Highly integrated childhood obesity prevention programs: a systematic review with meta-analysis

Background Childhood obesity (CO) is a global public health issu. 1 out of 10 children is obese or overweight, with differences among geographical areas. CO impact is impressive for morbidity, expectation of life reduction, direct and indirect costs. Integrated actions to face this issue are needed. Highly integrated prevention programs are proactive multi-tiers/ multi-setting/multi-component interventions tailored to specified targets. The aim of this study is to assess these programs to highlight their effectiveness in reducing prevalence of overweight and obesity in childhood population. Methods A systematic review has been conducted up to February 2015. The search was performed querying Medline and Scopus databases through the keywords: prevention and control, childhood obesity, coordinated program, community based, integrated approach. Meta-analysis was carried out with RevMan 5.3. Begg and Egger tests, one-way sensitivity analysis, when appropriate, and subgroup analyses for different geographical areas were performed. Results Out of the 335 retrieved studies 25 were finally included describing 13 ‘highly integrated’ community prevention programs all facing childhood overweight and obesity with a multi-component and multi-setting approach, based on diet and physical activity. Meta-analysis confirmed the reduction of overweight and obesity prevalence among the participants in the communities of intervention (RR = 0.90; 95%IC = 0.84– 0.96) with a p for heterogeneity=0.01; I2 = 58%. Differences were found related to geographical area with a RR = 0.80 (95%IC = 0.64–0.99; p = 0.03; I2 = 72%) obtained for Europe and a RR = 0.80 (95%IC = 0.68-0.95; p = 0.004; I2 = 82 %) for Australia. Conclusions Highly integrated targeted prevention programs have been shown to be effective in facing CO. The goal is to build an activated community in a single public health program coordinated across the partner organisations and the three different tiers (strategic, delivery, community) within a defined area. Key messages Such highly integrated community programs can represent an important instrument aimed at fighting the obesity epidemic among children especially in countries where wellness is part of their culture Structured/multi component cooperation among health authorities, schools and communities in childhood obesity prevention is more powerful than a single actio