Effective Interventions for Preventing Childhood Obesity in School Age Children

This review paper aims to identify effective interventions for preventing childhood obesity among school age children through systematic reviews. The findings suggest that childhood obesity is a major health problem that increases the risk of developing chronic illnesses. School-based interventions, such as healthy diet routines and physical health education, can help prevent obesity.

Running head: NURSING
Identification of effective intervention in preventing childhood obesity among school age children: Summary of findings from systematic
reviews
Name of the Student:
Name of the University:
Author Note:

1NURSING
Executive summary
Background
Childhood obesity has emerged as one of the most serious health concern of this century. More than 41 million children were affected with
obesity and majority of these children are below the age of five. Further, it was also seen that more than 28% of the population in Australia is
suffering from obesity and within these children belonging to Aboriginal and Torres Strait islanders are in higher rate. Therefore, in this review
project, the key issues related to childhood obesity would be identified and then with the help of these key issues, the interventions that could
help to prevent the childhood obesity among school age children would be identified.
Objective
The primary objective of this research project would be to research and collect the interventions so that childhood obesity related concern in
Australian society could be resolved and with the help of that, the childhood obesity in the school aged children could be reduced.
Inclusion criteria
The inclusion criteria included research articles within 10 years of publication, English language, presence of RCT and/or systematic review
study whereas, exclusion criteria was associated with different language, publication date before 2010, research process other than RCT and
systematic review.
Type of participants
This review paper included all the school age children that are affected with childhood obesity and were included in interventions that were
proven effective or ineffective with research findings.

2NURSING
Type of studies
This review paper considered the qualitative and qualitative methods with primary research so that all the primary research with novel and
effective measures could be collected and the interventions for childhood obesity prevention could be identified.
Outcomes
The primary outcomes that this review paper examined are related to the primary causes, physiological, mental or socio- economical due to
which children in Australian community suffer from obesity related aspects.
Search strategy
This search strategy in this process aimed to collect both published and unpublished report so that all the research articles could be collected
from the systematic review process. Data bases selected for this process are Pub Med and CLINAHL.
Methodological quality
The assessment method that was selected for the evaluation and assessment for the methodological reliability for their inclusion in the review
process was the Assessment of Multiple Systematic Reviews (AMSTAR).
Data extraction and synthesis
The data extraction process would be inclusive of accurate details of the participants included, the method of the study, included participants,
interventions collected from the evidences and the significance and objectives of the review.

3NURSING
Results
On the basis of the cumulative findings retrieved from reviewing the scholarly literatures, it can be mentioned that childhood obesity is a major
health problem that increases the risk of developing chronic illness disorders such as stroke and Diabetes in the later part of the life.
Conclusion
From this analysis, it was understood that majority of the research process that included in the study were able to provide future implication of
the interventions that should be used in the healthcare process of children that are affected with childhood obesity.
Keywords: childhood obesity, school age children, systematic review, search strategy, AMSTAR review, school children

4NURSING
Table of Contents
Background..................................................................................................................................................................................................................1
Objective......................................................................................................................................................................................................................1
Inclusion criteria...........................................................................................................................................................................................................1
Type of participants......................................................................................................................................................................................................1
Type of studies.............................................................................................................................................................................................................1
Outcomes......................................................................................................................................................................................................................2
Search strategy.............................................................................................................................................................................................................2
Methodological quality.................................................................................................................................................................................................2
Data extraction and synthesis.......................................................................................................................................................................................2
Results..........................................................................................................................................................................................................................2
Conclusion....................................................................................................................................................................................................................2
Background..................................................................................................................................................................................................................5
Objectives.....................................................................................................................................................................................................................6

5NURSING
Considering studies for the review...............................................................................................................................................................................7
Search strategy.............................................................................................................................................................................................................9
Methods of the review..................................................................................................................................................................................................9
Data synthesis.............................................................................................................................................................................................................10
Review results............................................................................................................................................................................................................11
Flow diagram of the paper selection process.............................................................................................................................................................11
References..................................................................................................................................................................................................................19
Appendix....................................................................................................................................................................................................................22

6NURSING
Background
Childhood obesity has emerged as one of the most serious health concern of the 21st century world as the World Health Organisation
(2019) has mentioned that this global problem is affecting both the high income and low income societies. More precisely, the urban settings
around the world are facing concerns related to childhood obesity and this concern has reached up to an alarming condition. As per the global
status provided by the World Health Organisation (2019), more than 41 million children were affected with obesity in the year 2016 and
majority of these children are below the age of five.
Australian societies are also affected with this serious health concern and as per the governmental reports by Australian Bureau of Statistics
(2019), more than 28% of the population in Australia is suffering from obesity and within these children belonging to Aboriginal and Torres
Strait islanders are in higher rate. Further, as per the Australian Bureau of Statistics (2019), alone in Victoria, 22.6% children within the age of 2
to 17 is affected with obesity and hence, if a bigger picture is considered the complete Australian society is suffering from the risk of childhood
obesity that should be addressed with accurate and immediate aspects.
In this review project, the key issues related to childhood obesity would be identified and then with the help of these key issues the interventions
that could help to prevent the childhood obesity among school age children would be identified in this review paper. Hence, the aim of the paper
would be to collecting evidences for the identification of interventions for prevention of childhood obesity among school age children in
Australia. Further to achieve the aim, objectives related to systematic search critical analysis of the recent and latest research findings would be

7NURSING
conducted. While collecting evidences from the recent research conducted by Verrotti et al. (2014) in which the researchers critically evaluated
the prevention process of obesity among school children with the help of school-based interventions. The research paper focused on the
qualitative aspect of the research question and intended to examine that whether or not school-based physical health interventions were an
effective obesity prevention strategy among the school children. Overall, the findings suggested that the use of school based interventions such
as inclusion of healthy diet routine and incorporation of physical health education helped in the prevention of obesity among children. In
addition to this, the research study conducted by Hollis et al. (2016), intended to evaluate the effectiveness of physical health intervention in
order to control obesity among the school children. A research study conducted by Waters et al. (2014), conducted a review in order to evaluate
the effective interventions that could help in controlling childhood obesity. The findings of the research suggested that inclusion of a school
curriculum that supports healthy eating and physical activity can help in preventing obesity. Further, improvement in terms of nutritional quality
as well as support offered from teachers and parents can help in preventing childhood obesity. Hence, these research articles, their findings and
their evidence based interventions would be collected and then would be used in the research process.
Objectives
The sole objective of this research project was to research and collect the interventions so that childhood obesity related concern in
Australian society could be resolved and then childhood obesity in the school aged children could be reduced. Besides this, in the process, it

8NURSING
provided detailed systematic search process and this helps to identify the presence of disease among the Australian children could be identified
the PICO question developed for the paper is as follows:
population Intervention Control Outcome
school aged children identification of
evidence based
interventions
than other healthcare
interventions
improved weight and
wellbeing
The research question: What are the most effective interventions to prevent childhood obesity among school age children than other
health interventions?
Keywords: childhood obesity, effective interventions for prevention, school age children
Considering studies for the review
Type of studies
This review paper considered the qualitative and qualitative methods with primary research so that all the primary research with novel
and effective measures could be collected and the interventions for childhood obesity prevention could be identified. Besides this, systematic

9NURSING
reviews were also considered for the research process as Leun et al. (2012) mentioned systematic review papers as the high level of evidence and
inclusion if such paper could increase the accuracy of collected interventions in preventing childhood obesity.
Type of participants
This review paper included all the school age children that are affected with childhood obesity and were included in interventions that
were proven effective or ineffective with research findings.
Type of interventions
This paper included all the evidence based healthcare interventions that should be implemented on the children so that they can overcome
their obesity condition. Further by involving children in the global aspect of care helped to analyse the interventions that are important for the
healthcare of obese children.
Type of outcome measures
The primary outcomes that this review paper examined are related to the primary causes, physiological, mental or socio- economical due to
which children in Australian community suffer from obesity related aspects. Besides this it also analyses the outcomes related to the
interventions that could prevent or treat children with obesity especially those who belong to the school age group. It was found that inclusion of
school based physical fitness programs and obesity awareness educational workshops can help in the prevention of obesity.

10NURSING
Search strategy
This search strategy in this process aimed to collect both published and unpublished report so that all the research articles could be
collected from the systematic review process. The primary focus of this search were done from the following databases:
1. PubMed
2. CINAHL
These two databases were searched for the process of systematic search process as well as multiple inclusion and exclusion criteria so that 10
accurate research articles could be collected and then these could be used in the assessment process. Within these, each of the 10 articles and
their reference list would be used for the additional resources so that all the RCTs and systematic reviews could be used for the data collection
and analysis process. The inclusion criteria included research articles within 10 years of publication, English language, presence of RCT and/or
systematic review study whereas, exclusion criteria was associated with different language, publication date before 2010, research process other
than RCT and systematic review. These inclusion and exclusion criteria promoted all the research articles so that promotion of the recent and
relevant research processes could be developed. The search table of both the databases has been provided in the appendix section.
Methods of the review
Assessment of methodological quality

11NURSING
The assessment method that was selected for the evaluation and assessment for the methodological reliability for their inclusion in the
review process was the Assessment of Multiple Systematic Reviews (AMSTAR). As per Leun et al. (2012), AMSTAR is the effective and
reliable instrument which is used for the methodological quality determination so that all the article that have been used in the process. It
includes more than 11 criteria and hence, methodological qualities are assessed. One such AMSTAR critical reflection tool has been provided in
the appendix section.
Data extraction
The data extraction process would be inclusive of accurate details of the participants included, the method of the study, included
participants, interventions collected from the evidences and the significance and objectives of the review. The data extraction table has been
included in the appendix section for a clear and concise idea.
Data synthesis
In this process, it should be mentioned that all the data, that would be included in the paper would be inclusive of facts and figures so that
accurate presentation of the data would be included.

12NURSING
Review results
The total articles that were collected after the first few hits in both of the databases included 1437 articles and within that, with inclusion and
exclusion criteria total 32 articles were selected. Further, after this process, duplication of the articles were assessed and then total 10 articles
were selected for the process. The flow chart of the search strategy and the data extraction table has been attached in the appendix section. This
section included all the sample and population, sampling techniques, data collection process and the instruments used for the analytical process.
This process was conducted to understand the fact that majority of the qualitative and quantitative aspects that were included in the paper
provided a concurrent mixed approach to the study. As per Leun et al. (2012), including this mixed phases include philosophical assumptions to
guide the data collection procedures to better understand the research questions. Hence, all these studies and articles that were included in the
process as it would help the researchers to design accurate interventions and programs so that all the children could be provided with accurate
healthcare interventions for their obesity prevention.
Flow diagram of the paper selection process

13NURSING

14NURSING
Article 1 (Kelishadi & Azizi-Soleiman, 2014)
Sample size
Researchers Kelishadi and Azizi-Soleiman (2014) collected 105 relevant research articles form electronic databases such as Medline,
PubMed, ISI web of science as well as Scopus scientific database.
Participants
Papers in which, participants with age 18 years and below were chosen, has been selected for the meta- analysis study in this paper.
Intervention
This paper discusses about the family based, school based and clinical based intervention and then used the papers selected to understand the
primary interventions among these three aspects while dealing with childhood obesity.
Outcome measures
The findings indicated that school based programs are effective in dealing with childhood obesity and the multidisciplinary approach
helped to provide effective and feasible approach to overcome their childhood obesity concerns.

15NURSING
Article 2 (Verrotti et al. 2014)
Sample size
All the pertinent databases, namely the CINAHL, Pub Med and Cochrane were searched for research articles with school-based
interventions performed in primary schools.
Participants
School aged children below the age of 15 were included in all the papers that were collected in this systematic review paper.
Interventions
It was mentioned that educational intervention as well as the healthy diet and physical activity among school age children could be an
important and effective strategy to prevent obesity.
Outcome measures
The outcome measurement mentioned that early detection and treatment of obesity among children is the best and most appropriate
approach so that the morbidity and mortality rate among the children could be decreased.

16NURSING
Article 3 (Sobol‐Goldberg, Rabinowitz & Gross , 2013)
Sample size
More than 32 studies were selected from 109 selected articles and in this aspect articles till 2006 year were selected for this study.
Participants
32 papers were included as the studies in meta analysis and the school age children below the age of 15 were selected for the paper.
Interventions
The interventions related to school based interventions such as physical activity, nutritional aspects was applied upon the selected
participants.
Outcome measures
It was seen that school based intervention is the most effective preventive measures that was effective in reducing the BMI in children
and for this the support of parents were important.

17NURSING
Article 4 (Leung et al. 2013)
Sample size
Total 12 studies were included in the papers in which 3 papers with School based interventions, 1 physical activity related paper and 6
articles with school based as well as physical activity and diet intervention were included in the paper.
Participants
Children with age 6 to 19 were included in the paper and the interventions were applied for more than 12 weeks.
Interventions
School based interventions, physical activity and dietary interventions were applied as interventions for childhood obesity.
Outcome measurement
Overall interventions involved in the paper were proven to be effective in maintaining the childhood obesity among school based children.

18NURSING
Article 5 (Kelley, Kelley & Pate, 2017)
Sample size
34 studies were included in the paper from 6 electronic databases and cross referencing as well as expert review.
Participants
More than 2239 participants with age less than 15 were included in the study so that these children and their obesity could be addressed.
Interventions
Exercise sessions, such as aerobic interventions with strength training were included in the study so that childhood obesity could be
prevented.
Outcome measures
Application of abovementioned intervention effectively reduced the BMI score among the school aged children and consequently the rate
of obesity decreased.

19NURSING
Results
On the basis of the above mentioned search strategy as well as stringent inclusion and exclusion criteria, a number of research studies
were included within the review. The research conducted by Verrotti et al. (2014) critically evaluated the prevention of obesity among school
children with the help of school-based interventions. The research paper focused on the qualitative aspect of the research question and intended
to examine that whether or not school-based physical health interventions were an effective obesity prevention strategy among the school
children. Overall, the findings suggested that the use of school based interventions such as inclusion of healthy diet routine and incorporation of
physical health education helped in the prevention of obesity among children. According to Kelley et al. (2014), the use of aerobic exercises,
strength based exercises as well as using a combination of both the exercises helped in the prevention of obesity among the children as well as
adolescents attending. The researchers conducted a systematic review of the randomised control trials in order to evaluate that whether or not the
use of physical exercises helped in improving the BMI score. The findings collected from the systematic review of the scholarly literatures was
analysed using the statistical analysis approach. Ash et al. (2017) conducted a systematic review of the literatures in order to access the efficacy
of the family based interventions to control childhood obesity. The authors evaluated the efficacy of the family based interventions on the basis
of statistical analysis. The overall findings of the research paper suggested that there is an increasing need to implement customized family-
based interventions for the prevention of childhood obesity by making use of the evidence base in order to acquire positive outcome. In addition
to this, the research study conducted by Hollis et al. (2016), intended to evaluate the effectiveness of physical health intervention in order to
control obesity among the school children. The researchers conducted a randomised controlled tried across 10 secondary schools in New South

20NURSING
Wales, Australia. The BMI score and the body weight measurement were taken into consideration which was evaluated on the basis of statistical
analysis. Typically, the implementation of the physical health program known as the ‘Physical Activity 4 everyone’. Typically it was found that
the implementation of the school based physical activity helped significantly helped in the reduction of adiposity among the adolescents who
belonged to the socially disadvantaged groups of the society. Further Leun et al. (2012), also conducted a review in order to evaluate the
effectiveness of the interventions that intend to reduce the sedentary lifestyle among the school students and at the same time identify
interventions that can help in reducing the sedentary behaviour among the school students. The overall findings of the research study suggested
that sedentary behaviour could be controlled by reducing the time spent on sedentary activities and at the same time improvising the existing
anthropometric measurement methods associated with measuring childhood obesity helped in achieving positive outcome. Further, as per
Kelishadi and Azizi-Soleiman(2014), childhood obesity has emerged out to be a problem within the context of health care and physical
wellbeing. The researchers conducted a thorough systematic review of literatures in order to evaluate the most effective intervention that could
prevent childhood obesity. The findings critically states that school based intervention strategies helped in achieving positive outcome. Typically
the findings suggested that the inclusion of diet routine and exercise in combination with motivation fostered by the parents help in acquiring
positive outcome. As stated by Elinder et al. (2018), obesity prevention intervention can be best effective if parents are involved closely in the
process. The findings of the research study stated that school based interventions serves as the most feasible program that helps in reducing or
preventing childhood obesity in children. Therefore, on the basis of the cumulative findings retrieved from reviewing the scholarly literatures, it
can be mentioned that childhood obesity is a major health problem that increases the risk of developing chronic illness disorders such as stroke

21NURSING
and Diabetes in the later part of the life. It was further evaluated from the evidence base that incorporation of school based obesity prevention
programs could help in achieving positive outcome.
Discussion:
Healthy diet routine and increased physical activity could prevent childhood obesity
According to Lobstein et al. (2015), the increasing trend of child obesity and being overweight has become a primary problem globally.
As per Lobstein et al. (2015), it has been stated that the average weight of the infant has gone up by 5 Kgs. The problem does not remain
restricted to the developed nations but also includes the developing nations where in despite the pertinent problem of food scarcity and
malnutrition, the obesity level of the children continue to rise up through the years. The researchers were of the opinion that promotion of
healthy diet routine and nutrient rich food products can help in curtaining the increased intake of unhealthy and high calorie value food. This
would positively help in the prevention of obesity among the school children. In addition to this, a number of scholarly literatures have also
suggested that revisiting the policies in relation to the level of physical activity and nutritional intake can help in the prevention of obesity among
the children. In addition to this, as per Hawkes et al. (2015), childhood obesity in recent times has emerged as a public health problem which
needs to be addressed on a priority basis.

22NURSING
School based health promotion programs could help in the prevention of childhood obesity
Effective revision of food policies can help in the prevention of obesity. Hawkes et al. (2015) have widely emphasised upon implementing
appropriate diet routine and nutritional intake in order to prevent obesity and promote wellness among the school children. In addition to this
Sobol-Goldberg (2013) conducted a review of literatures in order to evaluate the best intervention strategy for the reduction of obesity among the
school children. The researchers were of the opinion that making use of school-based programs can prove to be effective and can help in the
prevention of childhood obesity. Typically school based intervention strategies must include physical exercise routine as well as proper dietary
intake and monitoring of the metabolic index in order to ensure prevention of obesity and promote wellness among the children.
Effective psychological intervention programs could help in the prevention of childhood obesity
In addition to this, it should further be stated that Amini et al. (2015) also evaluated the effectiveness of school-based intervention programs in
order to test the efficacy of school based intervention for the prevention of obesity. The researchers were of the opinion that inclusion of
psychological based intervention for avoiding adverse physical and psychological impact arising from the intervention can help in controlling the
increasing incidence of obesity among the children. In addition to this, psychological based interventions such as counselling as well as
motivational interviewing has also been evaluated to have positive outcome in controlling excess weight and obesity among the children. Wyatt
et al. (2013), stated that the implementation of Healthy Lifestyles Programme can effectively help in promoting positive outcome and prevention
of obesity in children. The H.e.L.Pprogram aims at the creation of a receptive environment that includes a setting a goal, using drama activities

23NURSING
as well as reinforcement activities to enhance participation of students for a weight management program. The effective outcome of the program
is evaluated on the basis of measurement of BMI index. This research further add up to the evidence base that innovation school based obesity
prevention programs can help in managing body weight and acquiring positive outcome. In addition to this, Li et al. (2014), suggested that
obesity is a serious health problem among the children and appropriate physical health intervention implementation to control the issue still
needs to be researched and evaluated. The researcher conducted a non-randomised control trail and made use of multi-component physical
activity intervention in order to decrease the level of BMI, fasting glucose, skin fold thickness as well as increasing duration of MVPA. The
implementation of the interventions yielded a positive outcome suggesting that the use of school based interventions could help in achieving
positive outcome.
Imparting education and awareness among family members could help in childhood obesity prevention
As per Stephen et al. (2015), imparting education and awareness among the family members can help in reducing the risk of acquiring
childhood obesity which might progress to later stages of life. The paper suggests that education and awareness must be incorporated and
proactively disseminated by care professionals and paediatricians so as to improve overall health outcome. Care professionals can help in
disseminating awareness in relation to risk factors that trigger obesity and motivate the family members of the obese children to choose a
healthier lifestyle. A research study conducted by Waters et al. (2014), conducted a review in order to evaluate the effective interventions that
could help in controlling childhood obesity. The findings of the research suggested that inclusion of a school curriculum that supports healthy
eating and physical activity can help in preventing obesity. Further, improvement in terms of nutritional quality as well as support offered from

24NURSING
teachers and parents can help in preventing childhood obesity. Further, Tucker and Foster (2015), also suggested that inclusion of school based
physical fitness programs and obesity awareness educational workshops can help in the prevention of obesity. Also, education in relation to an
active lifestyle and healthier lifestyle choices can help in the prevention of obesity and contribute to positive outcome.
Conclusion:
Nowadays the world is suffering from several healthcare complications due to which people and their lives are affected due to negative
and long-term effects for the individuals, communities as well as households. Childhood obesity is one such healthcare condition due to which
the Australian communities are suffering from critical aspects. In this process, it should be mentioned that prevalence of such diseases has
dramatically increased in the last few years and the healthcare conditions were controlled using several interventions. Majority of the children
that were under the age of 5 were also included in the study so that childhood obesity and their related healthcare complications could be
overcome. In this paper, search strategy were included in the process, and after deciding 10 research articles for the paper, the research and
discussion process was conducted. Further, it should also be mentioned that AMSTAR and data extraction table were also included in the
appendix so that collection could be assessed and accurate research articles could be collected. From this analysis, it was understood that
majority of the research process that included in the study were able to provide future implication of the interventions that should be used in the
healthcare process of children that are affected with childhood obesity.

25NURSING
References
Amini, M., Djazayery, A., Majdzadeh, R., Taghdisi, M. H., & Jazayeri, S. (2015). Effect of school-based interventions to control childhood
obesity: a review of reviews. International journal of preventive medicine, 6.
Ash, T., Agaronov, A., Aftosmes-Tobio, A., & Davison, K. K. (2017). Family-based childhood obesity prevention interventions: a systematic
review and quantitative content analysis. International Journal of Behavioral Nutrition and Physical Activity, 14(1), 113.
Australian Bureau of Statistics. (2019). Facts and figures on childhood obesity. Retrieved from
http://www.abs.gov.au/ausstats/abs@.nsf/mf/4364.0.55.001
Daniels, S. R., & Hassink, S. G. (2015). The role of the pediatrician in primary prevention of obesity. Pediatrics, 136(1), e275-e292.
Hawkes, C., Smith, T. G., Jewell, J., Wardle, J., Hammond, R. A., Friel, S., ... & Kain, J. (2015). Smart food policies for obesity prevention. The
Lancet, 385(9985), 2410-2421.
Hollis, J. L., Sutherland, R., Campbell, L., Morgan, P. J., Lubans, D. R., Nathan, N., ... & Cohen, K. E. (2016). Effects of a ‘school-
based’physical activity intervention on adiposity in adolescents from economically disadvantaged communities: secondary outcomes of
the ‘Physical Activity 4 Everyone’RCT. International Journal of Obesity, 40(10), 1486.

26NURSING
Kelishadi, R., & Azizi-Soleiman, F. (2014). Controlling childhood obesity: A systematic review on strategies and challenges. Journal of
research in medical sciences: the official journal of Isfahan University of Medical Sciences, 19(10), 993.
Kelley, G. A., Kelley, K. S., & Pate, R. R. (2017). Exercise and BMI z‐score in Overweight and Obese Children and Adolescents: A Systematic
Review and Network Meta‐Analysis of Randomized Trials. Journal of Evidence‐Based Medicine, 10(2), 108-128.
Leung, M. M., Agaronov, A., Grytsenko, K., & Yeh, M. C. (2011). Intervening to reduce sedentary behaviors and childhood obesity among
school-age youth: a systematic review of randomized trials. Journal of obesity, 2012.
Li, X. H., Lin, S., Guo, H., Huang, Y., Wu, L., Zhang, Z., ... & Wang, H. J. (2014). Effectiveness of a school-based physical activity intervention
on obesity in school children: a nonrandomized controlled trial. BMC public health, 14(1), 1282.
Lobstein, T., Jackson-Leach, R., Moodie, M. L., Hall, K. D., Gortmaker, S. L., Swinburn, B. A., ... & McPherson, K. (2015). Child and
adolescent obesity: part of a bigger picture. The Lancet, 385(9986), 2510-2520.
Sobol‐Goldberg, S., Rabinowitz, J., & Gross, R. (2013). School‐based obesity prevention programs: A meta‐analysis of randomized controlled
trials. Obesity, 21(12), 2422-2428.
Tucker, S., & Lanningham-Foster, L. M. (2015). Nurse-led school-based child obesity prevention. The Journal of School Nursing, 31(6), 450-
466.

27NURSING
Verrotti, A., Penta, L., Zenzeri, L., Agostinelli, S., & De Feo, P. (2014). Childhood obesity: prevention and strategies of intervention. A
systematic review of school-based interventions in primary schools. Journal of endocrinological investigation, 37(12), 1155-1164.
Waters, E., de Silva‐Sanigorski, A., Burford, B. J., Brown, T., Campbell, K. J., Gao, Y., ... & Summerbell, C. D. (2011). Interventions for
preventing obesity in children. Cochrane database of systematic reviews, (12).
Wyatt, K. M., Lloyd, J. J., Abraham, C., Creanor, S., Dean, S., Densham, E., ... & Taylor, R. S. (2013). The Healthy Lifestyles Programme
(HeLP), a novel school-based intervention to prevent obesity in school children: study protocol for a randomised controlled
trial. Trials, 14(1), 95.
World Health Organization. (2019). Facts and figures on childhood obesity. Retrieved from https://www.who.int/end-childhood-obesity/facts/en/

28NURSING
Appendix
Detailed search strategy for CINAHL
1. Childhood obesity
2. ((childhood* or obesity* or Intervention*) adj3 (intervention* or mistake* or severe*)).tw.
3. ((severity* or inability*) adj3 (childhood* or obesity or intervention)).tw.
4. ((prevention* or intervention* or childhood obesity*) and reduced*).tw.
5. 1 or 2 or 3 or 4
6. (prevention* or reduction* or intervention*).tw.
7. Preventive measures of childhood obesity/
8. intervention measures /
9. Intervention monitoring/
10. Proper prevention system/

29NURSING
11. Nutritional treatment and physical activities/
12. ((medication* or medicine* or drug*) adj3 (physical activity* or nutrition* or intervention* or manag*)).tw.
13. ((prescrib* or prescription*) adj2 (prevention* or intervention*)).tw.
14. 6 or 7 or 8 or 9 or 10 or 11 or 12 or 13
15. 5 and 14
16. meta-analysis.pt.
17. Meta-Analysis as Topic/
18. (Meta analy* or metaanaly*).tw.
19. (systematic* adj2 (review* or overview*)).tw.
20. 16 or 17 or 18 or 19
21. 15 and 20
22. Limit11 to (meta-analysis or systematic reviews)
23. Limit 12 to (English language and year= "2010 to current")

30NURSING
Total number of articles found after the search strategy: 16 within which 10 was used for the assessment.
Critical appraisal checklist/ tool (AMSTAR tool)
AMSTAR item (Li et al.,
2014)
(Wyatt et
al., 2013)
(Amini et
al., 2015)
(Hawkes
et al.,
2015)
(Tucker &
Lanningha
m-Foster
2015)
(Lobstein
et al.,
2015)
(Waters et
al., 2011)
(Sobol‐
Goldberg,
Rabinowit
z & Gross,
2013)
(Daniels &
Hassink,
2015)
(Kelley,
Kelley, K
& Pate,
2017)
1. Was an a priori design provided? Yes Yes Yes Yes Yes yes yes yes yes yes
2. Was there duplicate study
selection and data extraction?
Yes No Yes Yes No No No No No No
3. Was a comprehensive literature
search performed?
Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
4. Was the status of publication
(that is, grey literature) used as an
inclusion criterion?
Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes

31NURSING
5. Was a list of studies (included
and excluded) provided?
No No No No No Yes Yes Yes Yes Yes
6. Were the characteristics of the
included studies provided?
Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
7. Was the scientific quality of the
included studies assessed and
documented?
Yes No No Yes No Yes Yes No No No
8. Was the scientific quality of the
included studies used
appropriately in
formulating conclusions?
Yes Yes No No No Yes Yes Yes Yes Yes
9. Were the methods used to
combine the findings of studies
appropriate?
Yes Yes Yes Yes Yes Yes No No Yes No
10. Was the likelihood of
publication bias assessed?
No Yes Yes Yes No Yes Yes No No No

32NURSING
11. Was the conflict of interest
included?
No No No No No Yes Yes Yes Yes Yes
Total Yes Yes Yes Yes No yes no yes yes No
Data extraction table
Author Year Country
Focus
Search details, range
(database
searched, articles
included
Quality score Number of studies Design
of included studies
Intervention/ comparisons Main outcomes
measures
Sobol‐Goldberg, S.,
Rabinowitz, J., &
Gross, R
2013
the USA
MEDLINE, ERIC,
EMBASE, CINHAL,
PSYCInfo,
Dissertation Abstracts,
Science Citation Index,
Social Science Citation
Index, and the
moderate score (5 to
8)
3481 Awareness about child
malnutrition so that long
term benefit could be
obtained.
The effectiveness of
school‐based
preventions may be
influenced by many
factors.

33NURSING
Attempts have been
made to reduce
childhood obesity
through school‐based
programs
Cochrane CENTRAL
Database of controlled
clinical trials
3481 studies included
Li, X. H., Lin, S., Guo,
H., Huang, Y., Wu, L.,
Zhang, Z., ... & Wang,
H. J
2014
the united kingdom
assess the effectiveness
of a school-based
physical activity
intervention during
It was a non-
randomized controlled
trial
moderate score (5 to
8)
20 increase the physical activity
of the children affected with
childhood obesity
ability to increase the
outcome

34NURSING
12 weeks on obesity
and related health
outcomes in school
children.
Lobstein, T., Jackson-
Leach, R., Moodie, M.
L., Hall, K. D.,
Gortmaker, S. L.,
Swinburn, B. A., ... &
McPherson, K.
2015
34 countries around
the world
90% of the global
burden could be
primary research
article
High score (9 to 11) school based children in
USA
it has been stated that the
average weight of the infant
has gone up by 5 Kgs. The
problem does not remain
restricted to the developed
nations but also includes the
developing nations where in
despite the pertinent
problem of food scarcity and
malnutrition, the obesity
level of the children continue
Good health and
nutrition of children
around the world.

35NURSING
assessed related to
childhood obesity
to rise up through the years.
Tucker, S., &
Lanningham-Foster, L.
M.
2015
Caribbean population
more than 50 articles
were searched so that
children and their
nutritional status that
leads to their obesity
governmental data of
the countries included
moderate score (5 to
8)
50 articles and its data School-based childhood
obesity prevention programs
have grown in response to
reductions in child physical
activity (PA), increased
sedentariness, poor diet, and
soaring child obesity rates.
nutritional content of
children around 50
countries
Kelley, G. A., Kelley,
K. S., & Pate, R. R.
(1) Medline, (2)
CINAHL, (3) Scopus,
high score (9 to 11) 242 articles conduct a systematic review
with meta-analysis to
increased physical
activity among involved

36NURSING
2017
The United Kingdom
Exercise and BMI z‐
score in Overweight
and Obese Children
and Adolescents.
(4) Academic Search
Complete, (5)
Educational Research
Complete, (6) Web of
Science, (7) Sport
Discus, (8) ERIC, (9)
LILACS, (10)
Cochrane Central
Register of Controlled
Trials (CENTRAL)
and Kelley et al. BMC
Pediatrics 2014, 14:225
Page 2 of 16
http://www.biomedcen
tral.com/1471-
2431/14/225 (11)
determine the effects of
exercise (aerobic, strength
or both) on body mass index
(BMI) z-score in overweight
and obese children and
adolescents
children

37NURSING
Proquest.