Effectiveness of web‐based programs on the reduction of childhood obesity in school‐aged children: a systematic review

Background There has been a rapid rise in obesity among school‐aged children despite efforts made in promoting weight management and physical activity. Overweight and obese children are likely to stay obese into adulthood and are more likely to develop diabetes and cardiovascular diseases at a younger age. Using web‐based technology is one avenue to reach this population. Web‐based technology is fast and interactive which makes it appealing to this population; therefore, it may increase participation and adherence. To date, the evidence has not been systematically evaluated to determine if web‐based interventions have a positive impact on reducing childhood obesity. Objective To identify the best available evidence on the effectiveness of web‐based programs on the reduction of childhood obesity in school‐aged children. Inclusion criteria Types of participants School‐age children, four to 18 years of age, regardless of gender, ethnicity, or national origin. Types of interventions Web‐based programs including, but not limited to, the Internet, social networking media, mobile applications, and email aimed at the reduction of obesity among school‐age children. Types of outcomes Weight measures such as body mass index, body weight, and/or waist circumference. Types of studies Randomized and pseudo‐randomized control trials. Search strategy To find both published and unpublished studies in the English Language from 1991 through August 2012. A search of MEDLINE, CINAHL, EMBASE, PubMed, PsychINFO, Healthsource Nursing/Academic Edition, ERIC and Academic Search Premier was conducted. A search for gray literature was also performed. Methodological quality Two reviewers evaluated the included studies for methodological quality using standardized critical appraisal instruments from the Joanna Briggs Institute. Data collection and synthesis Data were extracted using standardized data extraction instruments from the Joanna Briggs Institute. Due to clinical heterogeneity between included studies, statistical meta‐analysis was not possible. Results are presented in a narrative form. Results A total of 12 articles describing eight interventions were included in this review. All of the included studies were randomized controlled trials. Four of the eight interventions showed improvements in weight measurements. One study demonstrated a reduction in body mass index z‐score at 16‐weeks post intervention (F[5,60]=5.11, p=0.027). One study demonstrated a reduction in waist‐hip ratio at eight‐months post intervention (effect size = ‐0.01, p=0.02). One study demonstrated a greater loss in mean body fat in the intervention group compared to the control group (‐1.12 ± 0.47 vs. 0.42 ± 0.47, p<0.05). One study demonstrated a reduction in body mass index (t87 = ‐2.7, p<0.01) and body mass index z‐score (T87 = ‐3.1, p<0.01) at nine‐months follow‐up. Two interventions showed no difference in weight measures post intervention; two interventions showed an increase in body mass index post intervention. Conclusions A reduction in overweight and obesity in school‐aged children may be seen with the implementation of web‐based weight reduction interventions as part of a multi‐component intervention. The studies included in this review suggest that other components, such as parental involvement, face‐to‐face mentoring, and feedback and reminders, when coupled with web‐based weight management interventions, may improve patient outcomes. Implications for practice The evidence suggests that using web‐based technology as part of multicomponent intervention for the implementation of weight reduction programs in school‐aged children is promising. Implications for research Future studies should evaluate the effects of web‐based technology as a single intervention on a larger sample over longer periods of time to establish the full effect of web‐based interventions on reducing childhood obesity.