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Review
. 2018 Mar 2;3(3):CD009728.
doi: 10.1002/14651858.CD009728.pub4.

Physical activity, diet and other behavioural interventions for improving cognition and school achievement in children and adolescents with obesity or overweight

Anne Martin  1 , Josephine N Booth, Yvonne Laird, John Sproule, John J Reilly, David H Saunders
Affiliations
Review

Physical activity, diet and other behavioural interventions for improving cognition and school achievement in children and adolescents with obesity or overweight

Anne Martin et al. Cochrane Database Syst Rev. .

Abstract

Background: The global prevalence of childhood and adolescent obesity is high. Lifestyle changes towards a healthy diet, increased physical activity and reduced sedentary activities are recommended to prevent and treat obesity. Evidence suggests that changing these health behaviours can benefit cognitive function and school achievement in children and adolescents in general. There are various theoretical mechanisms that suggest that children and adolescents with excessive body fat may benefit particularly from these interventions.

Objectives: To assess whether lifestyle interventions (in the areas of diet, physical activity, sedentary behaviour and behavioural therapy) improve school achievement, cognitive function (e.g. executive functions) and/or future success in children and adolescents with obesity or overweight, compared with standard care, waiting-list control, no treatment, or an attention placebo control group.

Search methods: In February 2017, we searched CENTRAL, MEDLINE and 15 other databases. We also searched two trials registries, reference lists, and handsearched one journal from inception. We also contacted researchers in the field to obtain unpublished data.

Selection criteria: We included randomised and quasi-randomised controlled trials (RCTs) of behavioural interventions for weight management in children and adolescents with obesity or overweight. We excluded studies in children and adolescents with medical conditions known to affect weight status, school achievement and cognitive function. We also excluded self- and parent-reported outcomes.

Data collection and analysis: Four review authors independently selected studies for inclusion. Two review authors extracted data, assessed quality and risks of bias, and evaluated the quality of the evidence using the GRADE approach. We contacted study authors to obtain additional information. We used standard methodological procedures expected by Cochrane. Where the same outcome was assessed across different intervention types, we reported standardised effect sizes for findings from single-study and multiple-study analyses to allow comparison of intervention effects across intervention types. To ease interpretation of the effect size, we also reported the mean difference of effect sizes for single-study outcomes.

Main results: We included 18 studies (59 records) of 2384 children and adolescents with obesity or overweight. Eight studies delivered physical activity interventions, seven studies combined physical activity programmes with healthy lifestyle education, and three studies delivered dietary interventions. We included five RCTs and 13 cluster-RCTs. The studies took place in 10 different countries. Two were carried out in children attending preschool, 11 were conducted in primary/elementary school-aged children, four studies were aimed at adolescents attending secondary/high school and one study included primary/elementary and secondary/high school-aged children. The number of studies included for each outcome was low, with up to only three studies per outcome. The quality of evidence ranged from high to very low and 17 studies had a high risk of bias for at least one item. None of the studies reported data on additional educational support needs and adverse events.Compared to standard practice, analyses of physical activity-only interventions suggested high-quality evidence for improved mean cognitive executive function scores. The mean difference (MD) was 5.00 scale points higher in an after-school exercise group compared to standard practice (95% confidence interval (CI) 0.68 to 9.32; scale mean 100, standard deviation 15; 116 children, 1 study). There was no statistically significant beneficial effect in favour of the intervention for mathematics, reading, or inhibition control. The standardised mean difference (SMD) for mathematics was 0.49 (95% CI -0.04 to 1.01; 2 studies, 255 children, moderate-quality evidence) and for reading was 0.10 (95% CI -0.30 to 0.49; 2 studies, 308 children, moderate-quality evidence). The MD for inhibition control was -1.55 scale points (95% CI -5.85 to 2.75; scale range 0 to 100; SMD -0.15, 95% CI -0.58 to 0.28; 1 study, 84 children, very low-quality evidence). No data were available for average achievement across subjects taught at school.There was no evidence of a beneficial effect of physical activity interventions combined with healthy lifestyle education on average achievement across subjects taught at school, mathematics achievement, reading achievement or inhibition control. The MD for average achievement across subjects taught at school was 6.37 points lower in the intervention group compared to standard practice (95% CI -36.83 to 24.09; scale mean 500, scale SD 70; SMD -0.18, 95% CI -0.93 to 0.58; 1 study, 31 children, low-quality evidence). The effect estimate for mathematics achievement was SMD 0.02 (95% CI -0.19 to 0.22; 3 studies, 384 children, very low-quality evidence), for reading achievement SMD 0.00 (95% CI -0.24 to 0.24; 2 studies, 284 children, low-quality evidence), and for inhibition control SMD -0.67 (95% CI -1.50 to 0.16; 2 studies, 110 children, very low-quality evidence). No data were available for the effect of combined physical activity and healthy lifestyle education on cognitive executive functions.There was a moderate difference in the average achievement across subjects taught at school favouring interventions targeting the improvement of the school food environment compared to standard practice in adolescents with obesity (SMD 0.46, 95% CI 0.25 to 0.66; 2 studies, 382 adolescents, low-quality evidence), but not with overweight. Replacing packed school lunch with a nutrient-rich diet in addition to nutrition education did not improve mathematics (MD -2.18, 95% CI -5.83 to 1.47; scale range 0 to 69; SMD -0.26, 95% CI -0.72 to 0.20; 1 study, 76 children, low-quality evidence) and reading achievement (MD 1.17, 95% CI -4.40 to 6.73; scale range 0 to 108; SMD 0.13, 95% CI -0.35 to 0.61; 1 study, 67 children, low-quality evidence).

Authors' conclusions: Despite the large number of childhood and adolescent obesity treatment trials, we were only able to partially assess the impact of obesity treatment interventions on school achievement and cognitive abilities. School and community-based physical activity interventions as part of an obesity prevention or treatment programme can benefit executive functions of children with obesity or overweight specifically. Similarly, school-based dietary interventions may benefit general school achievement in children with obesity. These findings might assist health and education practitioners to make decisions related to promoting physical activity and healthy eating in schools. Future obesity treatment and prevention studies in clinical, school and community settings should consider assessing academic and cognitive as well as physical outcomes.

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Conflict of interest statement

Anne Martin ‐ none known. Josephine N Booth ‐ none known. Yvonne Laird ‐ none known. John Sproule ‐ none known. John J Reilly ‐ none known. David H Saunders ‐ none known.

Figures

1
1
Potential causal links between obesity and impaired cognitive function, school achievement and future success. Reverse causation may also occur when cognitive function, school achievement and future success can impact the 'mediating factors', and both in turn may cause worsening of obesity.
2
2
Study flow diagram.
3
3
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
4
4
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
5
5
Forest plot of comparison: 4 Lifestyle intervention versus control, outcome: 4.1 BMI z‐score.
6
6
Forest plot of comparison: 4 Lifestyle intervention versus control, outcome: 4.2 Total body fat (%).
1.1
1.1. Analysis
Comparison 1 Physical activity intervention versus standard practice, Outcome 1 Mathematics achievement.
1.2
1.2. Analysis
Comparison 1 Physical activity intervention versus standard practice, Outcome 2 Reading achievement.
1.3
1.3. Analysis
Comparison 1 Physical activity intervention versus standard practice, Outcome 3 Language achievement.
1.4
1.4. Analysis
Comparison 1 Physical activity intervention versus standard practice, Outcome 4 2nd Language achievement.
1.5
1.5. Analysis
Comparison 1 Physical activity intervention versus standard practice, Outcome 5 Composite executive functions.
1.6
1.6. Analysis
Comparison 1 Physical activity intervention versus standard practice, Outcome 6 Inhibition control.
1.7
1.7. Analysis
Comparison 1 Physical activity intervention versus standard practice, Outcome 7 Attention.
1.8
1.8. Analysis
Comparison 1 Physical activity intervention versus standard practice, Outcome 8 Verbal working memory.
1.9
1.9. Analysis
Comparison 1 Physical activity intervention versus standard practice, Outcome 9 Non‐verbal working memory.
1.10
1.10. Analysis
Comparison 1 Physical activity intervention versus standard practice, Outcome 10 Visuo‐spatial abilities.
1.11
1.11. Analysis
Comparison 1 Physical activity intervention versus standard practice, Outcome 11 Cognitive flexibility.
1.12
1.12. Analysis
Comparison 1 Physical activity intervention versus standard practice, Outcome 12 Non‐verbal memory.
1.13
1.13. Analysis
Comparison 1 Physical activity intervention versus standard practice, Outcome 13 General intelligence.
2.1
2.1. Analysis
Comparison 2 Physical activity plus healthy lifestyle education interventions versus standard practice, Outcome 1 Average school achievement.
2.2
2.2. Analysis
Comparison 2 Physical activity plus healthy lifestyle education interventions versus standard practice, Outcome 2 Mathematics achievement.
2.3
2.3. Analysis
Comparison 2 Physical activity plus healthy lifestyle education interventions versus standard practice, Outcome 3 Reading achievement.
2.4
2.4. Analysis
Comparison 2 Physical activity plus healthy lifestyle education interventions versus standard practice, Outcome 4 Language achievement.
2.5
2.5. Analysis
Comparison 2 Physical activity plus healthy lifestyle education interventions versus standard practice, Outcome 5 Health class achievement.
2.6
2.6. Analysis
Comparison 2 Physical activity plus healthy lifestyle education interventions versus standard practice, Outcome 6 Inhibition control.
2.7
2.7. Analysis
Comparison 2 Physical activity plus healthy lifestyle education interventions versus standard practice, Outcome 7 Attention.
2.8
2.8. Analysis
Comparison 2 Physical activity plus healthy lifestyle education interventions versus standard practice, Outcome 8 Visuo‐spatial abilities.
2.9
2.9. Analysis
Comparison 2 Physical activity plus healthy lifestyle education interventions versus standard practice, Outcome 9 Non‐verbal memory.
3.1
3.1. Analysis
Comparison 3 Dietary interventions versus standard practice, Outcome 1 Average school achievement.
3.2
3.2. Analysis
Comparison 3 Dietary interventions versus standard practice, Outcome 2 Mathematics achievement.
3.3
3.3. Analysis
Comparison 3 Dietary interventions versus standard practice, Outcome 3 Reading achievement.
3.4
3.4. Analysis
Comparison 3 Dietary interventions versus standard practice, Outcome 4 Attention.
4.1
4.1. Analysis
Comparison 4 Lifestyle intervention versus control, Outcome 1 BMI z‐score.
4.2
4.2. Analysis
Comparison 4 Lifestyle intervention versus control, Outcome 2 Total body fat (%).
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    1. Wirt T, Schreiber A, Kesztyus D, Steinacker JM. Early life cognitive abilities and body weight: cross‐sectional study of the association of inhibitory control, cognitive flexibility, and sustained attention with BMI percentiles in primary school children. Journal of Obesity 2015;2015:534651. [DOI: 10.1155/2015/534651; DRKS00000494; PMC4383153; PUBMED: 25874122] - DOI - PMC - PubMed

References to studies excluded from this review

Bartholomew 2011 {published data only}
    1. Bartholomew JB, Jowers EM. Physically active academic lessons in elementary children. Preventive Medicine 2011;52 Suppl:S51‐4. [DOI: 10.1016/j.ypmed.2011.01.017; PUBMED: 21281672] - DOI - PMC - PubMed
Chaya 2012 {published data only}
    1. Chaya MS, Nagendra H, Selvam S, Kurpad A, Srinivasan K. Effect of yoga on cognitive abilities in schoolchildren from a socioeconomically disadvantaged background: a randomized controlled study. Journal of Alternative and Complementary Medicine 2012;18(12):1161‐7. [DOI: 10.1089/acm.2011.0579; PUBMED: 22909321] - DOI - PubMed
Crova 2014 {published data only}
    1. Crova C, Struzzolino I, Marchetti R, Masci I, Vannozzi G, Forte R, et al. Cognitively challenging physical activity benefits executive function in overweight children. Journal of Sports Sciences 2014;32 (3):201‐211. [DOI: 10.1080/02640414.2013.828849; PUBMED: 24015968 ] - DOI - PubMed
Delgado‐Rico 2012b {published data only}
    1. Delgado‐Rico E, Rio‐Valle JS, Albein‐Urios N, Caracuel A, González‐Jiménez E, Piqueras MJ, et al. Effects of a multicomponent behavioral intervention on impulsivity and cognitive deficits in adolescents with excess weight. Behavioural Pharmacology 2012;23(5‐6):609‐15. [DOI: 10.1097/FBP.0b013e328356c3ac; PUBMED: 22785438] - DOI - PubMed
Donnelly 2009 {published data only}
    1. Donnelly JE, Greene JL, Gibson CA, Smith BK, Washburn RA, Sullivan DK, et al. Physical activity across the curriculum (PAAC): a randomized controlled trial to promote physical activity and diminish overweight and obesity in elementary school children. Preventive Medicine 2009; Vol. 49, issue 4:336‐41. - PMC - PubMed
    1. Donnelly JE, Lambourne K. Classroom‐based physical activity, cognition, and academic achievement. Preventive Medicine 2011;52(42):S36‐42. - PubMed
Donnelly 2013 {published and unpublished data}
    1. Donnelly JE, Greene JL, Gibson CA, Sullivan DK, Hansen DM, Hillman CH, et al. Physical activity and academic achievement across the curriculum (A+ PAAC): rationale and design of a 3‐year, cluster‐randomized trial. BMC Public Health 2013;13(1):307. - PMC - PubMed
    1. NCT01699295. Physical Activity and Academic Achievement Across the Curriculum (A+PAAC). clinicaltrials.gov/show/NCT01699295 (first received 12 October 2012).
Epstein 2000 {published data only}
    1. Epstein LH, Paluch RA, Gordy CC, Saelens BE, Ernst MM. Problem solving in the treatment of childhood obesity. Journal of Consulting and Clinical Psychology 2000;68(4):717‐21. [PUBMED: 10965646] - PubMed
Gee 2014 {published data only}
    1. Gee L, Agras WS. A randomized pilot study of a brief outpatient problem‐solving intervention to promote healthy eating and activity habits in adolescents. Clinical Pediatrics 2014;53(3):293‐6. [DOI: 10.1177/0009922813497093; PUBMED: 23897759] - DOI - PubMed
Gentile 2009 {published data only}
    1. Eisenmann JC, Gentile DA, Welk GJ, Callahan R, Strickland S, Walsh M, et al. SWITCH: rationale, design, and implementation of a community, school, and family‐based intervention to modify behaviors related to childhood obesity. BMC Public health 2008 Jun 29;8(1):223. [DOI: 10.1186/1471-2458-8-223; PUBMED: 18588706 ] - DOI - PMC - PubMed
    1. Gentile DA, Reimer RA, Nathanson A, Walsh DA, Eisenmann JC. Protective effects of parental monitoring of children's media use a prospective study. JAMA Pediatrics 2014;168(5):479‐84. [DOI: 10.1001/jamapediatrics.2014.146; PUBMED: 24686493] - DOI - PubMed
    1. Gentile DA, Welk G, Eisenmann JC, Reimer RA, Walsh DA, Russell, DW. Evaluation of a multiple ecological level child obesity prevention program: switch® what you do, view, and chew. BMC Medicine 2009;7(1):49. [CENTRAL: PMC2758893; DOI: 10.1186/1741-7015-7-49] - DOI - PMC - PubMed
    1. Welk GJ, Chen S, Nam YH, Weber TE. A formative evaluation of the SWITCH obesity prevention program: print versus online programming. BMC Obesity 2015;2:20. [CENTRAL: PMC4511247; DOI: 10.1186/s40608-015-0049-1] - DOI - PMC - PubMed
Goldfield 2012 {published data only}
    1. Goldfield GS, Adamo KB, Rutherford J, Murray M. The effects of aerobic exercise on psychosocial functioning of adolescents who are overweight or obese. Journal of Pediatric Psychology 2012;37(10):1136‐47. [DOI: 10.1093/jpepsy/jss084; PUBMED: 23027721] - DOI - PubMed
Grieco 2009 {published data only}
    1. Grieco LA, Jowers EM, Bartholomew JB. Physically active academic lessons and time on task: the moderating effect of body mass index. Medicine and Science in Sports and Exercise 2009;41(10):1921‐6. [DOI: 10.1249/MSS.0b013e3181a61495; PUBMED: 19727020] - DOI - PubMed
Gunnarsdottir 2012b {published data only}
    1. Gunnarsdottir T, Njardvik U, Olafsdottir AS, Craighead L, Bjarnason R. Childhood obesity and co‐morbid problems: effects of Epstein's family‐based behavioural treatment in an Icelandic sample. Journal of Evaluation in Clinical Practice 2012;18(2):465‐72. [DOI: 10.1111/j.1365-2753.2010.01603.x; PUBMED: 21210895] - DOI - PubMed
Halberstadt 2017 {published data only}
    1. Halberstadt J, Vet E, Nederkoorn C, Jansen A, Weelden OH, Eekhout I. The association of self‐regulation with weight loss maintenance after an intensive combined lifestyle intervention for children and adolescents with severe obesity. BMC Obesity 2017;4(1):13. [DOI: 10.1186/s40608-016-0140-2; PUBMED: 28451439] - DOI - PMC - PubMed
Hill 2011 {published data only}
    1. Hill LJ, Williams JH, Aucott L, Thomson J, Mon‐Williams M. How does exercise benefit performance on cognitive tests in primary‐school pupils?. Developmental Medicine and Child Neurology 2011;53(7):630‐5. [DOI: 10.1111/j.1469-8749.2011.03954.x; PUBMED: 21649650] - DOI - PubMed
Hillman 2014 {published data only}
    1. Hillman CH, Pontifex MB, Castelli DM, Khan NA, Raine LB, Scudder MR, et al. Effects of the FITKids randomized controlled trial on executive control and brain function. Pediatrics 2014 Oct 1;134(4):e1063‐71. - PMC - PubMed
    1. Khan NA, Raine LB, Drollette ES, Scudder MR, Cohen NJ, Kramer AF, et al. The relationship between total water intake and cognitive control among prepubertal children. Annals of Nutrition & Metabolism 2015;66(Suppl 3):38‐41. [DOI: 10.1159/000381245; PUBMED: 26088046] - DOI - PubMed
    1. Khan NA, Raine LB, Drollette ES, Scudder MR, Pontifex MB, Castelli DM, et al. Impact of the FITKids physical activity intervention on adiposity in prepubertal children. Pediatrics 2014 2014133;4:e875‐e883. [DOI: 10.1542/peds.2013-224; PUBMED: 24685956 ] - DOI - PMC - PubMed
Hollar 2010 {published data only}
    1. Hollar D, Messiah SE, Lopez‐Mitnik G, Hollar T, Almon M, Agatston AS. Effect of a two‐year obesity prevention intervention on percentile changes in body mass index and academic performance in low‐income elementary school children. American Journal of Public Health 2010;100(4):646‐53. [DOI: 10.2105/AJPH.2009.165746.; PUBMED: 20167892] - DOI - PMC - PubMed
Hutson 2008 {published data only}
    1. Hutson JB. The Relationship between Adolescent Obesity Treatment and Academic Performance [Thesis]. Minneapolis: Walden University, 2008.
Leidy 2013 {published and unpublished data}
    1. Leidy HJ, Ortinau LC, Douglas SM, Hoertel HA. Beneficial effects of a higher‐protein breakfast on the appetitive, hormonal, and neural signals controlling energy intake regulation in overweight/obese,“breakfast‐skipping,” late‐adolescent girls. American Journal of Clinical Nutrition 2013;97(4):677‐88. [DOI: 10.3945/ajcn.112.053116; PUBMED: 23446906] - DOI - PMC - PubMed
    1. NCT01192100. The beneficial effects of a protein‐rich breakfast on appetite control & cognition in overweight and obese adolescents. clinicaltrials.gov/show/NCT01192100 (first received 31 August 2010).
Milosis 2007 {published data only}
    1. Milosis D, Papaioannou AG. Interdisciplinary teaching, multiple goals and self‐concept. In: Liokkonen J, Vanden Auweele Y, Vereijken B, Theodorakis Y editor(s). Psychology for Physical Educators: Student in Focus. 2nd Edition. Champaign (IL): Human Kinetics, 2007:175‐98.
Murray 2008 {published data only}
    1. Murray NG, Garza JC, Diamond PM, Stigler MH, Hoelscher D, Kelder S, et al. PASS & CATCH improves academic achievement. www.nemours.org/content/dam/nemours/wwwv2/filebox/service/healthy‐living... (accessed 21 October 2013).
Muzaffar 2014 {published data only}
    1. Muzaffar H, Chapman‐Novakofski K, Castelli DM, Scherer JA. The HOT (Healthy Outcome for Teens) project: using a web‐based medium to influence attitude, subjective norm, perceived behavioral control and intention for obesity and type 2 diabetes prevention. Appetite 2014;72:82‐9. [DOI: 10.1016/j.appet.2013.09.024; PUBMED: 24099704] - DOI - PubMed
Naar‐King 2016 {published data only}
    1. Hartlieb KB, Naar S, Ellis D, Tiura A, Carcone A. Translating basic behavioral science of learning and motivation into an adaptive community‐based obesity treatment for African American adolescents. Psychosomatic Medicine 2015;77(3):A127.
    1. Naar‐King S, Ellis DA, Idalski CA, Templin T, Jacques‐Tiura AJ, Brogan Hartlieb K, et al. Sequential multiple assignment randomized trial (SMART) to construct weight loss interventions for African American adolescents. Journal of Clinical Child and Adolescent Psychology 2016;45(4):428‐41. [DOI: 10.1080/15374416.2014.971459; PUBMED: 25668386] - DOI - PMC - PubMed
Pentz 2011 {published data only}
    1. Pentz MA, Huh J, Riggs NR, Spruijt‐Metz D, Chou CP. Effects of a childhood obesity prevention program aimed at executive cognitive function: the Pathways trial. Obesity 2011;19(S1):S121. [DOI: 10.1038/oby.2011.226] - DOI
Pesce 2016b {published data only}
    1. Pesce C, Masci I, Marchetti R, Vazou S, Saakslahti A, Tomporowski PD. Deliberate play and preparation jointly benefit motor and cognitive development: mediated and moderated effects. Frontiers in Psychology 2016;7:349. [DOI: 10.3389/fpsyg.2016.00349; PUBMED: 27014155 ] - DOI - PMC - PubMed
Puder 2011 {published data only}
    1. Niederer I, Bürgi F, Ebenegger V, Marques‐Vidal, Schindler C, Nydegger A, et al. Effects of a lifestyle intervention on adiposity and fitness in overweight or low fit preschoolers (ballabeina). Obesity 2013;21(3):E287‐93. [DOI: 10.1002/oby.20119; PUBMED: 23592683] - DOI - PubMed
    1. Niederer I, Kriemler S, Zahner L, Bürgi F, Ebenegger V, Hartmann T, et al. Influence of a lifestyle intervention in preschool children on physiological and psychological parameters (ballabeina): study design of a cluster randomized controlled trial. BMC Public Health 2009;9:94. [DOI: 10.1186/1471-2458-9-94; PUBMED: 19335890] - DOI - PMC - PubMed
    1. Puder JJ, Marques‐Vidal P, Schindler C, Zahner L, Niederer I, Ebenegger V, et al. Effect of multidimensional lifestyle intervention on fitness and adiposity in predominantly migrant preschool children (ballabeina): cluster randomised controlled trial. BMJ 2011;343(7830):945. [DOI: 10.1136/bmj.d6195; PUBMED: 21998346] - DOI - PMC - PubMed
Reed 2010 {published data only}
    1. Reed JA, Einstein G, Hahn E, Hooker SP, Gross VP, Kravitz J. Examining the impact of integrating physical activity on fluid intelligence and academic performance in an elementary school setting: a preliminary investigation. Journal of Physical Activity & Health 2010;7(3):343‐51. [PUBMED: 20551490] - PubMed
Reed 2012 {published data only}
    1. Reed JA, Maslow AL, Long S, Hughey M. Examining the impact of 45 minutes of daily physical education on cognitive ability, fitness performance, and body composition of African American youth. Journal of Physical Activity & Health 2013; Vol. 10, issue 2:185‐97. [PUBMED: 22820756] - PubMed
Robinson 2010 {published data only}
    1. Robinson TN, Matheson DM, Kraemer HC, Wilson DM, Obarzanek E, Thompson NS, et al. A randomized controlled trial of culturally tailored dance and reducing screen time to prevent weight gain in low‐Income African American girls: stanford GEMS. Archives of Pediatrics & Adolescent Medicine 2010;164(11):995‐1004. [DOI: 10.1001/archpediatrics.2010.197; PUBMED: 21041592] - DOI - PMC - PubMed
Salmoirago‐Blotcher 2015 {published data only}
    1. Salmoirago‐Blotcher E, Druker S, Meyer F, Bock B, Crawford S, Pbert L. Design and methods for "Commit to Get Fit" ‐ a pilot study of a school‐based mindfulness intervention to promote healthy diet and physical activity among adolescents. Contemporary Clinical Trials 2015;41:248‐58. [DOI: 10.1016/j.cct.2015.02.004; PUBMED: 25687667] - DOI - PMC - PubMed
Smith 2015 {published data only}
    1. Smith JD, Montano Z, Dishion TJ, Shaw DS, Wilson MN. Preventing weight gain and obesity: indirect effects of the family check‐up in early childhood. Prevention Science 2015;16(3):408‐19. [DOI: 10.1007/s11121-014-0505-z; PUBMED: 25263212] - DOI - PMC - PubMed
Tomporowski 2008 {published data only}
    1. Tomporowski PD, Davis CL, Lambourne K, Gregoski M, Tkacz J. Task switching in overweight children: effects of acute exercise and age. Journal of Sport & Exercise Psychology 2008;30(5):497‐511. [CENTRAL: PMC2705951] - PMC - PubMed
Vanhelst 2012 {published data only}
    1. Vanhelst J, Béghin L, Fardy PS, Bui‐Xuan G, Mikulovic J. A conative educational model for an intervention program in obese youth. BMC Public Health 2012;12:416. [DOI: 10.1186/1471-2458-12-416; PUBMED: 22676244] - DOI - PMC - PubMed
    1. Vanhelst J, Marchand F, Fardy P, Zunquin G, Loeuille GA, Renaut H, et al. The CEMHaVi program: control, evaluation, and modification of lifestyles in obese youth. Journal of Cardiopulmonary Rehabilitation and Prevention 2010;30(3):181‐5. [DOI: 10.1097/HCR.0b013e3181d0c2ba; PUBMED: 20190644] - DOI - PubMed
Verbeken 2013 {published data only}
    1. Verbeken S, Braet C, Goossens L, Oord S. Executive function training with game elements for obese children: a novel treatment to enhance self‐regulatory abilities for weight‐control. Behaviour Research and Therapy 2013;51(6):290‐9. [DOI: 10.1016/j.brat.2013.02.006; PUBMED: 23524063] - DOI - PubMed
Vos 2011 {published data only}
    1. Vos RC, Wit JM, Pijl H, Kruyff CC, Houdijk EC. The effect of family‐based multidisciplinary cognitive behavioral treatment in children with obesity: study protocol for a randomized controlled trial. Trials 2011;12:110. [CENTRAL: PMC3113984; DOI: 10.1186/1745-6215-12-110] - DOI - PMC - PubMed
Wong 2016 {published data only}
    1. Wong WW, Ortiz CL, Stuff JE, Mikhail C, Lathan D, Moore LA, et al. A community‐based healthy living promotion program improved self‐esteem among minority children. Journal of Pediatric Gastroenterology and Nutrition 2016;63(1):106‐112. [DOI: 10.1097/MPG.0000000000001088; PUBMED: 27336592] - DOI - PubMed

References to studies awaiting assessment

NCT02043626 {published data only}
    1. NCT02043626. Study to evaluate the health and wellness policies of the New Haven Public School District. (H&A) [School wellness policy: RCT to implement & evaluate impact on childhood obesity]. clinicaltrials.gov/show/NCT02043626 (first received 23 January 2014).
NCT02122224 {published data only}
    1. NCT02122224. Breakfast consumption in preschoolers: satiety, diet quality and memory. clinicaltrials.gov/show/NCT02122224 (first received 24 April 2014).
Vetter 2015 {published data only}
    1. Vetter M, O'Connor H, O'Dwyer N, Orr R. Active learning: effectiveness of learning a numeracy skill with physical activity, reducing sedentary time in school children. Journal of Science and Medicine in Sport 2015;19 Suppl:e12. [DOI: 10.1016/j.jsams.2015.12.408] - DOI
    1. Vetter M, O'Connor H, O'Dwyer N, Orr R. Learning 'on the move': a combined numeracy and physical activity program for primary school children. Journal of Science and Medicine in Sport 2014;18 Suppl 1:e63. [DOI: 10.1016/j.jsams.2014.11.288] - DOI

References to ongoing studies

Bau 2016 {published data only}
    1. Bau AM, Ernert A, Krude H, Wiegand S. Hormonal regulatory mechanisms in obese children and adolescents after previous weight reduction with a lifestyle intervention: maintain‐paediatric part‐a RCT from 2009–15. BMC Obesity 2016;3(1):29. [DOI: ] - PMC - PubMed
Cadenas‐Sanchez 2016 {published data only}
    1. Cadenas‐Sánchez C, Mora‐González J, Migueles JH, Martín‐Matillas M, Gómez‐Vida J, Escolano‐Margarit MV, et al. An exercise‐based randomized controlled trial on brain, cognition, physical health and mental health in overweight/obese children (ActiveBrains project): rationale, design and methods. Contemporary Clinical Trials 2016;47:315‐24. - PubMed
DRKS00005275 {published data only}
    1. DRKS00005275. Ballschule ‐ leicht gemacht (Ball School ‐ easy): physical exercise and diet counselling for overweight children. www.drks.de/DRKS00005275 (first received 06 March 2014).
ISRCTN12698269 {published data only}
    1. ISRCTN12698269. Effectiveness of the run‐a‐mile intervention [To evaluate the effectiveness and cost effectiveness of the daily ‘run a mile’ intervention implemented across primary schools located in Birmingham]. isrctn.com/ISRCTN12698269 (first received 27 October 2016).
NCT01737658 {published and unpublished data}
    1. NCT01737658. Insulin resistance and cognitive dysfunction on obese adolescents: pilot study. clinicaltrials.gov/show/NCT01737658 (first received 29 November 2012).
NCT02873715 {published data only}
    1. NCT02873715. Primary care pediatrics learning activity and nutrition with families (PLAN) [The effectiveness of family‐based weight loss treatment implemented in primary care centers]. clinicaltrials.gov/show/NCT02873715 (first received 19 August 2016).
NCT02972164 {published data only}
    1. NCT02972164. Adapted cognitive behavioral approach to addressing overweight and obesity among Qatari youth. clinicaltrials.gov/show/NCT02972164 (first received 23 November 2016).
Po'e 2013 {published data only}
    1. Po'e EK, Heerman WJ, Mistry RS, Barkin SL. Growing right onto wellness (GROW): a family‐centered, community‐based obesity prevention randomized controlled trial for preschool child‐parent pairs. Contemporary Clinical Trials 2013;36(2):436‐49. [DOI: 10.1016/j.cct.2013.08.013; PUBMED: 24012890] - DOI - PMC - PubMed
RBR‐38p23s {published data only}
    1. RBR‐38p23s. Psychological treatment for obese adolescents and their effects on social interaction and body mass index [Multifocal intervention in obese adolescents: social competence, behavior problems, academic performance and weight reduction]. www.ensaiosclinicos.gov.br/rg/RBR‐38p23s/ (first received 18 July 2014).
Robinson 2013 {published and unpublished data}
    1. NCT01642836. Clinic, family and community collaboration to treat overweight and obese children (Stanford GOALS). clinicaltrials.gov/show/NCT01642836 (first received 17 July 2012).
    1. Robinson TN, Matheson D, Desai M, Wilson DM, Weintraub DL, Haskell WL, et al. Family, community and clinic collaboration to treat overweight and obese children: stanford GOALS—a randomized controlled trial of a three‐year, multi‐component, multi‐level, multi‐setting intervention. Contemporary Clinical Trials 2013;36(2):421‐35. [DOI: 10.1016/j.cct.2013.09.001; PUBMED: 24028942] - DOI - PMC - PubMed
Sardinha 2014 {published data only}
    1. Sardinha LB, Marques A, Martins S, Palmeira A, Minderico C. Fitness, fatness, and academic performance in seventh‐grade elementary school students. BMC Pediatrics 2014 2014;14:176. [DOI: 10.1186/1471-2431-14-176; ISRCTN: 76013675] - DOI - PMC - PubMed
Scherr 2014 {published data only}
    1. Scherr RE, Linnell JD, Smith MH, Briggs M, Bergman J, Brian KM, et al. The shaping healthy choices program: design and implementation methodologies for a multicomponent, school‐based nutrition education intervention. Journal of Nutrition Education and Behavior 2014;46(6):e13‐e21. [DOI: 10.1016/j.jneb.2014.08.010; PUBMED: 25457732] - DOI - PubMed
Stanley 2016 {published data only}
    1. Stanley RM, Jones RA, Cliff DP, Trost SG, Berthelsen D, Salmon, J, et al. Increasing physical activity among young children from disadvantaged communities: study protocol of a group randomised controlled effectiveness trial. BMC Public Health 2016;16:1095. [DOI: 10.1186/s12889-016-3743-0] - DOI - PMC - PubMed

Additional references

Aadland 2017
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Aggio 2016
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Al‐Khudairy 2017
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Alarcón 2016
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