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      For whom and under what circumstances do school-based energy balance behavior interventions work? Systematic review on moderators

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          Abstract

          The aim of this review was to systematically review the results and quality of studies investigating the moderators of school-based interventions aimed at energy balance-related behaviors. We systematically searched the electronic databases of Pubmed, EMBASE, Cochrane, PsycInfo, ERIC and Sportdiscus. In total 61 articles were included. Gender, ethnicity, age, baseline values of outcomes, initial weight status and socioeconomic status were the most frequently studied potential moderators. The moderator with the most convincing evidence was gender. School-based interventions appear to work better for girls than for boys. Due to the inconsistent results, many studies reporting non-significant moderating effects, and the moderate methodological quality of most studies, no further consistent results were found. Consequently, there is lack of insight into what interventions work for whom. Future studies should apply stronger methodology to test moderating effects of important potential target group segmentations.

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          The obesity epidemic in the United States--gender, age, socioeconomic, racial/ethnic, and geographic characteristics: a systematic review and meta-regression analysis.

          Youfa Wang, May Beydoun (2007)
          This review of the obesity epidemic provides a comprehensive description of the current situation, time trends, and disparities across gender, age, socioeconomic status, racial/ethnic groups, and geographic regions in the United States based on national data. The authors searched studies published between 1990 and 2006. Adult overweight and obesity were defined by using body mass index (weight (kg)/height (m)(2)) cutpoints of 25 and 30, respectively; childhood "at risk for overweight" and overweight were defined as the 85th and 95th percentiles of body mass index. Average annual increase in and future projections for prevalence were estimated by using linear regression models. Among adults, obesity prevalence increased from 13% to 32% between the 1960s and 2004. Currently, 66% of adults are overweight or obese; 16% of children and adolescents are overweight and 34% are at risk of overweight. Minority and low-socioeconomic-status groups are disproportionately affected at all ages. Annual increases in prevalence ranged from 0.3 to 0.9 percentage points across groups. By 2015, 75% of adults will be overweight or obese, and 41% will be obese. In conclusion, obesity has increased at an alarming rate in the United States over the past three decades. The associations of obesity with gender, age, ethnicity, and socioeconomic status are complex and dynamic. Related population-based programs and policies are needed.
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            On the practice of dichotomization of quantitative variables.

            Robert MacCallum, Shaobo Zhang, Kristopher J Preacher … (2002)
            The authors examine the practice of dichotomization of quantitative measures, wherein relationships among variables are examined after 1 or more variables have been converted to dichotomous variables by splitting the sample at some point on the scale(s) of measurement. A common form of dichotomization is the median split, where the independent variable is split at the median to form high and low groups, which are then compared with respect to their means on the dependent variable. The consequences of dichotomization for measurement and statistical analyses are illustrated and discussed. The use of dichotomization in practice is described, and justifications that are offered for such usage are examined. The authors present the case that dichotomization is rarely defensible and often will yield misleading results.
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              Health-enhancing physical activity and sedentary behaviour in children and adolescents.

              Stuart J H Biddle, Trish Gorely, David J Stensel (2004)
              We provide a wide-ranging review of health-related physical activity in children and adolescents using a behavioural epidemiology framework. In contrast to many other reviews, we highlight issues associated with true sedentary behaviours alongside physically active behaviours. Specifically, we review the evidence concerning the links between physical activity and cardiovascular disease, overweight and obesity, psychosocial measures, type II diabetes, and skeletal health. Although the evidence is unconvincing at times, several factors lead to the conclusion that promoting physical activity in youth is desirable. A review of the prevalence of physical activity and sedentary behaviours shows that many young people are active, but this declines with age. A substantial number are not adequately active for health benefits and current trends in juvenile obesity are a cause for concern. Prevalence data on sedentary behaviours are less extensive but suggest that total media use by young people has not changed greatly in recent years. Most children and adolescents do not exceed recommended daily hours of TV viewing. Physical activity is unrelated to TV viewing. We also identified the key determinants of physical activity in this age group, highlighting demographic, biological, psychological, behavioural, social and environmental determinants. Interventions were considered for school, family and community environments. Finally, policy recommendations are offered for the education, governmental, sport and recreation, health, and mass media sectors.
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                Author and article information

                Contributors
                : On behalf of : On Behalf of The Energy-Consortium
                Journal
                Journal ID (nlm-ta): Int J Pediatr Obes
                Journal ID (publisher-id): spob
                Title: International Journal of Pediatric Obesity
                Publisher: Informa Healthcare
                ISSN (Print): 1747-7166
                ISSN (Electronic): 1747-7174
                Publication date (Print): June 2011
                Publication date (Electronic): 09 June 2011
                Volume: 6
                Issue: 2_2
                Pages: e46-e57
                Affiliations
                [1 ]Department of Public and Occupational Health and the EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands
                [2 ]Department of Epidemiology and Biostatistics and the EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands
                Author notes
                Mine Yıldırım,VU University Medical Center, EMGO Institute for Health Care Research,Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands. Tel: +31 20 4445379. Fax: +31 20 444 8181. E-mail: m.yildirim@ 123456vumc.nl
                Article
                DOI: 10.3109/17477166.2011.566440
                PMC ID: 3190836
                PubMed ID: 21651421
                SO-VID: 3908d079-312f-4bfa-b702-611d9b417e23
                Copyright © © 2011 Informa Healthcare
                License:

                This is an open access article distributed under the Supplemental Terms and Conditions for iOpenAccess articles published in Informa Healthcare journals , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 07 July 2010
                Date accepted : 02 December 2010
                Categories
                Subject: Review Article

                ScienceOpen disciplines: Pediatrics
                Keywords: moderator,physical activity,intervention,overweight,diet,children
                Data availability:
                ScienceOpen disciplines: Pediatrics
                Keywords: moderator, physical activity, intervention, overweight, diet, children

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