Reacción a "Programs focused on parents are insufficient to prevent childhood obesity, according to a meta-analysis"

Childhood obesity is a public health priority worldwide. Cardiovascular risk factors, particularly obesity, tend to persist from childhood through adolescence to adulthood. For this reason, numerous interventions have been proposed over the last two decades to prevent obesity from the earliest years of life. While early studies were focused on school age and adolescence, the effectiveness of interventions in the early years of life has subsequently been tested.

This systematic review and meta-analysis pooled data from 17 clinical trials involving children under one year old, to assess whether parent-focused behavioral interventions could reduce adiposity, as measured by BMI z-score — an accepted outcome measure for this type of randomised clinical trials. The included interventions of this meta-analysis were parent-centred and began before birth or in the first year of life. As well as assessing whether they improved BMI z-score at two years of age, the effectiveness of improving other outcomes related to breastfeeding, vegetable intake, sleep, screen time and parental feeding was also evaluated.

Overall, the study found no evidence of the effectiveness of paret-focused interventions on  improving adiposity or other secondary outcomes. Analyses by sex, immigrant status or parental educational level also did not identify a target population that was more responsive to this type of intervention. Likewise, gestational age, maternal BMI, birth weight or income level did not significantly influence the effectiveness of the interventions.

Therefore, if this impeccably designed study shows that parent-focused interventions are ineffective, are these types of intervention a waste of resources? My opinion is that this question cannot be answered using the data from this study for several reasons: the interventions included were very diverse; the groups of children targeted had different levels of risk relating to their family and social contexts; and, in general, the studies were generally very heterogeneous.

As the authors point out, perhaps interventions should focus more on the environmental context in which children live and develop (daycare centres, parental leave, neighborhood greenness, etc.) than on the family environment itself. In any case, the results of this study make it clear that the available scientific evidence is insufficient to recommend parent-delivered interventions for preventing obesity in the first two years of life.