Open Access Highly Accessed Research article

The impact of interventions to prevent obesity or improve obesity related behaviours in children (0–5 years) from socioeconomically disadvantaged and/or indigenous families: a systematic review

Rachel Laws16*, Karen J Campbell16, Paige van der Pligt1, Georgina Russell26, Kylie Ball16, John Lynch36, David Crawford16, Rachael Taylor56, Deborah Askew46 and Elizabeth Denney-Wilson26

Author Affiliations

1 Centre for Physical Activity and Nutrition Research, Deakin University, 221 Burwood Highway, Burwood, VIC 3125, Australia

2 Faculty of Health, University of Technology, Sydney, NSW, Australia

3 School of Population Health, University of Adelaide, Adelaide, SA, Australia

4 Inala Indigenous Health Service, Inala, QLD, Australia

5 University of Otago, Dunedin, New Zealand

6 Centre for Obesity Management and Prevention Research Excellence in Primary Health Care (COMPaRE-PHC), Australia

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BMC Public Health 2014, 14:779  doi:10.1186/1471-2458-14-779

Published: 1 August 2014

Abstract

Background

Children from disadvantaged families including those from low socioeconomic backgrounds and Indigenous families have higher rates of obesity, making early intervention a priority. The aim of this study was to systematically review the literature to examine the effectiveness of interventions to prevent obesity or improve obesity related behaviours in children 0-5 years from socioeconomically disadvantaged or Indigenous families.

Methods

Searches of major electronic databases identified articles published from 1993–2013 targeting feeding practices, anthropometric, diet, activity or sedentary behaviour outcomes. This was supplemented with snowballing from existing reviews and primary studies. Data extraction was undertaken by one author and cross checked by another. Quality assessments included both internal and external validity.

Results

Thirty-two studies were identified, with only two (both low quality) in Indigenous groups. Fourteen studies had a primary aim to prevent obesity. Mean differences between intervention and control groups ranged from -0.29 kg/m2 to -0.54 kg/m2 for body mass index (BMI) and -2.9 to -25.6% for the prevalence of overweight/obesity. Interventions initiated in infancy (under two years) had a positive impact on obesity related behaviours (e.g. diet quality) but few measured the longer-term impact on healthy weight gain. Findings amongst pre-schoolers (3–5 years) were mixed, with the more successful interventions requiring high levels of parental engagement, use of behaviour change techniques, a focus on skill building and links to community resources. Less than 10% of studies were high quality. Future studies should focus on improving study quality, including follow-up of longer-term anthropometric outcomes, assessments of cost effectiveness, acceptability in target populations and potential for implementation in routine service delivery.

Conclusion

There is an urgent need for further research on effective obesity prevention interventions for Indigenous children. The findings from the growing body of intervention research focusing on obesity prevention amongst young children from socioeconomically disadvantaged families suggest intervention effects are modest but promising. Further high quality studies with longer term follow up are required.

Trial registration

PROSPERO Registration no: CRD42013006536.

Keywords:
Obesity prevention; Children; Socioeconomically disadvantaged; Indigenous