Highly integrated childhood obesity prevention programs: a systematic review with meta-analysis [Comunicazione breve]

Background\r\nChildhood obesity (CO) is a global public health issue. 1 out of\r\n10 children is obese or overweight, with differences among\r\ngeographical areas. CO impact is impressive for morbidity,\r\nexpectation of life reduction, direct and indirect costs.\r\nIntegrated actions to face this issue are needed. Highly\r\nintegrated prevention programs are proactive multi-tiers/\r\nmulti-setting/multi-component interventions tailored to specified targets. The aim of this study is to assess these\r\nprograms to highlight their effectiveness in reducing prevalence\r\nof overweight and obesity in childhood population.\r\nMethods\r\nA systematic review has been conducted up to February 2015.\r\nThe search was performed querying Medline and Scopus\r\ndatabases through the keywords: prevention and control,\r\nchildhood obesity, coordinated program, community based,\r\nintegrated approach. Meta-analysis was carried out with\r\nRevMan 5.3. Begg and Egger tests, one-way sensitivity analysis,\r\nwhen appropriate, and subgroup analyses for different\r\ngeographical areas were performed.\r\nResults\r\nOut of the 335 retrieved studies 25 were finally included\r\ndescribing 13 ‘highly integrated’ community prevention\r\nprograms all facing childhood overweight and obesity with a\r\nmulti-component and multi-setting approach, based on diet\r\nand physical activity. Meta-analysis confirmed the reduction of\r\noverweight and obesity prevalence among the participants in\r\nthe communities of intervention (RR = 0.90; 95%IC = 0.84–\r\n0.96) with a p for heterogeneity=0.01; I2 = 58%. Differences\r\nwere found related to geographical area with a RR = 0.80\r\n(95%IC = 0.64–0.99; p = 0.03; I2 = 72%) obtained for Europe\r\nand a RR = 0.80 (95%IC = 0.68-0.95; p = 0.004; I2 = 82 %) for\r\nAustralia.\r\nConclusions\r\nHighly integrated targeted prevention programs have been\r\nshown to be effective in facing CO. The goal is to build an\r\nactivated community in a single public health program\r\ncoordinated across the partner organisations and the three\r\ndifferent tiers (strategic, delivery, community) within a defined\r\narea.\r\nKey messages\r\n Such highly integrated community programs can represent\r\nan important instrument aimed at fighting the obesity\r\nepidemic among children especially in countries where\r\nwellness is part of their culture\r\n Structured/multi component cooperation among health\r\nauthorities, schools and communities in childhood obesity\r\nprevention is more powerful than a single action.