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Diet and physical activity interventions to prevent or treat obesity in South Asian children and adults: a systematic review and meta-analysis.

Brown T, Smith S, Bhopal R, Kasim A, Summerbell C - Int J Environ Res Public Health (2015)

Bottom Line: The metabolic risks associated with obesity are greater for South Asian populations compared with White or other ethnic groups, and levels of obesity in childhood are known to track into adulthood.There was no evidence that interventions were more or less effective according to whether the intervention was set in South Asia or not, or by socio-economic status.There is also evidence of culturally appropriate approaches to, and characteristics of, effective interventions in adults which we believe could be transferred and used to develop effective interventions in children.

View Article: PubMed Central - PubMed

Affiliation: Obesity Related Behaviours (ORB) Research Group, School of Medicine, Pharmacy and Health, Wolfson Research Institute for Health and Wellbeing, Queen's Campus, Durham University, Stockton-on-Tees, TS17 6BH, UK. tamara.brown@durham.ac.uk.

ABSTRACT

Background and aims: The metabolic risks associated with obesity are greater for South Asian populations compared with White or other ethnic groups, and levels of obesity in childhood are known to track into adulthood. Tackling obesity in South Asians is therefore a high priority. The rationale for this systematic review is the suggestion that there may be differential effectiveness in diet and physical activity interventions in South Asian populations compared with other ethnicities. The research territory of the present review is an emergent, rather than mature, field of enquiry, but is urgently needed. Thus the aim of this systematic review and meta-analysis was to assess the effectiveness of diet and physical activity interventions to prevent or treat obesity in South Asians living in or outside of South Asia and to describe the characteristics of effective interventions.

Methods: Systematic review of any type of lifestyle intervention, of any length of follow-up that reported any anthropometric measure for children or adults of South Asian ethnicity. There was no restriction on the type of comparator; randomised controlled trials, controlled clinical trials, and before-after studies were included. A comprehensive search strategy was implemented in five electronic databases: ASSIA, Cochrane Controlled Trials Register, Embase, Medline and Social Sciences Citation Index. The search was limited to English language abstracts published between January 2006 and January 2014. References were screened; data extraction and quality assessment were carried out by two reviewers. RESULTS are presented in narrative synthesis and meta-analysis.

Results: Twenty-nine studies were included, seven children, 21 adult and one mixed age. No studies in children under six were identified. Sixteen studies were conducted in South Asia, ten in Europe and three in USA. Effective or promising trials include physical activity interventions in South Asian men in Norway and South Asian school-children in the UK. A home-based, family-orientated diet and physical activity intervention improved obesity outcomes in South Asian adults in the UK, when adjusted for baseline differences. Meta-analyses of interventions in children showed no significant difference between intervention and control for body mass index or waist circumference. Meta-analyses of adult interventions showed significant improvement in weight in data from two trials adjusted for baseline differences (mean difference -1.82 kgs, 95% confidence interval -2.48 to -1.16) and in unadjusted data from three trials following sensitivity analysis (mean difference -1.20 kgs, 95% confidence interval -2.23 to -0.17). Meta-analyses showed no significant differences in body mass index and waist circumference for adults. Twenty of 24 intervention groups showed improvements in adult body mass index from baseline to follow-up; average change in high quality studies (n = 7) ranged from 0.31 to -0.8 kg/m2. There was no evidence that interventions were more or less effective according to whether the intervention was set in South Asia or not, or by socio-economic status.

Conclusions: Meta-analysis of a limited number of controlled trials found an unclear picture of the effects of interventions on body mass index for South Asian children. Meta-analyses of a limited number of controlled trials showed significant improvement in weight for adults but no significant differences in body mass index and waist circumference. One high quality study in South Asian children found that a school-based physical activity intervention that was delivered within the normal school day which was culturally sensitive, was effective. There is also evidence of culturally appropriate approaches to, and characteristics of, effective interventions in adults which we believe could be transferred and used to develop effective interventions in children.

No MeSH data available.


Related in: MedlinePlus

Mean change in BMI for adults from baseline to follow-up for intervention groups. grey = high quality (quality score 5–6); black = medium quality (quality score 3–4); pattern = low quality (quality score 0–2).
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ijerph-12-00566-f003: Mean change in BMI for adults from baseline to follow-up for intervention groups. grey = high quality (quality score 5–6); black = medium quality (quality score 3–4); pattern = low quality (quality score 0–2).

Mentions: There were seven RCTs [34,36,40,41,54,55,60] and 15 BAs [37,38,39,42,43,44,45,48,49,51,52,56,57,58,61] of D and PA interventions in adults. BMI was the most commonly reported obesity outcome in adults; Figure 3 shows change in BMI from baseline to follow-up in intervention arms only (24 arms from 19 studies; three studies did not report BMI). The quality of these 19 studies was assessed as: seven “high”, six “medium” and six “low”. The data suggests, all other things being equal, that lower quality studies were associated with larger changes in BMI. Mean change in BMI from baseline to follow-up ranged from −0.3 kgs to −9.6 kgs for low quality studies, 0.2 kgs to −1.5 kgs for medium quality studies and 0.31 kgs to −0.8 kgs for high quality studies.


Diet and physical activity interventions to prevent or treat obesity in South Asian children and adults: a systematic review and meta-analysis.

Brown T, Smith S, Bhopal R, Kasim A, Summerbell C - Int J Environ Res Public Health (2015)

Mean change in BMI for adults from baseline to follow-up for intervention groups. grey = high quality (quality score 5–6); black = medium quality (quality score 3–4); pattern = low quality (quality score 0–2).
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4306880&req=5

ijerph-12-00566-f003: Mean change in BMI for adults from baseline to follow-up for intervention groups. grey = high quality (quality score 5–6); black = medium quality (quality score 3–4); pattern = low quality (quality score 0–2).
Mentions: There were seven RCTs [34,36,40,41,54,55,60] and 15 BAs [37,38,39,42,43,44,45,48,49,51,52,56,57,58,61] of D and PA interventions in adults. BMI was the most commonly reported obesity outcome in adults; Figure 3 shows change in BMI from baseline to follow-up in intervention arms only (24 arms from 19 studies; three studies did not report BMI). The quality of these 19 studies was assessed as: seven “high”, six “medium” and six “low”. The data suggests, all other things being equal, that lower quality studies were associated with larger changes in BMI. Mean change in BMI from baseline to follow-up ranged from −0.3 kgs to −9.6 kgs for low quality studies, 0.2 kgs to −1.5 kgs for medium quality studies and 0.31 kgs to −0.8 kgs for high quality studies.

Bottom Line: The metabolic risks associated with obesity are greater for South Asian populations compared with White or other ethnic groups, and levels of obesity in childhood are known to track into adulthood.There was no evidence that interventions were more or less effective according to whether the intervention was set in South Asia or not, or by socio-economic status.There is also evidence of culturally appropriate approaches to, and characteristics of, effective interventions in adults which we believe could be transferred and used to develop effective interventions in children.

View Article: PubMed Central - PubMed

Affiliation: Obesity Related Behaviours (ORB) Research Group, School of Medicine, Pharmacy and Health, Wolfson Research Institute for Health and Wellbeing, Queen's Campus, Durham University, Stockton-on-Tees, TS17 6BH, UK. tamara.brown@durham.ac.uk.

ABSTRACT

Background and aims: The metabolic risks associated with obesity are greater for South Asian populations compared with White or other ethnic groups, and levels of obesity in childhood are known to track into adulthood. Tackling obesity in South Asians is therefore a high priority. The rationale for this systematic review is the suggestion that there may be differential effectiveness in diet and physical activity interventions in South Asian populations compared with other ethnicities. The research territory of the present review is an emergent, rather than mature, field of enquiry, but is urgently needed. Thus the aim of this systematic review and meta-analysis was to assess the effectiveness of diet and physical activity interventions to prevent or treat obesity in South Asians living in or outside of South Asia and to describe the characteristics of effective interventions.

Methods: Systematic review of any type of lifestyle intervention, of any length of follow-up that reported any anthropometric measure for children or adults of South Asian ethnicity. There was no restriction on the type of comparator; randomised controlled trials, controlled clinical trials, and before-after studies were included. A comprehensive search strategy was implemented in five electronic databases: ASSIA, Cochrane Controlled Trials Register, Embase, Medline and Social Sciences Citation Index. The search was limited to English language abstracts published between January 2006 and January 2014. References were screened; data extraction and quality assessment were carried out by two reviewers. RESULTS are presented in narrative synthesis and meta-analysis.

Results: Twenty-nine studies were included, seven children, 21 adult and one mixed age. No studies in children under six were identified. Sixteen studies were conducted in South Asia, ten in Europe and three in USA. Effective or promising trials include physical activity interventions in South Asian men in Norway and South Asian school-children in the UK. A home-based, family-orientated diet and physical activity intervention improved obesity outcomes in South Asian adults in the UK, when adjusted for baseline differences. Meta-analyses of interventions in children showed no significant difference between intervention and control for body mass index or waist circumference. Meta-analyses of adult interventions showed significant improvement in weight in data from two trials adjusted for baseline differences (mean difference -1.82 kgs, 95% confidence interval -2.48 to -1.16) and in unadjusted data from three trials following sensitivity analysis (mean difference -1.20 kgs, 95% confidence interval -2.23 to -0.17). Meta-analyses showed no significant differences in body mass index and waist circumference for adults. Twenty of 24 intervention groups showed improvements in adult body mass index from baseline to follow-up; average change in high quality studies (n = 7) ranged from 0.31 to -0.8 kg/m2. There was no evidence that interventions were more or less effective according to whether the intervention was set in South Asia or not, or by socio-economic status.

Conclusions: Meta-analysis of a limited number of controlled trials found an unclear picture of the effects of interventions on body mass index for South Asian children. Meta-analyses of a limited number of controlled trials showed significant improvement in weight for adults but no significant differences in body mass index and waist circumference. One high quality study in South Asian children found that a school-based physical activity intervention that was delivered within the normal school day which was culturally sensitive, was effective. There is also evidence of culturally appropriate approaches to, and characteristics of, effective interventions in adults which we believe could be transferred and used to develop effective interventions in children.

No MeSH data available.


Related in: MedlinePlus