Abstract
IMPORTANCE: The rapid rise in childhood central obesity and its cardiometabolic complications in adulthood highlight the urgent need for targeted global interventions. OBJECTIVE: To examine the association of lifestyle, behavioral, and pharmacological interventions with childhood central obesity. DATA SOURCES: MEDLINE, Embase, CINHAL, PsycINFO, PubMed, Academic Search Database, and ProQuest from inception to September 25, 2024. STUDY SELECTION: Inclusion criteria included (1) randomized clinical trials (RCTs) focusing on children aged 5 to 18 years with overweight or obesity at baseline and (2) measured central obesity as a primary or secondary outcome. DATA EXTRACTION AND SYNTHESIS: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guideline was followed. Two authors independently extracted data. Risk of bias was assessed using the revised Cochrane risk-of-bias tool (RoB 2.0). A random-effects meta-analysis was conducted to pool standardized mean differences (SMD) from individual studies. Sensitivity analysis, meta-regression, and subgroup analyses were also conducted. MAIN OUTCOMES AND MEASURES: The main outcome was childhood central obesity measured using waist circumference (WC), waist-to-height ratio, waist-to-hip ratio, and WC z score. RESULTS: This review included 34 RCTs, involving 8183 children aged 5 to 18 years. Twelve studies had a low risk of bias, whereas 8 were deemed to have a higher risk of bias. The meta-analysis of 2 RCTs examining low-fat lunchboxes and a Mediterranean diet along with physical activity (lasting up to 150 minutes per week over 6 to 9 months) showed a significant association with WC (standard mean difference [SMD], -0.38 [95% CI, -0.58 to -0.19]). Five additional RCTs involved behavioral interventions on dietary education to reduce unhealthy snacks, increase fruit and vegetable intake, promote daily physical activity, and limit screen time, supported by online resources also showed a significant association with WC (SMD, -0.54 [95% CI, -1.06 to -0.03]). However, standalone dietary, physical activity, pharmacotherapy, dietary supplements, motivational interviewing, and combined dietary, physical activity, and behavioral methods did not show a significant association with WC. CONCLUSIONS AND RELEVANCE: In this meta-analysis of RCTs, combining dietary changes with physical activity, as well as using behavioral strategies alone, were associated with reduced central obesity in children from high- and middle-income countries. Findings from this study have policy implications for Sustainable Development Goals of ending all forms of malnutrition and reducing premature mortality from noncommunicable diseases.