The dose of behavioral interventions to prevent and treat childhood obesity: A systematic review and meta-regression

William J. Heerman, Meghan M. JaKa, Jerica M. Berge, Erika S. Trapl, Evan C. Sommer, Lauren R. Samuels, Natalie Jackson, Jacob L. Haapala, Alicia S. Kunin-Batson, Barbara A. Olson-Bullis, Heather K. Hardin, Nancy E. Sherwood, Shari L. Barkin

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23 Scopus citations


Background: A better understanding of the optimal "dose" of behavioral interventions to affect change in weight-related outcomes is a critical topic for childhood obesity intervention research. The objective of this review was to quantify the relationship between dose and outcome in behavioral trials targeting childhood obesity to guide future intervention development. Methods: A systematic review and meta-regression included randomized controlled trials published between 1990 and June 2017 that tested a behavioral intervention for obesity among children 2-18years old. Searches were conducted among PubMed (Web-based), Cumulative Index to Nursing and Allied Health Literature (EBSCO platform), PsycINFO (Ovid platform) and EMBASE (Ovid Platform). Two coders independently reviewed and abstracted each included study. Dose was extracted as intended intervention duration, number of sessions, and length of sessions. Standardized effect sizes were calculated from change in weight-related outcome (e.g., BMI-Z score). Results: Of the 258 studies identified, 133 had sufficient data to be included in the meta-regression. Average intended total contact (#sessions x length of sessions) was 27.7 (SD 32.2) hours and average duration was 26.0 (SD 23.4) weeks. When controlling for study covariates, a random-effects meta-regression revealed no significant association between contact hours, intended duration or their interaction and effect size. Conclusions: This systematic review identified wide variation in the dose of behavioral interventions to prevent and treat pediatric obesity, but was unable to detect a clear relationship between dose and weight-related outcomes. There is insufficient evidence to provide quantitative guidance for future intervention development. One limitation of this review was the ability to uniformly quantify dose due to a wide range of reporting strategies. Future trials should report dose intended, delivered, and received to facilitate quantitative evaluation of optimal dose. Trial registrations: The protocol was registered on PROSPERO (#Registration CRD42016036124 ).

Original languageEnglish (US)
Article number157
JournalInternational Journal of Behavioral Nutrition and Physical Activity
Issue number1
StatePublished - Nov 15 2017

Bibliographical note

Funding Information:
This research was supported by the National Heart, Lung, and Blood Institute, the Eunice Kennedy Shriver National Institute of Child Health and Development, and the NIH Office of Behavioral and Social Sciences Research (Grant Numbers U01HL103561, U01HL103620, U01HL103622, U01HL103629, and U01HD068890). Dr. Heerman’s time was supported by a K23 grant from the NHLBI (K23 HL127104). Dr. Hardin’s time was supported by a T32 grant from the NINR (T32 NR015433–01). Dr. Barkin’s time was partially supported by the NIDDK (P30DK092986). The project described was also supported by Award Number UL1TR000114 from the National Center for Advancing Translational Sciences (NCATS) of the National Institutes of Health (NIH). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Center For Research Resources or the National Institutes of Health. Study data were collected and managed using REDCap electronic data capture tools hosted at the University of Minnesota. The funders of the study provided support for investigator time but did not contribute directly to the carrying out the review, interpretation of the results, or approval of the content.

Publisher Copyright:
© 2017 The Author(s).


  • Behavioral intervention
  • Childhood obesity
  • Dose
  • Health behavior
  • Systematic review


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