Systematic review on community-based interventions targeting prevention of overweight and obesity in children and adolescents: An update

Julia Santamaria^1*Nikolai Müuhlberger¹Daniela Schmid²Igor Kuchin¹Erica Suzumura³Nardeen Ayad⁴Yuli Lily Hsieh^5,6Kieran Michael Tuohy⁷Michael Laxy⁸Uwe Siebert^1,6,9Beate Jahn¹

• ¹Institute of Public Health, Medical Decision Making and Health Technology Assessment; Department of Public Health, Health Services Research and Health Technology Assessment, UMIT TIROL - University for Health Sciences and Technology, Hall in Tirol, Austria
• ²Faculty of Life Sciences, Hochschule Albstadt-Sigmaringen, Sigmaringen, Germany
• ³Department of Preventive Medicine, Universidade de Sao Paulo Faculdade de Medicina, São Paulo, Brazil
• ⁴Department of Pediatrics, Washington University in St Louis, St. Louis, United States
• ⁵Interfaculty Initiative in Health Policy, Harvard University, Cambridge, United States
• ⁶Center for Health Decision Science; Departments of Epidemiology and Health Policy & Management, Harvard T H Chan School of Public Health, Boston, United States
• ⁷Nutrition and Nutrigenomics Unit, Research and Innovation Center - Fondazione Edmund Mach, S. Michele all' Adige, Italy
• ⁸Public Health and Prevention, School of Medicine and Health, Technical University of Munich, Munich, Germany
• ⁹Institute for Technology Assessment and Department of Radiology; Massachusetts General Hospital, Harvard Medical School, Boston, United States

Background: With increasing obesity rates, community-based interventions (CBI) have gained attention as more evidence suggests that the environment has a significant impact on individuals' behaviors. Our aim was to conduct a systematic review of CBIs to prevent overweight/obesity in children and adolescents. Subject and Methods: We searched PubMed (January 2011-December 2024) for studies evaluating CBIs for overweight and/or obesity prevention. We included controlled interventional studies that reported weight-related outcomes. The assessment of the risk of bias of the included studies was performed using the Cochrane Collaboration tool. Results are reported in systematic evidence tables, including information on main study characteristics and effect sizes. Results: A total of 2,724 articles were retrieved, of which 37 publications representing 28 projects from seven world regions were included for review. Most of the interventions targeted children. Reported intervention effects ranged from no to small effects. A beneficial intervention effect was observed in eleven out of 16 studies that calculated the intervention effect for BMI z-score, and in seven out of nine studies for prevalence of overweight/obesity. Effect sizes ranged from -0.26 to -0.03 for BMI z-score and up to an adjusted odds ratio of 0.65 in the intervention compared to the control group in the prevalence of overweight/obesity. The risk of bias of the studies was moderate to high. Conclusion: Overall, our study found inconclusive evidence on the benefits of CBIs. While creating health-promoting environments can influence population-wide nutrition and physical activity behaviors by making healthy choices more accessible, methodological challenges exist to accurately capture the true effects of CBIs.