Effectiveness of behavioural and psychological interventions for managing obesity in children and adolescents: A systematic review and meta-analysis framed using minimal important difference estimates based on GRADE guidance to inform a clinical practice guideline

M Henderson; S A Moore; S Harnois-Leblanc; B C Johnston; D Fitzpatrick-Lewis; A M Usman; D Sherifali; R Merdad; A M Rigsby; Z Esmaeilinezhad; K M Morrison; J Hamilton; G D C Ball; C S Birken; Steering Committee for Updating Canada's Clinical Practice Guideline for Managing Pediatric Obesity

doi:10.1111/ijpo.13193

Effectiveness of behavioural and psychological interventions for managing obesity in children and adolescents: A systematic review and meta-analysis framed using minimal important difference estimates based on GRADE guidance to inform a clinical practice guideline

Pediatr Obes. 2025 Mar;20(3):e13193. doi: 10.1111/ijpo.13193. Epub 2025 Jan 16.

Authors

M Henderson^{1

2

3}, S A Moore^{4

5}, S Harnois-Leblanc^{1

6}, B C Johnston^{7

8}, D Fitzpatrick-Lewis^{9

10}, A M Usman^{10

11}, D Sherifali^{9

10}, R Merdad¹², A M Rigsby⁷, Z Esmaeilinezhad⁷, K M Morrison^{13

14}, J Hamilton^{15

16}, G D C Ball¹⁷, C S Birken^{16

18}; Steering Committee for Updating Canada's Clinical Practice Guideline for Managing Pediatric Obesity

Collaborators

Steering Committee for Updating Canada's Clinical Practice Guideline for Managing Pediatric Obesity:
Annick Buchholz, Jennifer Cantwell, Jenny Cooper, Julius Erdstein, Stasia Hadjiyannakis, Dawn Hatanaka, Tracy Lebel, Patrice Lindsay, Katherine Morrison, Shawn Page, Nicole Pearce, Meghan Sebastianski, Julie St-Pierre, Jessica Wijesundera, Ian Zenlea

Affiliations

¹ Sainte-Justine University Hospital Research Center, Université de Montréal, Montréal, Quebec, Canada.
² Department of Pediatrics, Faculty of Medicine, Université de Montréal, Montréal, Quebec, Canada.
³ Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, Montréal, Quebec, Canada.
⁴ School of Health and Human Performance, Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada.
⁵ Department of Pediatrics, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.
⁶ Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, Massachusetts, USA.
⁷ Department of Nutrition, College of Agriculture and Life Science, Texas A&M University, College Station, Texas, USA.
⁸ Department of Epidemiology and Biostatistics, School of Public Health, Texas A&M University, College Station, Texas, USA.
⁹ School of Nursing, McMaster University, Hamilton, Ontario, Canada.
¹⁰ McMaster Evidence Review and Synthesis Team, McMaster University, Hamilton, Ontario, Canada.
¹¹ Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.
¹² Department of Community Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia.
¹³ Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada.
¹⁴ McMaster Children's Hospital, Hamilton, Ontario, Canada.
¹⁵ The Hospital for Sick Children, Toronto, Ontario, Canada.
¹⁶ Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.
¹⁷ Department of Pediatrics, Faculty of Medicine & Dentistry, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada.
¹⁸ Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada.

Abstract

Objective: Conduct a systematic review and meta-analysis of randomized controlled trials (RCTs) of behavioural and psychological interventions for managing paediatric obesity.

Methods: Eligible studies, published between 1985 and 2022, included 0 to 18 year olds with outcomes reported ≥3 months post-baseline, including patient-reported outcome measures (PROMs), cardiometabolic and anthropometric outcomes, and adverse events (AEs). We pooled data using a random effects model and assessed certainty of evidence (CoE) related to minimally important difference estimates for outcomes using GRADE.

Results: We included 73 unique RCTs (n = 6305 participants, 53% female). Intervention types included physical activity (n = 1437), nutrition (n = 447), psychological (n = 1336), technology-based (n = 901) or multicomponent (≥2 intervention types, n = 2184). Physical activity had a small effect on health-related quality of life (HRQoL), varying effects ranging from moderate to very large on blood pressure, lipids and insulin resistance, and a small effect on BMIz. Nutrition had a small effect on lipids, insulin resistance and BMIz. Psychological interventions showed a small effect on HRQoL and triglycerides and moderate benefits on depressive symptoms, while technology interventions showed small benefits on blood pressure and BMIz. Multicomponent interventions had a large benefit on anxiety, small benefit on depressive symptoms, with large to very large benefits on lipids, and small benefits for diastolic blood pressure, insulin resistance and BMIz. AEs were reported infrequently, and when reported, were described as mild.

Conclusion: Physical activity and multicomponent interventions showed improvements in PROMs, cardiometabolic and anthropometric outcomes. Future trials should consistently measure PROMs, evaluate outcomes beyond the intervention period, and study children <6 years of age.

Keywords: behavioural interventions; lifestyle interventions; meta‐analysis; paediatric obesity; randomized controlled trials; systematic review.

Publication types

Systematic Review
Meta-Analysis

MeSH terms

Adolescent
Behavior Therapy* / methods
Child
Exercise
Female
Humans
Male
Pediatric Obesity* / psychology
Pediatric Obesity* / therapy
Practice Guidelines as Topic
Psychosocial Intervention / methods
Quality of Life
Randomized Controlled Trials as Topic
Treatment Outcome