Table 1

Characteristics of studies reporting adiposity outcomes with results of mean change in BMI-SDS and percentage body fat

Author,
Country,
(Intervention name)
Study design:
Sample size (n)
Analysed (An)
Obesity definitionAge range (inclusion):
Mean ± (SD)
Sex (% F)
Pubertal status measuredDiet D)/
Exercise (E)/
D+E:
Setting
Format & contentDuration
(months):
Follow up
(months)
Method of % body fat measurementΔ BMI SDS/
z-score
by subgroup when reported
Δ % body fat score
by subgroup when reported
1Bell et al 52
Australia
Cohort
Total = 14 (14)
BMI ≥95th %ileAge range:
9–16
12.70(2.32); F=43%
Yes—TannerE:
community
8 weeks structured circuits exercise training: 3 x 1hr sessions/week. No standard dietary modifications.2:
0
DXAAll: −0.03All: −0.57
2Bock et al 53
Canada
HIP KIDS
Cohort:
Total = 42 (41)
BMI ≥95th %ile
(CDC)
Age range:
8–17
12.8 ±3.14; F=50%
Yes—TannerD+E:
Clinic (Hospital)
Intensive phase (3 months): bi-weekly 90 min counselling. Maintenance phase (9 months): alternating mthly GP or individual sessions (90 mins). Sessions focus on exercise/psychosocial/behavioural aspects.12:
0
BIAAll: −0.04All: −1.39
3Bruyndonckz et al 36
Belgium
Quasi-RCT:
Total = 61
IG = 33 (27)
CG = 28 (21)
BMI ≥97th %ile adolescents <16 years; BMI ≥35 adolescents ≥16 yearsAge range:
12–18
IG: 15.4±1.5; F = 79%
CG: 15.1±1.2;
F=73%
NRD+E:
Clinic (Hospital)
Intervention: Dietary restriction 1500-1800 kcal/day + 2 hrs/day supervised play/lifestyle activities + 2hrs/wk PE + 3 x 40min/wk supervised training session.
Control: Usual care.
10:
0
Subsample also measured using DXAIG: −1.21
CG: 0.13
IG: −11.30
CG: 0.4
4Bustos et al 54
Chile
Cohort:
Total = 50 (28 completed)
CDCAge range: NR
9.5 ±1.9; F=48%
NRD+E:
Academic Institution
Nutrition/behavioural modification session 40 min/wk + PA 50 min x2/wk+ Family support every 15 days for first 2 months, then monthly.8:
0
DXAAll: −0.3All: −3.00
5Calcaterra et al 55 ItalyCohort: Total = 22 (22)BMI > 95th %ileAge range:
9−16
13.23 ± 1.76; F=41%
Yes - TannerE:
Academic Institution
2 x 90 mins exercise training sessions/wk3:
0
BIAAll: −0.15All: −3.30
6Dobe et al 46 Germany
OBELDICKS – mini
Cohort:
Total = 103 (103)
>97th to 99.5 percentileAge range:
4−8
6.1 ±1
F=56%
NRD+E:
Academic Institution
Obeldicks mini: focus on training parents (22.5 hrs for parents, 4.5 hrs for children). Group sessions. Parents+children classes every 4th session,
Children’s classes: 9 x monthly sessions (30 mins): 1 x introduction; 3 x diet; 5 x eating habits
Parenting classes: 13 x monthly sessions (1.5 hrs): 1x introduction 1x medicine 3x nutrition 5x eating habits + education tips
3x discussion circle
Individual consultation: every 2 months (30 mins)
Exercise: 50 x weekly sessions (1.5 hrs)
12:
0
BIAObeldicks-mini: −0.46Obeldicks mini: −3.00
7Farpour-Lambert et al 56
Switzerland
RCT:
Total = 44
IG= 22 (22)
OC =22 (22)
BMI >97th %ileAge range:
6-11
8.9 ± 1.5
IG: F=59%
OC: F= 68%
YesE
Clinic (Hospital)
180 min/wk PA + 135 min/wk PE3:
0
Skinfold measurementsIG: -0.1
CG: 0
IG: -1.50
CG: 0.80
8Ford et al 48 57
UK
RCT:
Total = 106 (91)
Gp1 SC = 52 (46)
Gp 2 Mandometer = 54 (45)
BMI ≥95th %ile (CDC)Mandometer: 9.0−16.9
SC: 9.1−17.5
Mandometer: 12.7±2.2
SC: 12.5±2.3 overall F=56%
YesD
Clinic (Hospital)
Mandometer device to regulate rate of eating and total intake vs SC12:
0
DXAIG: −0.36
CG: −0.14
IG: −4.60
CG: −1.30
9Gajewska et al 37
Poland
Cohort:
Total = 100 (76)
With WL =71 (56)
Without WL = 29 (20)
BMI SDS >2Age range:
5−10
with WL: 8.1 (6.8−9.2); F= 51%
without WL: 8.8(7.3−9.6);
F=59%
overall F = 53%
Reported with Tanner stage, any with pubertal develop-ment excluded.D+E:
Community & Academic institution
3-month intervention, low energy diet (1200−1400kcal), 3−5 meals every day, instructions concerning PA, 10−14 food day diary, 3-day food diary.3:
0
BIAWL: −0.98
No WL:−0.2
WL: −2.90
No WL:0.30
10Garanty-Bogacka et al 58
Poland
Cohort:
Total = 50 (50)
BMI >97th %ile (Polish ref pop.)Age range:
8−18
14.2 ±2.6; F=58%
YesD+E:
Clinic (Hospital)
Exercise therapy (Instructions in PA + reducing sedentary behaviour) + reduction in fat and sugar intake.6:
0
Skinfold measurements & Lohman’s formulaAll:−1All: −4.70
11Grønbæk et al 59 & Kazankov et al 60
Denmark
Julemaerkehjemmet Hobro (same cohort)
Cohort:
Total = 117 (117)
(n=71 attended 12 mth FU)
NR.
Obese.
BL BMI-SDS: 2.93±0.52
Age range: NR
12.1 ±1.3
F=56%
NRD+E:
Community
Individually designed healthy diet + moderately strenuous PA program (at least 1hr/day).2.5 months/10 weeks:
12
BIAAll: −0.63All: −4.30
12Hvidt et al 61
Denmark
Cohort:
Total = 61 (61)
Children’s Obesity Clinic; BMI >90th %ile (Danish ref pop.) = z-score 1.28.
BL BMI-SDS: 2.73±0.60
Age range:
10−18
Median: 12.5
F=54%
NRD+E:
Clinic (Hospital)
Family-centred approach involving behaviour changing techniques (90 advice and advice strategies on low-calorie diet + activity for example, 10−20 items aimed to reduce obesity).12:
0
BIAAll: −0.21All: −3.40
13Kirk et al 47
USA
Cohort:
Total = 177 (177)
Children (5–10yrs) = 85
Adolescents (11–19yrs) = 92
BMI >95th %ileAge range:
5–19
9.0±1.5
Overall F=61%
Children: F = 24%
Adolescents: F = 59%
NRD+E:
Clinic (Hospital)
Behavioural intervention with individualised behavioural goals for nutrition, PA & family support.5:
6
DXAGP1: –0.18
GP2: –0.13
All: –0.15
GP1: –2.10
GP2: –2.40
All: –2.20
14Klijn et al 62
The Netherlands
Cohort:
Total = 15 (15)
BMI >30Age range:
10–18
14.7 (2.1); F=NR
NRE:
Community
Aerobic exercise training programme – 12 weeks; 3 x 30–60 min aerobic group sessions/week (2x gym/outdoors, 1 x swimming pool). P.E teacher led. Diverse indoor, outdoor and swimming activities.3:
0
% body fat calculated by “dividing fat mass by total body mass”All: –0.4All: –3.80
15Lazzer et al 63
Italy
Cohort:
Total = 19
Boys = 7 (7)
Girls = 12 (12)
BMI >97th %ileAge range:
8–12
Boys: 9.9±1.6 Girls: 11.2±1.5
Overall F=63%
Yes –
Tanner
D+E:
Community
2 x 50min/wk endurance training + 2hr/wk PE lessons + 1 x wk child & parent dietetic class + 1 x wk psychological group class.8:
12
DXABoys: –0.4
Girls: –0.2
Boys: –4.00
Girls: –2.20
16Meyer et al 64
Germany
RCT:
Total = 67
IG=33 (33)
OC=34 (34)
BMI >97th %ile (German paediatric population)Age range: 11–16
IG: 13.7±2.1; F=48%
OC: 14.1±2.4; F =50%
Yes - TannerE:
Clinic (Hospital)
3 x exercise sessions (Monday: swimming and aqua aerobic training 60 min + Wednesday sports games 90 min + Friday walking 60 min)/ wk;
Control: Maintain current level of PA
6:
0
BIAIG: –0.43
CG: –0.14
IG: –1.00
CG: 0.00
17Miraglia et al 65
Brazil
Cohort:
Total = 27 (27)
BMI z-score >2Age range:
6–13
Median 10.3; F=48%
NRD+E:
Clinic (Hospital)
AmO: Outpatient Ambulatory. Obesity outpatient clinic - lifestyle change based on goals agreed relative to feeding habits & physical exercise, followed mthly. 12 months: Subjects assessed at inclusion & after 12 months of FU to obtain anthropometric & adipokine measurements.12:
0
BIAAll: –0.4All: –0.10
18Morell-Azanza et al 66 &
Rendo-Urteaga et al 67
Spain
(same cohort)
Cohort:
Total = 54 (40)
high responders =21
low responders = 19
OW/OB as per Cole et al 2000Age range:
7–15
Mean =11
F=53% (of N analysed)
Yes –
Tanner
D:
Clinic (Hospital)
Moderate energy-restricted diet + nutritional education sessions with dietitian + family involvement.2.5:
0
BIAHR: –0.79
LR: –0.18
HR: –0.64
LR: –0.07
HR: –3.10
LR: –0.60
HR: –2.49
LR: –0.37
19Murer et al 68 &
Aeberli et al 69
Switzerland
(same cohort)
Cohort:
Total = 206 (203)
BMI >98th %ileAge range:
10–18
14.1±1.9; F=44%
NRD+E:
Clinic, hospital
Moderate caloric restriction.2 x 60–90 min/day endurance exercise + 4–5 hr/wk. exercise session + behaviour modification.2:
0
BIAAll: –0.42All: –5.50
20Murdolo et al 70 ItalyCohort:
Total = 53(53)
Responders
= 44
Non-responders
= 9
NRAge range:
5–13
Responders: 9.0±1.1;
F=50% Non-responders: 2.09±0.32; F=33%
Yes –
Tanner
D+E:
Community
Educational Wt Excess Reduction Program24:
>6
BIAResponders:
–0.44
Non-responders:
0.11
Responders:–2.90
Non-responders:
–2.00
21Ning et al 71
& BEAN et al 72
USA
TEENS
(same cohort)
Cohort:
Total = 145**(145)
BMI ≥95th %ile (CDC)Age range: 11–18
13.1
F=65%
NRD+E:
Academic Institution
12 x 30 min nutritional session with adolescent and parent/s + Education/behavioural support sessions once every 2 wks, or alternating wks + PA 3 x 60 min/wk during initial 12 wks, then minimum of twice/wk.6:
0
DXAAll: –0.1All: –2.40
22Pacifico et al 73
Italy
Cohort:
Total = 120 (120)
BMI >95th %ileAge range: (11.5–12.2)
11.9; F=35%
Yes (method ND)D+E:
Clinic (Hospital)
Hypocaloric diet (25–30 Kcal/kg/day) + 60 min/day ~ 5 days/wk moderate exercise + Reduce sedentary behaviour.12:
0
NRAll: –0.32All: –2.10
23Racil et al 32
Tunisia
RCT:
Total = 34
HIIT = 11 (11)
MIIT = 11 (11)
OC = 12 (12)
BMI >97th %ile (French standards)Age range: NR
HIIT: 15.6±0.7 MIIT: 16.3±0.52
OC:15.9±1.2
Overall F=100%
Yes -TannerD+E:
Community
4-day diet records + HIIT or MIIT. Interval training program 3 x /wk on non-consecutive days.3:
0
BIAHIT: –0.4
MIT: –0.3
OC: 0
HIT: –2.90
MIT: –2.00
OC: –0.40
24Racil et al 33
Tunisia
RCT:
Total = 47
HIIT = 17 (17)
MIIT = 16 (16)
OC = 14
BMI >97th %ile (French standards)Age range: NR
14.2±1.2; F=100%
NRE:
Academic Institution
HIIT (Warm up + Interval training at 100%/50% MAS + Cooling down);
MIIT (Warm up + Interval training 80%/50% MAS + Cooling down)
3:
0
BIAHIT: –0.3
MIT: –0.3
OC: 0
HIT:- –3.90
MIT: –3.40
OC: –0.50
25Reinehr et al 38 Germany
OBELDICKS
Cohort:
Total = 42 (42)
BMI ≥97th %ileAge range: 6.1–15.1
10.2; F=57%
Yes - TannerD+E:
Clinic (Hospital)
Obeldicks: Intensive phase 3 months (Parents’ course 2x/month + Behaviour therapy 2x/month + Nutritional course 2x/month + Exercise therapy 1x/wk) + Establishing phase 3 months (Talk rounds for parents 1x/month + Psychological therapy + Exercise therapy 1x/wk) + Establishing phase 2 for 3 months (Psychological therapy + Exercise therapy 1x/wk) + Establishing phase 3 for 3 months (Exercise therapy 1x/wk).12:
0
% body fat
skinfold thickness
Sig. WL –0.9
NS WL: –0.2
Sig. WL: –7.50
NS WL: –3.00
26Reinehr et al 74 75
Germany
OBELDICKS
Cohort:
Ob + Sub.
WL = 25
Ob + no change = 18
Normal control = 19 (BL data only)
IOTF using pop. -specific dataOb: 10.8±2.6; F=61%
Lean C: 10.3±2.9; F=58%
Ob + Sub. WL : F= 68%
Ob + no change: F = 50%
Yes -TannerD+E:
Clinic (Hospital)
Obeldicks12:
0
% body fat
skinfold thickness
WL: –0.6
No WL: –0.1
WL: –8.00
No WL: 0.00
27Rohrer et al 76 Germany
Fit Kids
Cohort:
Total = 22 (22)
Unchanged BMI= 12
Reduced BMI = 10
BMI >99.5th %ile (German standard values) or
BMI >97th %ile with obesity-associated risk factors or
BMI >90th %ile with obesity-associated disease
Age range:
7–15
Median: 11.9
F=27%
Unchanged BM: F = 33%
Reduced BMI: F=20%
NRD+E:
Community
Physical exercise (2 x wk, 100 hrs in total) + Nutritional/heath education and psychological care for the child (x wk, 43.5 hrs total) and parent/s (2 x wk, 12 hrs total).12:
0
BIAIncreased BMI: 0.12
Reduced
BMI: –0.35
Increased BMI: 1.05
Reduced BMI:–0.05
28Rolland-Cachera et al 77
France
RCT:
Total = 99
PROT- = 61 (53)
PROT+ =60 (46)
BMI > 97th %ile (French reference values)Age range: 11-16
PROT- = 14.1±1.2; F = 74%
PROT + =14.4±1.3; F = 72%
NRD+E:
Academic Institution
Wt reducing diet; 7hr/wk vigorous sports + 7hr/wk outdoor activities; advice on nutrition & PA during wkends/holidays.9:
12+24
BIAPROT- :–2.6
PROT+:–2.5
PROT- :–12.40
PROT+:–12.10
29Roth et al 78 Germany
OBELDICKS
Cohort:
Total = 69
OB + WL = 32
OB + with WL = 37
OB as per IOTF criteriaNR – (see Obeldicks age range)
Ob with WL: 11.8±2.0; F=50%
Ob without WL: 12.1±2.1; F=51% Normal wt: 12.3±3.0; F=45%
Yes - TannerD+E:
Clinic (Hospital)
Obeldicks12:
0
% body fat skinfold thicknessWL: –0.69
No WL: 0.03
WL: –9.60
No WL:
–4.30
30Savoye et al 79
USA
Bright Bodies
Cohort:
Total = 33 (25)
SMP = 10 (8)
BFC = 23 (17)
BMI ≥95th %ileAge range: 11–16
13.5±0.3;
SMP:13.3±0.6; F=75%
BFC: 13.6±0.3; F= 65%
NRD+E:
Academic Institution
Bright Bodies Weight Management Program: nutrition education, exercise, behavioural modification.
2 x 30 min exercise sessions + 1 x 45 min nutrition/behaviour medication group session per week. 4 levels: Beginner, Intermediate i, Intermediate ii, Advanced. All levels 12 weeks duration.
Monthly maintenance classes after 1 yr (support-group style)
12:
12
BIASMP: –0.36
BFC: –0.12
SMP:–6.50
BFC: –4.20
31Savoye et al 80 81
USA
Bright Bodies
(data taken from 2011 paper)
RCT+ Long term FU results (cohort)
RCT Total = 174
BB = 105
CC = 69
1 YR ANALYSIS
BB = 75
CC = 44
BMI ≥95th %ile (CDC)Age range:
8–16
BB: 12.0±2.5; F=56%
CC: 12.5±2.3; F=68%
NRD+E:
Academic Institution (local school).
Bright Bodies Weight Management Program: nutrition education, exercise, behavioural modification. 2 x sessions/wk for 6 months, then biweekly for next 6 months. BB: 2x50 min exercise + 1x40 min nutrition/behaviour modification per wk + 12 months no active intervention.
Control group: standard care – paed. obesity clinic (biannual clinic appt; diet + exercise counselling) Structured tx & teaching program (28 x 45 min therapeutic sessions for example, PA, nutrition, healthy cooking)
12:
12
FU
1.5:
24
BIAIG: –0.21
CG: 0.01
IG: –3.90
CG: 2.10
32Savoye et al 82
USA
Bright Bodies
RCT
Total = 75
BB = 38 (31)
CC = 37 (27)
BMI ≥95th %ileAge range:
10–16
BB: 12.7 (1.9); F=68%
CC: 13.2 (1.8); F=62%
Yes-TannerD+E:
Academic Institution
Bright Bodies Weight Management Program: nutrition education, exercise, behavioural modification. 2 x 30 min exercise sessions + 1 x 45 min nutrition/behaviour medication group session per week. 4 levels: Beginner, Intermediate I, Intermediate ii, Advanced. All levels 12 weeks duration. Monthly maintenance classes after 1 yr (support-group style)6:
0
BIABB: –0.05
CC: 0.04
BB: –3.30
CC: 0.40
33Schiel et al 83GermanyCohort:
Total = 143 (143)
BMI-SDS ≥97th %ileAge range: NR
13.9±2.4; F=62%
NRD+E:
Clinic (Hospital)
Structured Tx & Teaching Program (STTP):
28 x 45 min therapeutic sessions for example, PA, nutrition, healthy cooking
1.5:
24
NRAll: –0.26All: –3.40
34Seabra et al 34 PortugalCohort:
Total = 88
soccer = 29 (29)
Trad. Act. = 29 (29)
OC = 30 (30)
BMI-SDS > 2Age range:
8–12
Soccer: 10.5±1.5 Trad. act: 11.0±1.6
OC=10.0±1.3
Overall F=0%
Yes - TannerE:
Community
Soccer & trad. activity programmes (3 x 60-90min/wk) + 2 x 1hr at BL & 3 months later energy balance session.6:
0
DXASoccer: –0.2
Trad.: –0.2
CG: –0.1
Soccer:–2.20
Trad:–4.10
CG:3.10
35Truby et al 84
Australia
RCT:
Total = 87
SMC = 37 (33)
SLF = 36 (32)
WList OC = 14 (14)
BMI >90th %ile (CDC)Age range: 10–17
SMC: 13.2±1.9; F=73%
SLF: 13.2±2.1; F=72%
WList OC: 13.6±1.9; F=71%
Yes -TannerD:
Clinic (Hospital)
Structured modified CHO diet (35% CHO; 30% protein; 35% fat), structured low-fat diet (55% CHO; 20% protein; 25% fat),
Control (no dietary advice).
3:
0
BIASLF: –0.09
SMC:–0.15
CG: 0.02
SLF: –0.13
SMC: –0.40
CG: 2.62
36Van der Baan-Slootweg et al 85
The Netherlands
RCT:
Total = 90
Inpt. = 45 (37)
AmO = 45 (36)
BMI z score ≥ 3.0 or > 2.3 with OB-related health problemsAge range:
8–18
Inpt: 13.8±2.3; F=58%
AmO: 13.9±2.5; F=58%
NRD+E:
Clinic (Hospital)
Inpt. (Hospitalised 26 wks on working days - 4 days/wk 30-60min exercise + nutrition/BM once/wk + parents/caregivers 3 x 1hr lesson on nutrition/BM);
Ambulatory (12 visits at increasing time intervals - 1 hr exercise session + encouraged 3 x exercise/wk + 1 hr educational programme + 30 min nutrition education).
6:
24
BIAInpT: –0.6
AmO: –0.35
InP: –3.34
AmO:–7.87
37Visuthranukul et al 86
Thailand
RCT:
Total = 70 (52)
I = 35(25)
OC = 35 (27)
ND.
BL BMI z-score:
I = 3.7±0.9
C = 3.6±1.6
Age range:
9–16
I = 11.9±1.9; F=36%
C = 12.0±2.1; F=30%
Yes -TannerD:
Clinic (Hospital)
I (Low GI diet + Energy restriction 1400-1500 kcal/day + Increased exercise);
OC (Energy restriction 1200-1300 kcal/day + Low fat/high fibre diet + Increased exercise).
6:
0
BIAIG:–0.3
CG: –0.3
IG:0.10
CG:0.10
38Vitola et al 87
USA
Cohort:
Total = 8(7)
BMI ≥95th %ileAge range: NR
15.3±0.6; F=12.8%
Yes -TannerD+E:
Clinic (Hospital)
Individual behavioural therapy sessions with psychologist. Parents involvement encouraged. Self-monitoring of PA & food intake. Gradual reduction of caloric intake to ≈1200-1500 kcal/day. Ongoing therapy - wt loss therapy repeated when 5% body wt lost & wt stable for at least 4 wksNRDXAAll: –0.3All: –5.30
39Wickham et al 88 &
Evans et al 89
USA
TEENS (same cohort)
Cohort:
Total = 168 (64)**
Completers only = 57
BMI ≥95th %ile (CDC)Age range: 11–18
13.9±1.9; F=62%
NRD+E:
Academic Institution
Exercise 1 day/wk at facility + 2 additional exercise days at facility of ppts’ choice + 30 min/wk nutrition education/behavioural support sessions.6:
0
BIACompleters:
–0.07
Completers:–1.30
  • For studies reported in multiple publications, the reference that provided the most comprehensive information has been used (thus Ning et al 71 includes data from Bean et al 72; Evans et al 89 is reported under Wickham et al 88; Aeberli et al 69 is reported under Murer et al 68; Rendo-Urteaga et al 67 is reported under Morell-Azanza et al 66 and Kazankov et al 60 is reported under Grønbæk et al.59

  • *studies with change in % body fat included in the analysis.

  • **Minor discrepancies in reporting of data in papers.

  • KEY: %ile, percentile; AmO, outpatient ambulatory; An., analysed; apt., appointment; BB, Bright Bodies; BIA, bioelectrical impedance analysis; BFC, better food choices; BL, baseline; BM, behaviour modification; BMI, body mass index; C, control; CBT, cognitive behavioural therapy; CDC, Centre for Disease Control; CG, control group; CHO, carbohydrate; D, diet; DXA, Dual-energy X-ray absorption; E, exercise; FBBT, family-based behavioural treatment; F, female; FU, follow up; GI, glycaemic index; GT, group therapy; HGI, high glycaemic index; HIIT, high intensity interval training; hr, hour; HZ, heterozygous; HO, homozygous; ht, height; I, intervention; IG, intervention group; IOTF, International Obesity Task Force; Inpt., inpatient; LGI, low glycaemic index; LMS, least-mean-squares; LS, long stay; MAS, maximal aerobic speed; MIIT, moderate intensity interval training; min, minute; MO, morbidly obese; norm., normal; n, number; NAFLD, Non-alcoholic fatty liver disease; ND, not described; NR, not reported; OB, obese; OC, obese control; OW, overweight; paed., paediatric; PA, physical activity; PE, physical activity; PROT, protein; RCT, randomised controlled trial; SD, standard deviation; SDS, standard deviation score; SMP, structured meal plan; SS, short stay; Sub., substantial; SMC, structured modified carbohydrate diet; trad., traditional; trad. act, traditional activity; tx, treatment; wk, week; WList OC, wait list obese control; WL, weight loss; wt, weight; X-over, crossover; yr, year.