Abstract
BackgroundA better understanding of the optimal “dose” of behavioral interventions to affect change in weight-related outcomes is a critical topic for childhood obesity intervention research. The objective of this review was to quantify the relationship between dose and outcome in behavioral trials targeting childhood obesity to guide future intervention development.MethodsA systematic review and meta-regression included randomized controlled trials published between 1990 and June 2017 that tested a behavioral intervention for obesity among children 2–18 years old. Searches were conducted among PubMed (Web-based), Cumulative Index to Nursing and Allied Health Literature (EBSCO platform), PsycINFO (Ovid platform) and EMBASE (Ovid Platform). Two coders independently reviewed and abstracted each included study. Dose was extracted as intended intervention duration, number of sessions, and length of sessions. Standardized effect sizes were calculated from change in weight-related outcome (e.g., BMI-Z score).ResultsOf the 258 studies identified, 133 had sufficient data to be included in the meta-regression. Average intended total contact (# sessions x length of sessions) was 27.7 (SD 32.2) hours and average duration was 26.0 (SD 23.4) weeks. When controlling for study covariates, a random-effects meta-regression revealed no significant association between contact hours, intended duration or their interaction and effect size.ConclusionsThis systematic review identified wide variation in the dose of behavioral interventions to prevent and treat pediatric obesity, but was unable to detect a clear relationship between dose and weight-related outcomes. There is insufficient evidence to provide quantitative guidance for future intervention development. One limitation of this review was the ability to uniformly quantify dose due to a wide range of reporting strategies. Future trials should report dose intended, delivered, and received to facilitate quantitative evaluation of optimal dose.Trial registrationsThe protocol was registered on PROSPERO (Registration #CRD42016036124).
Highlights
A better understanding of the optimal “dose” of behavioral interventions to affect change in weightrelated outcomes is a critical topic for childhood obesity intervention research
With several areas of research supporting the notion that dose is related to efficacy in behavioral interventions, the pediatric research community is left with a critical unanswered question: how much exposure to a behavioral intervention over what period of time is necessary to affect sustainable behavior change and reduce childhood obesity?
Whether the lack of an association between dose intensity and change in weight-related outcome is because behavior change is non-linear or whether variability in the reporting of both dose and outcome obscured a relationship
Summary
A better understanding of the optimal “dose” of behavioral interventions to affect change in weightrelated outcomes is a critical topic for childhood obesity intervention research. Systematic reviews that have attempted to draw meaningful conclusions from randomized controlled trials of these interventions have pointed to modestly efficacious results [1,2,3,4,5,6]. These same reviews highlight a wide range of variability both in the approach taken (e.g., type of intervention, setting, and age group) and in the evaluative methods employed (e.g., strength of trial designs, measurement approaches, and reporting of processes). With several areas of research supporting the notion that dose is related to efficacy in behavioral interventions, the pediatric research community is left with a critical unanswered question: how much exposure to a behavioral intervention over what period of time is necessary to affect sustainable behavior change and reduce childhood obesity?
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