Systematic review of multicomponent interventions with overweight middle adolescents: implications for clinical practice and research.

BACKGROUND Being overweight is a global epidemic that occurs in more than 10% of school-aged children (age 5-17) worldwide. The rate of adolescents being overweight continues to rise despite numerous public health campaigns and programs to increase awareness and modify unhealthy lifestyle patterns. AIMS The purpose of this systematic review was to determine the most efficacious intervention for treating overweight adolescents. Evidence from this systematic review could guide clinical practice and future research with this high-risk population in youth. METHODS In adolescents of 13-17 years of age who are above ideal body weight, are multicomponent interventions that integrate nutrition, activity, and behavioral components more efficacious than any type of comparison group in improving weight, body mass index (BMI), percentage body fat, or behaviors of dietary intake or activity level? Literature searches were completed in Cochrane Library, MEDLINE, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), and PsycINFO databases as well as hand searching. RESULTS Due to a lack of consistency among the studies regarding methods and rigor of the studies, the evidence is not entirely clear on the best multicomponent program for addressing overweight in middle adolescents. The success of an intervention was associated with the dose of the intervention received by the adolescent and parent. CONCLUSIONS A structured program addressing nutrition, physical activity, and behavioral skills appears to be efficacious in reducing weight and cardiovascular risk factors. Primarily, interventions have included the individual and varying degrees of parental participation. In the past few years, more research has addressed the multiple levels of the ecological model. Further research addressing the five levels of the ecological model will assist in illuminating the impact of the environment on behavior change in adolescents.