Impact of weight management nutrition interventions on dietary outcomes in children and adolescents with overweight or obesity: A systematic review with meta-analysis

Background The impact of obesity interventions on dietary intake in children and adolescents with overweight or obesity is unclear. This systematic review aimed to investigate the impact of the dietary component of weight management interventions on the change in diet in children and adolescents with overweight or obesity. Methods Eligible RCTs published between 1975 and 2020 were identified by a systematic search following PRISMA guidelines. Meta-analyses of eligible study outcomes was performed using R statistical software. A multi-level random effects model was used with three significant random effects fitted using Restricted Maximum Likelihood estimation. Results This review identified 109 RCTs, including 95 that reported at least one statistically significant dietary outcome change, and 14 reporting no significant dietary change. Results from the meta-analyses (n= 29 studies) indicated that compared to control groups, intervention groups achieved significantly greater reductions in mean total energy intake at ≤6 months (-194kcal/day, 95%CI -275.80 to -112.90kcal/day, p<0.001) and up to 12 months (-112k cal/ day 95% CI -218.92 to -5.83kcal/ day)p=0.038), increases in fruit and/or vegetable intakes over 2-12 months (n=34, range +0.6 to +1.5 servings/day) and reductions in consumption of sugar-sweetened beverages (n=28, range -0.25 to -1.5 servings/day) at 4-24 months follow-up. Conclusions Obesity interventions with a dietary component have a modest, but sustained impact on reducing total energy intake and improving intakes of specific food groups in children and adolescents with overweight or obesity. High quality RCTs that are powered to detect change in diet as a primary outcome are warranted.