Cochrane review: Interventions for treating obesity in children
Identifieur interne : 000973 ( Istex/Corpus ); précédent : 000972; suivant : 000974Cochrane review: Interventions for treating obesity in children
Auteurs : Hiltje Oude Luttikhuis ; Louise Baur ; Hanneke Jansen ; Vanessa A. Shrewsbury ; Claire O'Malley ; Ronald P. Stolk ; Carolyn D. SummerbellSource :
- Evidence‐Based Child Health: A Cochrane Review Journal [ 1557-6272 ] ; 2009-12.
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Abstract
Child and adolescent obesity is increasingly prevalent, and can be associated with significant short‐ and long‐term health consequences.
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DOI: 10.1002/ebch.462
Links to Exploration step
ISTEX:6394647E5113C48FA27C1956FA203D76D70C8E0FLe document en format XML
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Children's Hospital and Department of Epidemiology, University Medical Center Groningen, PO Box 30.001 (CA80), 9700RB, Groningen, Netherlands.</json:string></affiliations></json:item><json:item><name>Louise Baur</name><affiliations><json:string>Department of Paediatrics and Child Health, The University of Sydney, Westmead, NSW 2145, Australia</json:string></affiliations></json:item><json:item><name>Hanneke Jansen</name><affiliations><json:string>Department of Epidemiology, University Medical Center Groningen, Groningen, Netherlands</json:string></affiliations></json:item><json:item><name>Vanessa A Shrewsbury</name><affiliations><json:string>Department of Paediatrics and Child Health, The University of Sydney, Westmead, NSW 2145, Australia</json:string></affiliations></json:item><json:item><name>Claire O'Malley</name><affiliations><json:string>School of Medicine and Health, Wolfson Research Institute, Durham University, Stockton‐on‐Tees, TS17 6BH, UK</json:string></affiliations></json:item><json:item><name>Ronald P Stolk</name><affiliations><json:string>Department of Epidemiology, University Medical Center Groningen, Groningen, Netherlands</json:string></affiliations></json:item><json:item><name>Carolyn D Summerbell</name><affiliations><json:string>School of Medicine and Health, Wolfson Research Institute, Durham University, Stockton‐on‐Tees, TS17 6BH, UK</json:string></affiliations></json:item></author><subject><json:item><lang><json:string>eng</json:string></lang><value>Anti‐Obesity Agents [therapeutic use]</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>Diet, Reducing</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>Life Style</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>Motor Activity</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>Obesity 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children</title><genre><json:string>other</json:string></genre><host><volume>4</volume><publisherId><json:string>EBCH</json:string></publisherId><pages><total>159</total><last>1729</last><first>1571</first></pages><issn><json:string>1557-6272</json:string></issn><issue>4</issue><subject><json:item><value>Cochrane Review</value></json:item></subject><genre><json:string>journal</json:string></genre><language><json:string>unknown</json:string></language><eissn><json:string>1557-6272</json:string></eissn><title>Evidence‐Based Child Health: A Cochrane Review Journal</title><doi><json:string>10.1002/(ISSN)1557-6272</json:string></doi></host><publicationDate>2009</publicationDate><copyrightDate>2009</copyrightDate><doi><json:string>10.1002/ebch.462</json:string></doi><id>6394647E5113C48FA27C1956FA203D76D70C8E0F</id><score>1</score><fulltext><json:item><extension>pdf</extension><original>true</original><mimetype>application/pdf</mimetype><uri>https://api.istex.fr/document/6394647E5113C48FA27C1956FA203D76D70C8E0F/fulltext/pdf</uri></json:item><json:item><extension>zip</extension><original>false</original><mimetype>application/zip</mimetype><uri>https://api.istex.fr/document/6394647E5113C48FA27C1956FA203D76D70C8E0F/fulltext/zip</uri></json:item><istex:fulltextTEI uri="https://api.istex.fr/document/6394647E5113C48FA27C1956FA203D76D70C8E0F/fulltext/tei"><teiHeader><fileDesc><titleStmt><title level="a" type="main" xml:lang="en">Cochrane review: Interventions for treating obesity in children</title></titleStmt><publicationStmt><authority>ISTEX</authority><publisher>John Wiley & Sons, Ltd.</publisher><pubPlace>Chichester, UK</pubPlace><availability><p>Copyright © 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.</p></availability><date>2009</date></publicationStmt><sourceDesc><biblStruct type="inbook"><analytic><title level="a" type="main" xml:lang="en">Cochrane review: Interventions for treating obesity in children</title><author xml:id="author-1"><persName><forename type="first">Hiltje</forename><surname>Oude Luttikhuis</surname></persName><affiliation>Beatrix Children's Hospital and Department of Epidemiology, University Medical Center Groningen, Groningen, Netherlands</affiliation><affiliation>Beatrix Children's Hospital and Department of Epidemiology, University Medical Center Groningen, PO Box 30.001 (CA80), 9700RB, Groningen, Netherlands.</affiliation></author><author xml:id="author-2"><persName><forename type="first">Louise</forename><surname>Baur</surname></persName><affiliation>Department of Paediatrics and Child Health, The University of Sydney, Westmead, NSW 2145, Australia</affiliation></author><author xml:id="author-3"><persName><forename type="first">Hanneke</forename><surname>Jansen</surname></persName><affiliation>Department of Epidemiology, University Medical Center Groningen, Groningen, Netherlands</affiliation></author><author xml:id="author-4"><persName><forename type="first">Vanessa A</forename><surname>Shrewsbury</surname></persName><affiliation>Department of Paediatrics and Child Health, The University of Sydney, Westmead, NSW 2145, Australia</affiliation></author><author xml:id="author-5"><persName><forename type="first">Claire</forename><surname>O'Malley</surname></persName><affiliation>School of Medicine and Health, Wolfson Research Institute, Durham University, Stockton‐on‐Tees, TS17 6BH, UK</affiliation></author><author xml:id="author-6"><persName><forename type="first">Ronald P</forename><surname>Stolk</surname></persName><affiliation>Department of Epidemiology, University Medical Center Groningen, Groningen, Netherlands</affiliation></author><author xml:id="author-7"><persName><forename type="first">Carolyn D</forename><surname>Summerbell</surname></persName><affiliation>School of Medicine and Health, Wolfson Research Institute, Durham University, Stockton‐on‐Tees, TS17 6BH, UK</affiliation></author></analytic><monogr><title level="j">Evidence‐Based Child Health: A Cochrane Review Journal</title><title level="j" type="abbrev">Evid.‐Based Child Health</title><idno type="pISSN">1557-6272</idno><idno type="eISSN">1557-6272</idno><idno type="DOI">10.1002/(ISSN)1557-6272</idno><imprint><publisher>John Wiley & Sons, Ltd.</publisher><pubPlace>Chichester, UK</pubPlace><date type="published" when="2009-12"></date><biblScope unit="volume">4</biblScope><biblScope unit="issue">4</biblScope><biblScope unit="page" from="1571">1571</biblScope><biblScope unit="page" to="1729">1729</biblScope></imprint></monogr><idno type="istex">6394647E5113C48FA27C1956FA203D76D70C8E0F</idno><idno type="DOI">10.1002/ebch.462</idno><idno type="ArticleID">EBCH462</idno></biblStruct></sourceDesc></fileDesc><profileDesc><creation><date>2009</date></creation><langUsage><language ident="en">en</language></langUsage><abstract><p>Child and adolescent obesity is increasingly prevalent, and can be associated with significant short‐ and long‐term health consequences.</p></abstract><abstract><p>To assess the efficacy of lifestyle, drug and surgical interventions for treating obesity in childhood.</p></abstract><abstract><p>We searched CENTRAL on The Cochrane Library Issue 2 2008, MEDLINE, EMBASE, CINAHL, PsycINFO, ISI Web of Science, DARE and NHS EED. Searches were undertaken from 1985 to May 2008. References were checked. No language restrictions were applied.</p></abstract><abstract><p>We selected randomised controlled trials (RCTs) of lifestyle (i.e. dietary, physical activity and/or behavioural therapy), drug and surgical interventions for treating obesity in children (mean age under 18 years) with or without the support of family members, with a minimum of six months follow up (three months for actual drug therapy). Interventions that specifically dealt with the treatment of eating disorders or type 2 diabetes, or included participants with a secondary or syndromic cause of obesity were excluded.</p></abstract><abstract><p>Two reviewers independently assessed trial quality and extracted data following the Cochrane Handbook. Where necessary authors were contacted for additional information.</p></abstract><abstract><p>We included 64 RCTs (5230 participants). Lifestyle interventions focused on physical activity and sedentary behaviour in 12 studies, diet in 6 studies, and 36 concentrated on behaviorally orientated treatment programs. Three types of drug interventions (metformin, orlistat and sibutramine) were found in 10 studies. No surgical intervention was eligible for inclusion. The studies included varied greatly in intervention design, outcome measurements and methodological quality. Meta‐analyses indicated a reduction in overweight at 6 and 12 months follow up in: i) lifestyle interventions involving children; and ii) lifestyle interventions in adolescents with or without the addition of orlistat or sibutramine. A range of adverse effects was noted in drug RCTs.</p></abstract><abstract><p>While there is limited quality data to recommend one treatment program to be favoured over another, this review shows that combined behavioural lifestyle interventions compared to standard care or self‐help can produce a significant and clinically meaningful reduction in overweight in children and adolescents. In obese adolescents, consideration should be given to the use of either orlistat or sibutramine, as an adjunct to lifestyle interventions, although this approach needs to be carefully weighed up against the potential for adverse effects. Furthermore, high quality research that considers psychosocial determinants for behaviour change, strategies to improve clinician‐family interaction, and cost‐effective programs for primary and community care is required.</p></abstract><abstract><p>Treating obesity in children Childhood obesity affects both the physical and psychosocial health of children and may put them at risk of ill health as adults. More information is needed about the best way to treat obesity in children and adolescents. In this review, 64 studies were examined including 54 studies on lifestyle treatments (with a focus on diet, physical activity or behaviour change) and 10 studies on drug treatment to help overweight and obese children and their families with weight control. No surgical treatment studies were suitable to include in this review. This review showed that lifestyle programs can reduce the level of overweight in child and adolescent obesity 6 and 12 months after the beginning of the program. In moderate to severely obese adolescents, a reduction in overweight was found when either the drug orlistat, or the drug sibutramine were given in addition to a lifestyle program, although a range of adverse effects was also noted. Information on the long‐term outcome of obesity treatment in children and adolescents was limited and needs to be examined in some high quality studies.</p></abstract><textClass xml:lang="en"><keywords scheme="keyword"><list><head>keywords</head><item><term>Anti‐Obesity Agents [therapeutic use]</term></item><item><term>Diet, Reducing</term></item><item><term>Life Style</term></item><item><term>Motor Activity</term></item><item><term>Obesity [*therapy]</term></item><item><term>Randomized Controlled Trials as Topic</term></item><item><term>Child</term></item><item><term>Humans</term></item></list></keywords></textClass><textClass><keywords scheme="Journal Subject"><list><head>article-category</head><item><term>Cochrane Review</term></item></list></keywords></textClass></profileDesc><revisionDesc><change when="2009-12">Published</change></revisionDesc></teiHeader></istex:fulltextTEI><json:item><extension>txt</extension><original>false</original><mimetype>text/plain</mimetype><uri>https://api.istex.fr/document/6394647E5113C48FA27C1956FA203D76D70C8E0F/fulltext/txt</uri></json:item></fulltext><metadata><istex:metadataXml wicri:clean="Wiley, elements deleted: body"><istex:xmlDeclaration>version="1.0" encoding="UTF-8" standalone="yes"</istex:xmlDeclaration><istex:document><component version="2.0" type="serialArticle" xml:lang="en"><header><publicationMeta level="product"><publisherInfo><publisherName>John Wiley & Sons, Ltd.</publisherName><publisherLoc>Chichester, UK</publisherLoc></publisherInfo><doi registered="yes">10.1002/(ISSN)1557-6272</doi><issn type="print">1557-6272</issn><issn type="electronic">1557-6272</issn><idGroup><id type="product" value="EBCH"></id></idGroup><titleGroup><title type="main" xml:lang="en" sort="EVIDENCE-BASED CHILD HEALTH: A COCHRANE REVIEW JOURNAL">Evidence‐Based Child Health: A Cochrane Review Journal</title><title type="short">Evid.‐Based Child Health</title></titleGroup></publicationMeta><publicationMeta level="part" position="40"><doi origin="wiley" registered="yes">10.1002/ebch.v4:4</doi><numberingGroup><numbering type="journalVolume" number="4">4</numbering><numbering type="journalIssue">4</numbering></numberingGroup><coverDate startDate="2009-12">December 2009</coverDate></publicationMeta><publicationMeta level="unit" type="miscellaneous" position="140" status="forIssue"><doi origin="wiley" registered="yes">10.1002/ebch.462</doi><idGroup><id type="unit" value="EBCH462"></id></idGroup><countGroup><count type="pageTotal" number="159"></count></countGroup><titleGroup><title type="articleCategory">Cochrane Review</title><title type="tocHeading1">Obesity</title></titleGroup><copyright ownership="thirdParty">Copyright © 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.</copyright><eventGroup><event type="firstOnline" date="2009-12-16"></event><event type="publishedOnlineFinalForm" date="2009-12-16"></event><event type="xmlConverted" agent="Converter:JWSART34_TO_WML3G version:2.3.18.1 mode:FullText source:FullText result:FullText" date="2010-09-09"></event><event type="xmlConverted" agent="Converter:WILEY_ML3G_TO_WILEY_ML3GV2 version:3.8.8" date="2014-01-19"></event><event type="xmlConverted" agent="Converter:WML3G_To_WML3G version:4.1.7 mode:FullText,remove_FC" date="2014-10-16"></event></eventGroup><numberingGroup><numbering type="pageFirst">1571</numbering><numbering type="pageLast">1729</numbering></numberingGroup><correspondenceTo>Beatrix Children's Hospital and Department of Epidemiology, University Medical Center Groningen, PO Box 30.001 (CA80), 9700RB, Groningen, Netherlands.</correspondenceTo><linkGroup><link type="toTypesetVersion" href="file:EBCH.EBCH462.pdf"></link></linkGroup></publicationMeta><contentMeta><countGroup><count type="figureTotal" number="2"></count><count type="tableTotal" number="4"></count><count type="referenceTotal" number="315"></count></countGroup><titleGroup><title type="main" xml:lang="en">Cochrane review: Interventions for treating obesity in children</title><title type="short" xml:lang="en">Interventions for treating obesity in children</title></titleGroup><creators><creator xml:id="au1" creatorRole="author" affiliationRef="#af1" corresponding="yes"><personName><givenNames>Hiltje</givenNames><familyName>Oude Luttikhuis</familyName></personName><contactDetails><email>h.oudeluttikhuis@bkk.umcg.nl</email></contactDetails></creator><creator xml:id="au2" creatorRole="author" affiliationRef="#af2"><personName><givenNames>Louise</givenNames><familyName>Baur</familyName></personName></creator><creator xml:id="au3" creatorRole="author" affiliationRef="#af3"><personName><givenNames>Hanneke</givenNames><familyName>Jansen</familyName></personName></creator><creator xml:id="au4" creatorRole="author" affiliationRef="#af2"><personName><givenNames>Vanessa A</givenNames><familyName>Shrewsbury</familyName></personName></creator><creator xml:id="au5" creatorRole="author" affiliationRef="#af4"><personName><givenNames>Claire</givenNames><familyName>O'Malley</familyName></personName></creator><creator xml:id="au6" creatorRole="author" affiliationRef="#af3"><personName><givenNames>Ronald P</givenNames><familyName>Stolk</familyName></personName></creator><creator xml:id="au7" creatorRole="author" affiliationRef="#af5"><personName><givenNames>Carolyn D</givenNames><familyName>Summerbell</familyName></personName></creator></creators><affiliationGroup><affiliation xml:id="af1" countryCode="NL" type="organization"><unparsedAffiliation>Beatrix Children's Hospital and Department of Epidemiology, University Medical Center Groningen, Groningen, Netherlands</unparsedAffiliation></affiliation><affiliation xml:id="af2" countryCode="AU" type="organization"><unparsedAffiliation>Department of Paediatrics and Child Health, The University of Sydney, Westmead, NSW 2145, Australia</unparsedAffiliation></affiliation><affiliation xml:id="af3" countryCode="NL" type="organization"><unparsedAffiliation>Department of Epidemiology, University Medical Center Groningen, Groningen, Netherlands</unparsedAffiliation></affiliation><affiliation xml:id="af4" countryCode="GB" type="organization"><unparsedAffiliation>School of Medicine and Health, Wolfson Research Institute, Durham University, Stockton‐on‐Tees, TS17 6BH, UK</unparsedAffiliation></affiliation><affiliation xml:id="af5" countryCode="GB" type="organization"><unparsedAffiliation>School of Medicine and Health, Wolfson Research Institute, Durham University, Stockton‐on‐Tees, TS17 6BH, UK</unparsedAffiliation></affiliation></affiliationGroup><keywordGroup xml:lang="en" type="author"><keyword xml:id="kwd1">Anti‐Obesity Agents [therapeutic use]</keyword><keyword xml:id="kwd2">Diet, Reducing</keyword><keyword xml:id="kwd3">Life Style</keyword><keyword xml:id="kwd4">Motor Activity</keyword><keyword xml:id="kwd5">Obesity [*therapy]</keyword><keyword xml:id="kwd6">Randomized Controlled Trials as Topic</keyword><keyword xml:id="kwd7">Child</keyword><keyword xml:id="kwd8">Humans</keyword></keywordGroup><abstractGroup><abstract type="main" xml:lang="en"><title type="main">Abstract</title><section xml:id="abs1-1"><title type="main">Background</title><p>Child and adolescent obesity is increasingly prevalent, and can be associated with significant short‐ and long‐term health consequences.</p></section><section xml:id="abs1-2"><title type="main">Objectives</title><p>To assess the efficacy of lifestyle, drug and surgical interventions for treating obesity in childhood.</p></section><section xml:id="abs1-3"><title type="main">Search strategy</title><p>We searched CENTRAL on <i>The Cochrane Library</i> Issue 2 2008, MEDLINE, EMBASE, CINAHL, PsycINFO, ISI Web of Science, DARE and NHS EED. Searches were undertaken from 1985 to May 2008. References were checked. No language restrictions were applied.</p></section><section xml:id="abs1-4"><title type="main">Selection criteria</title><p>We selected randomised controlled trials (RCTs) of lifestyle (i.e. dietary, physical activity and/or behavioural therapy), drug and surgical interventions for treating obesity in children (mean age under 18 years) with or without the support of family members, with a minimum of six months follow up (three months for actual drug therapy). Interventions that specifically dealt with the treatment of eating disorders or type 2 diabetes, or included participants with a secondary or syndromic cause of obesity were excluded.</p></section><section xml:id="abs1-5"><title type="main">Data collection and analysis</title><p>Two reviewers independently assessed trial quality and extracted data following the Cochrane Handbook. Where necessary authors were contacted for additional information.</p></section><section xml:id="abs1-6"><title type="main">Main results</title><p>We included 64 RCTs (5230 participants). Lifestyle interventions focused on physical activity and sedentary behaviour in 12 studies, diet in 6 studies, and 36 concentrated on behaviorally orientated treatment programs. Three types of drug interventions (metformin, orlistat and sibutramine) were found in 10 studies. No surgical intervention was eligible for inclusion. The studies included varied greatly in intervention design, outcome measurements and methodological quality.</p><p>Meta‐analyses indicated a reduction in overweight at 6 and 12 months follow up in: i) lifestyle interventions involving children; and ii) lifestyle interventions in adolescents with or without the addition of orlistat or sibutramine. A range of adverse effects was noted in drug RCTs.</p></section><section xml:id="abs1-7"><title type="main">Authors' conclusions</title><p>While there is limited quality data to recommend one treatment program to be favoured over another, this review shows that combined behavioural lifestyle interventions compared to standard care or self‐help can produce a significant and clinically meaningful reduction in overweight in children and adolescents. In obese adolescents, consideration should be given to the use of either orlistat or sibutramine, as an adjunct to lifestyle interventions, although this approach needs to be carefully weighed up against the potential for adverse effects. Furthermore, high quality research that considers psychosocial determinants for behaviour change, strategies to improve clinician‐family interaction, and cost‐effective programs for primary and community care is required.</p></section><section xml:id="abs1-8"><title type="main">Plain Language Summary</title><p><b>Treating obesity in children</b></p><p>Childhood obesity affects both the physical and psychosocial health of children and may put them at risk of ill health as adults. More information is needed about the best way to treat obesity in children and adolescents. In this review, 64 studies were examined including 54 studies on lifestyle treatments (with a focus on diet, physical activity or behaviour change) and 10 studies on drug treatment to help overweight and obese children and their families with weight control. No surgical treatment studies were suitable to include in this review. This review showed that lifestyle programs can reduce the level of overweight in child and adolescent obesity 6 and 12 months after the beginning of the program. In moderate to severely obese adolescents, a reduction in overweight was found when either the drug orlistat, or the drug sibutramine were given in addition to a lifestyle program, although a range of adverse effects was also noted. Information on the long‐term outcome of obesity treatment in children and adolescents was limited and needs to be examined in some high quality studies.</p></section></abstract></abstractGroup></contentMeta></header></component></istex:document></istex:metadataXml><mods version="3.6"><titleInfo lang="en"><title>Cochrane review: Interventions for treating obesity in children</title></titleInfo><titleInfo type="abbreviated" lang="en"><title>Interventions for treating obesity in children</title></titleInfo><titleInfo type="alternative" contentType="CDATA" lang="en"><title>Cochrane review: Interventions for treating obesity in children</title></titleInfo><name type="personal"><namePart type="given">Hiltje</namePart><namePart type="family">Oude Luttikhuis</namePart><affiliation>Beatrix Children's Hospital and Department of Epidemiology, University Medical Center Groningen, Groningen, Netherlands</affiliation><affiliation>Beatrix Children's Hospital and Department of Epidemiology, University Medical Center Groningen, PO Box 30.001 (CA80), 9700RB, Groningen, Netherlands.</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Louise</namePart><namePart type="family">Baur</namePart><affiliation>Department of Paediatrics and Child Health, The University of Sydney, Westmead, NSW 2145, Australia</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Hanneke</namePart><namePart type="family">Jansen</namePart><affiliation>Department of Epidemiology, University Medical Center Groningen, Groningen, Netherlands</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Vanessa A</namePart><namePart type="family">Shrewsbury</namePart><affiliation>Department of Paediatrics and Child Health, The University of Sydney, Westmead, NSW 2145, Australia</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Claire</namePart><namePart type="family">O'Malley</namePart><affiliation>School of Medicine and Health, Wolfson Research Institute, Durham University, Stockton‐on‐Tees, TS17 6BH, UK</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Ronald P</namePart><namePart type="family">Stolk</namePart><affiliation>Department of Epidemiology, University Medical Center Groningen, Groningen, Netherlands</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Carolyn D</namePart><namePart type="family">Summerbell</namePart><affiliation>School of Medicine and Health, Wolfson Research Institute, Durham University, Stockton‐on‐Tees, TS17 6BH, UK</affiliation><role><roleTerm type="text">author</roleTerm></role></name><typeOfResource>text</typeOfResource><genre type="other" displayLabel="miscellaneous"></genre><originInfo><publisher>John Wiley & Sons, Ltd.</publisher><place><placeTerm type="text">Chichester, UK</placeTerm></place><dateIssued encoding="w3cdtf">2009-12</dateIssued><copyrightDate encoding="w3cdtf">2009</copyrightDate></originInfo><language><languageTerm type="code" authority="rfc3066">en</languageTerm><languageTerm type="code" authority="iso639-2b">eng</languageTerm></language><physicalDescription><internetMediaType>text/html</internetMediaType><extent unit="figures">2</extent><extent unit="tables">4</extent><extent unit="references">315</extent></physicalDescription><abstract>Child and adolescent obesity is increasingly prevalent, and can be associated with significant short‐ and long‐term health consequences.</abstract><abstract>To assess the efficacy of lifestyle, drug and surgical interventions for treating obesity in childhood.</abstract><abstract>We searched CENTRAL on The Cochrane Library Issue 2 2008, MEDLINE, EMBASE, CINAHL, PsycINFO, ISI Web of Science, DARE and NHS EED. Searches were undertaken from 1985 to May 2008. References were checked. No language restrictions were applied.</abstract><abstract>We selected randomised controlled trials (RCTs) of lifestyle (i.e. dietary, physical activity and/or behavioural therapy), drug and surgical interventions for treating obesity in children (mean age under 18 years) with or without the support of family members, with a minimum of six months follow up (three months for actual drug therapy). Interventions that specifically dealt with the treatment of eating disorders or type 2 diabetes, or included participants with a secondary or syndromic cause of obesity were excluded.</abstract><abstract>Two reviewers independently assessed trial quality and extracted data following the Cochrane Handbook. Where necessary authors were contacted for additional information.</abstract><abstract>We included 64 RCTs (5230 participants). Lifestyle interventions focused on physical activity and sedentary behaviour in 12 studies, diet in 6 studies, and 36 concentrated on behaviorally orientated treatment programs. Three types of drug interventions (metformin, orlistat and sibutramine) were found in 10 studies. No surgical intervention was eligible for inclusion. The studies included varied greatly in intervention design, outcome measurements and methodological quality. Meta‐analyses indicated a reduction in overweight at 6 and 12 months follow up in: i) lifestyle interventions involving children; and ii) lifestyle interventions in adolescents with or without the addition of orlistat or sibutramine. A range of adverse effects was noted in drug RCTs.</abstract><abstract>While there is limited quality data to recommend one treatment program to be favoured over another, this review shows that combined behavioural lifestyle interventions compared to standard care or self‐help can produce a significant and clinically meaningful reduction in overweight in children and adolescents. In obese adolescents, consideration should be given to the use of either orlistat or sibutramine, as an adjunct to lifestyle interventions, although this approach needs to be carefully weighed up against the potential for adverse effects. Furthermore, high quality research that considers psychosocial determinants for behaviour change, strategies to improve clinician‐family interaction, and cost‐effective programs for primary and community care is required.</abstract><abstract>Treating obesity in children Childhood obesity affects both the physical and psychosocial health of children and may put them at risk of ill health as adults. More information is needed about the best way to treat obesity in children and adolescents. In this review, 64 studies were examined including 54 studies on lifestyle treatments (with a focus on diet, physical activity or behaviour change) and 10 studies on drug treatment to help overweight and obese children and their families with weight control. No surgical treatment studies were suitable to include in this review. This review showed that lifestyle programs can reduce the level of overweight in child and adolescent obesity 6 and 12 months after the beginning of the program. In moderate to severely obese adolescents, a reduction in overweight was found when either the drug orlistat, or the drug sibutramine were given in addition to a lifestyle program, although a range of adverse effects was also noted. Information on the long‐term outcome of obesity treatment in children and adolescents was limited and needs to be examined in some high quality studies.</abstract><subject lang="en"><genre>keywords</genre><topic>Anti‐Obesity Agents [therapeutic use]</topic><topic>Diet, Reducing</topic><topic>Life Style</topic><topic>Motor Activity</topic><topic>Obesity [*therapy]</topic><topic>Randomized Controlled Trials as Topic</topic><topic>Child</topic><topic>Humans</topic></subject><relatedItem type="host"><titleInfo><title>Evidence‐Based Child Health: A Cochrane Review Journal</title></titleInfo><titleInfo type="abbreviated"><title>Evid.‐Based Child Health</title></titleInfo><genre type="journal">journal</genre><subject><genre>article-category</genre><topic>Cochrane Review</topic></subject><identifier type="ISSN">1557-6272</identifier><identifier type="eISSN">1557-6272</identifier><identifier type="DOI">10.1002/(ISSN)1557-6272</identifier><identifier type="PublisherID">EBCH</identifier><part><date>2009</date><detail type="volume"><caption>vol.</caption><number>4</number></detail><detail type="issue"><caption>no.</caption><number>4</number></detail><extent unit="pages"><start>1571</start><end>1729</end><total>159</total></extent></part></relatedItem><identifier type="istex">6394647E5113C48FA27C1956FA203D76D70C8E0F</identifier><identifier type="DOI">10.1002/ebch.462</identifier><identifier type="ArticleID">EBCH462</identifier><accessCondition type="use and reproduction" contentType="copyright">Copyright © 2009 The Cochrane Collaboration. 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