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A Systematic Review of Randomized Trials

Clare E. Collins, PhD, BSc, Dip(Nutr&Diet), Dip(ClinEpi), AdvAPD; Janet Warren, PhD, BSc, RD; Melinda Neve, BND, APD; Penelope McCoy, BHSc(Nutr&Diet), APD; Barrie J. Stokes, BSc, MMath

Arch Pediatr Adolesc Med. 2006;160:906-922.

Objectives  To assess the effectiveness of dietetic treatment for obese children and to report details of dietary interventions.

Data Sources  English-language articles from 1975 to 2003 available from health and medical databases.

Study Selection  Randomized controlled trials with subjects younger than 18 years of age that included a dietary intervention in isolation or in combination with lifestyle modifications and/or psychological therapies. One person searched the databases; 2 people independently critically appraised the articles for methodological quality and then extracted data using standardized tools.

Data Extraction  Thirty-seven randomized controlled trials met the inclusion criteria; 17 contained sufficient information for a Forest plot of the standardized effects. Eight studies had a true control and were included in a meta-analysis. The random effects model was reported if the Q noncombinability ² statistic was significant at the 10% level because it has low power as a strict test of homogeneity.

Data Synthesis  The 2 strongly qualified meta-analyses suggest that interventions that include a dietary treatment do achieve relative weight loss. Details of the dietary intervention or participant food intake are rarely described.

Conclusions  It is not possible to evaluate the effectiveness of dietary treatment for childhood obesity because of the lack of high-quality studies and the heterogeneity of designs, treatment combinations, outcome measures, and follow-up. There is an urgent need to improve the quality of studies in this area because childhood obesity poses major health risks for populations, yet there is limited evidence on which to base treatment strategies.

Author Affiliations: School of Health Sciences (Drs Collins and Warren and Mss Neve and McCoy) and Discipline of Clinical Pharmacology (Mr Stokes), University of Newcastle, Callaghan, Australia; and Food and Nutrition Australia, Sydney (Ms McCoy).

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