Contemp Clin Trials. 2011;32(3):353–62.
Hakanen M, Lagstrom H, Pahkala K, et al. Dietary and lifestyle counselling reduces the clustering of overweight-related cardiometabolic risk factors in adolescents. Acta Paediatr. 2010;99(6):888–95.
Lapinleimu H, Salo P, Routi T, et al. Prospective randomised trial in 1062 infants of diet low in saturated fat and cholesterol. Lancet. 1995;345(8948):471–6.
Lagstrom H, Hakanen M, Niinikoski H, et al. Growth patterns and obesity development in overweight or normal-weight 13-year-old adolescents: the STRIP study. Pediatrics. 2008;122(4):e876–83.
Talvia S, Rasanen L, Lagstrom H, et al. Parental eating attitudes and indicators of healthy eating in a longitudinal randomized dietary intervention trial (the STRIP study). Public Health Nutr. 2011;14(11):2065–73.
Niinikoski H, Lagstrom H, Jokinen E, et al. Impact of repeated dietary counseling between infancy and 14 years of age on dietary intakes and serum lipids and lipoproteins: the STRIP study. Circulation. 2007;116(9):1032–40.
Pahkala K, Heinonen OJ, Lagstrom H, et al. Clustered metabolic risk and leisure-time physical activity in adolescents: effect of dose? Br J Sports Med. 2012;46(2):131–7.
Hakanen M, Lagström H, Kaitosaari T, et al. Development of overweight in an atherosclerosis prevention trial starting in early childhood. STRIP study Int J Obesity. 2006;30(4):618–26.
Martin RM, Patel R, Kramer MS, et al. Effects of promoting longer-term and exclusive breastfeeding on adiposity and insulin-like growth factor-I at age 11.5 years: a randomized trial. JAMA. 2013;309(10):1005–13.
Kramer MS, Chalmers B, Hodnett ED, et al. Promotion of Breastfeeding Intervention Trial (PROBIT): a randomized trial in the Republic of Belarus. JAMA. 2001;285(4):413–20.
Paul IM, Savage JS, Anzman SL, et al. Preventing obesity during infancy: a pilot study. Obesity (Silver Spring). 2011;19(2):353–61.
Anzman-Frasca S, Stifter CA, Paul IM, Birch LL. Infant temperament and maternal parenting self-efficacy predict child weight outcomes. Infant Behav Dev. 2013;36(4):494–7.
Wake M, Price A, Clifford S, Ukoumunne OC, Hiscock H. Does an intervention that improves infant sleep also improve overweight at age 6? Follow-up of a randomised trial. Arch Dis Child. 2011;96(6):526–32.
Price AM, Wake M, Ukoumunne OC, Hiscock H. Five-year follow-up of harms and benefits of behavioral infant sleep intervention: randomized trial. Pediatrics. 2012;130(4):643–51.
Hiscock H, Bayer J, Gold L, Hampton A, Ukoumunne O, Wake M. Improving infant sleep and maternal mental health: a cluster randomised trial. Arch Dis Child. 2006.
Birken CS, Maguire J, Mekky M, et al. Office-based randomized controlled trial to reduce screen time in preschool children. Pediatrics. 2012;130(6):1110–5.
Quattrin T, Roemmich JN, Paluch R, Yu J, Epstein LH, Ecker MA. Efficacy of family-based weight control program for preschool children in primary care. Pediatrics. 2012;130(4):660–6.
Stark LJ, Spear S, Boles R, et al. A pilot randomized controlled trial of a clinic and home-based behavioral intervention to decrease obesity in preschoolers. Obesity (Silver Spring). 2011;19(1):134–41.
Taveras EM, Gortmaker SL, Hohman KH, et al. Randomized controlled trial to improve primary care to prevent and manage childhood obesity: the High Five for Kids study. Arch Pediatr Adolesc Med. 2011;165(8):714–22.
Taveras EM, Hohman KH, Price SN, et al. Correlates of participation in a pediatric primary care-based obesity prevention intervention. Obesity (Silver Spring). 2011;19(2):449–52.
Woo Baidal JA, Price SN, Gonzalez-Suarez E, et al. Parental perceptions of a motivational interviewing-based pediatric obesity prevention intervention. Clin Pediatr (Phila). 2013;52(6):540–8.
Arauz Boudreau AD, Kurowski DS, Gonzalez WI, Dimond MA, Oreskovic NM. Latino families, primary care, and childhood obesity: a randomized controlled trial. Am J Prev Med. 2013;44(3):S247–57.
Banks J, Sharp DJ, Hunt LP, Shield JP. Evaluating the transferability of a hospital-based childhood obesity clinic to primary care: a randomised controlled trial. Br J Gen Pract. 2012;62(594):e6–e12.
Banks J, Shield JP, Sharp D. Barriers engaging families and GPs in childhood weight management strategies. Br J Gen Pract. 2011;61(589):e492–7.
Banks J, Williams J, Cumberlidge T, Cimonetti T, Sharp DJ, Shield JP. Is healthy eating for obese children necessarily more costly for families? Br J Gen Pract. 2012;62(594):e1–5.
Hollinghurst S, Hunt LP, Banks J, Sharp DJ, Shield JP. Cost and effectiveness of treatment options for childhood obesity. Pediatr Obes. 2014;9(1):e26–34.
Barkin SL, Gesell SB, Poe EK, Ip EH. Changing overweight Latino preadolescent body mass index: the effect of the parent–child dyad. Clin Pediatr (Phila). 2011;50(1):29–36.
Gesell SB, Scott TA, Barkin SL. Accuracy of perception of body size among overweight Latino preadolescents after a 6-month physical activity skills building intervention. Clin Pediatr (Phila). 2010;49(4):323–9.
Guzmn A, Richardson IM, Gesell S, Barkin SL. Recruitment and retention of Latino children in a lifestyle intervention. Am J Health Behav. 2009;33(5):581–6.
Davis AM, Sampilo M, Gallagher KS, Landrum Y, Malone B. Treating rural pediatric obesity through telemedicine: outcomes from a small randomized controlled trial. J Pediatr Psychol. 2013;38(9):932–43.
Gallagher KS, Davis AM, Malone B, Landrum Y, Black W. Treating rural pediatric obesity through telemedicine: baseline data from a randomized controlled trial. J Pediatr Psychol. 2011;36(6):687–95.
Davis AM, James RL, Boles RE, Goetz JR, Belmont J, Malone B. The use of TeleMedicine in the treatment of paediatric obesity: feasibility and acceptability. Matern Child Nutr. 2011;7(1):71–9.
Diaz RG, Esparza-Romero J, Moya-Camarena SY, Robles-Sardin AE, Valencia ME. Lifestyle intervention in primary care settings improves obesity parameters among Mexican youth. J Am Diet Assoc. 2010;110(2):285–90.
Duggins M, Cherven P, Carrithers J, Messamore J, Harvey A. Impact of family YMCA membership on childhood obesity: a randomized controlled effectiveness trial. J Am Board Fam Med. 2010;23(3):323–33.
Gillis D, Brauner M, Granot E. A community-based behavior modification intervention for childhood obesity. J Pediatr Endocrinol Metab. 2007;20(2):197–203.
McCallum Z, Wake M, Gerner B, et al. Outcome data from the LEAP (Live, Eat and Play) trial: a randomized controlled trial of a primary care intervention for childhood overweight/mild obesity. Int J Obesity. 2007;31(4):630–6.
McCallum Z, Wake M, Gerner B, et al. Can Australian general practitioners tackle childhood overweight/obesity? Methods and processes from the LEAP (Live, Eat and Play) randomized controlled trial. J Paediatr Child H. 2005;41(9–10):488–94.
Wake M, Gold L, McCallum Z, Gerner B, Waters E. Economic evaluation of a primary care trial to reduce weight gain in overweight/obese children: the LEAP trial. Ambul Pediatr. 2008;8(5):336–41.
Rogers L, Gerner B, Wake M. LEAP trial. Aust Fam Physician. 2007;36(11):887–8.
Nova A, Russo A, Sala E. Long-term management of obesity in paediatric office practice: experimental evaluation of two different types of intervention. Ambulatory Child Health. 2001;7(3–4):239–47.
O’Connor TM, Hilmers A, Watson K, Baranowski T, Giardino AP. Feasibility of an obesity intervention for paediatric primary care targeting parenting and children: Helping HAND. Child Care Health Dev. 2013;39(1):141–9.
Ledoux T, Hilmers A, Watson K, Baranowski T, O’Connor TM. Development and feasibility of an objective measure of patient-centered communication fidelity in a pediatric obesity intervention. J Nutr Educ Behav. 2013;45(4):349–54.
Small L, Bonds-McClain D, Melnyk B, Vaughan L, Gannon AM. The preliminary effects of a primary care–based randomized treatment trial with overweight and obese young children and their parents. J Pediatr Health Car. 2014;28(3):198–207.
van Grieken A, Veldhuis L, Renders CM, et al. Population-based childhood overweight prevention: outcomes of the ‘Be active, eat right’ study. PLoS One. 2013;8(5):e65376.
Veldhuis L, Struijk MK, Kroeze W, et al. ‘Be active, eat right’, evaluation of an overweight prevention protocol among 5-year-old children: design of a cluster randomised controlled trial. BMC Public Health. 2009;9:177.
Wake M, Baur LA, Gerner B, et al. Outcomes and costs of primary care surveillance and intervention for overweight or obese children: the LEAP 2 randomised controlled trial. BMJ. 2009;339:b3308.
Wake M, Lycett K, Clifford SA, et al. Shared care obesity management in 3–10 year old children: 12 month outcomes of HopSCOTCH randomised trial. BMJ. 2013;346:f3092.
Wake M, Lycett K, Sabin MA, et al. A shared-care model of obesity treatment for 3–10 year old children: protocol for the HopSCOTCH randomised controlled trial. BMC Pediatr. 2012;12:39.
Weigel C, Kokocinski K, Lederer P, Dotsch J, Rascher W, Knerr I. Childhood obesity: concept, feasibility, and interim results of a local group-based, long-term treatment program. J Nutr Educ Behav. 2008;40(6):369–73.
Wright JA, Phillips BD, Watson BL, Newby PK, Norman GJ, Adams WG. Randomized trial of a family-based, automated, conversational obesity treatment program for underserved populations. Obesity (Silver Spring). 2013;21(9):E369–78.
Patrick K, Calfas KJ, Norman GJ, et al. Randomized controlled trial of a primary care and home-based intervention for physical activity and nutrition behaviors: PACE+ for adolescents. Arch Pediatr Adolesc Med. 2006;160(2):128–36.
DeBar LL, Stevens VJ, Perrin N, et al. A primary care-based, multicomponent lifestyle intervention for overweight adolescent females. Pediatrics. 2012;129(3):e611–20.
Macdonell K, Brogan K, Naar-King S, Ellis D, Marshall S. A pilot study of motivational interviewing targeting weight-related behaviors in overweight or obese African American adolescents. J Adolesc Health. 2012;50(2):201–3.
Saelens BE, Sallis JF, Wilfley DE, Patrick K, Cella JA, Buchta R. Behavioral weight control for overweight adolescents initiated in primary care. Obes Res. 2002;10(1):22–32.
Force UPST. Screening for obesity in children and adolescents: US Preventive Services Task Force recommendation statement. Pediatrics. 2010;125(2):361–7.
Doolen J, Alpert PT, Miller SK. Parental disconnect between perceived and actual weight status of children: a metasynthesis of the current research. J Am Acad Nurse Pract. 2009;21(3):160–6.
Pollak KI, Alexander SC, Østbye T, et al. Primary care physicians’ discussions of weight-related topics with overweight and obese adolescents: results from the Teen CHAT Pilot study. J Adolescent Health. 2009;45(2):205–7.
Bravender T, Tulsky JA, Farrell D, et al. Teen CHAT: development and utilization of a web-based intervention to improve physician communication with adolescents about healthy weight. Patient Educ Couns. 2013;93(3):525–31. This article describes a promising online training for pediatric health care providers on motivational interviewing skills for counseling patients on obesity and weight-related behaviors.
Ariza AJ, Hartman J, Grodecki J, et al. Linking pediatric primary care obesity management to community programs. J Health Care Poor U. 2013;24(2):158–67.
DuPlessis HM, Boulter CSC, Cora-Bramble D, et al. The pediatrician’s role in community pediatrics. Pediatrics. 2005;115:1092–4.
Pediatrics AAO. AAP publications reaffirmed and retired. Pediatrics. 2010;126(1):177.
Sherwood NE, French SA, Veblen-Mortenson S, et al. NET-Works: linking families, communities and primary care to prevent obesity in preschool-age children. Contemp Clin Trials. 2013;36(2):544–54.
Robinson TN, Matheson D, Desai M, et al. Family, community and clinic collaboration to treat overweight and obese children: Stanford GOALS-A randomized controlled trial of a three-year, multi-component, multi-level, multi-setting intervention. Contemp Clin Trials. 2013;36(2):421–35.
Steinberg L, Morris AS. Adolescent development. Annu Rev Psychol. 2001;52:83–110.
Shrewsbury VA, Nguyen B, O’Connor J, et al. Short-term outcomes of community-based adolescent weight management: The Loozit(R) Study. BMC Pediatr. 2011;11:13.
Acknowledgments
The project was supported by Grant Numbers 1R01DK084475 (PI: Sherwood), P30DK050456 (PI: Levine), and P30DK092924 (PI: Schmittdiel) from the National Institute of Diabetes and Digestive and Kidney Diseases.
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Elisabeth M. Seburg, Barbara A. Olson-Bullis, Dani M. Bredeson, Marcia G. Hayes, and Nancy E. Sherwood declare that they have no conflict of interest.
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Seburg, E.M., Olson-Bullis, B.A., Bredeson, D.M. et al. A Review of Primary Care-Based Childhood Obesity Prevention and Treatment Interventions. Curr Obes Rep 4, 157–173 (2015). https://doi.org/10.1007/s13679-015-0160-0
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DOI: https://doi.org/10.1007/s13679-015-0160-0