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Epidemiology and Population Health

Effectiveness of peer-led programs for overweight and obesity in children: systematic review and meta-analysis

Abstract

Child health promotion has used peer-led interventions for decades, but their effectiveness for childhood obesity is unknown. This review assesses the effectiveness of peer-led interventions on child and adolescent obesity using a range of adiposity outcomes. We included studies that used a peer-led approach for delivering behavior change communications with a minimum intervention duration of four weeks. Studies needed to report results for any of the outcomes: BMI, BMI z-score or BMI percentile. The review included 14 studies of moderate to high quality from high-income countries. A meta-analysis involving 2506 children from 9 studies showed that programs were effective with a mean difference in BMI of −0.15 kg/m2 (95% confidence interval [−0.26, −0.03]), p = 0.01. Heterogeneity was low (I2 = 28%, p = 0.19) for children in the intervention group. The mean difference varied with subgroups with significantly greater effects from interventions that focused on physical activity alone or with longer duration of implementation. Sensitivity analysis showed similar significant findings to the primary meta-analysis. We found moderately strong evidence to support the advantageous effect of peer-led interventions for obesity prevention in children and adolescents. However, given the small number of studies included, and possible reporting bias, the results must be interpreted cautiously.

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Fig. 1
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Fig. 6: Funnel plot of comparison: Peer-led intervention vs Control.
Fig. 7: Forest plot of subgroup analysis comparing individual vs. clustered randomized design on BMI.
Fig. 8: Forest plot of subgroup analysis for the age of participants on BMI.
Fig. 9: Forest plot of subgroup analysis for duration of intervention on BMI.
Fig. 10: Forest plot of subgroup analysis for the content of interventions on BMI.
Fig. 11 : Forest plot of sensitivity analysis with variations of correlations for BMI.
Fig. 12
Fig. 13

Data availability

All data generated or analysed during this study are included in this published article (and its Supplementary Information files). Other related data are available from the corresponding author on reasonable request.

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Acknowledgements

The authors would like to thank the University of Sydney, Sydney Medical School and Higher Degree Scholarship Office for providing student allowances and supporting this systematic review and meta-analysis. We also acknowledged the valuable contribution of Jenny Peat on additional editing work for this manuscript.

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NMN and MJD drafted the idea and design of the systematic review. NMN and AA developed the search terms and searching schemes. NMN and MJD searched the literature. NMN, AA, and HKT contributed to the screening of manuscripts. NMN and AA extracted the data from the included studies. NMN conducted the meta-analysis and MJD verified this process. NMN drafted the manuscript, and MJD revised the manuscript.

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Correspondence to Ngoc-Minh Nguyen.

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Nguyen, NM., Dibley, M.J., Tang, H.K. et al. Effectiveness of peer-led programs for overweight and obesity in children: systematic review and meta-analysis. Int J Obes 46, 2070–2087 (2022). https://doi.org/10.1038/s41366-022-01219-8

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