Physical activity, diet and other behavioural interventions for improving cognition and school achievement in children and adolescents with obesity or overweight.

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childhood obesity 8 endocrinologydiseases
metabolic syndrome 2 endocrinologydiseases
obesity 190 endocrinologydiseases

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childhood obesity 20464 household income).Description of the interventionClinical guidelines for prevention and treatment of childhood obesity from countries such as the UK ([150]; [172]), Australia ([149]), Canada ([133]) and Malaysia ([120])
childhood obesity 32198 (standard classroom education) ([169]).Why it is important to do this reviewThe current global trend in childhood obesity ([146]; [183]) suggests that the prevalence of cognitive and educational problems among children is
childhood obesity 32640 diet, physical activity, sedentary behaviour and thinking patterns for prevention and treatment of childhood obesity are well established ([72]; [90]; [142]; [182]) and are reflected in clinical guidelines for the management
childhood obesity 35857 programme aiming to improve cognitive and academic outcomes without a stated intention to prevent or treat childhood obesity . Where any measure or proxy of adiposity was included as a covariate only, the study was not eligible
childhood obesity 39545 intervention might work). It was not our intention to assess the effect of interventions for treatment of childhood obesity on adiposity or body weight status. This has recently been examined in three other Cochrane Reviews
childhood obesity 57338 analysis when studies:used different criteria or variations in the thresholds of criteria to define childhood obesity and overweight (e.g. clinical versus public health thresholds);were judged at 'high risk of bias' in
childhood obesity 163359 socio-economically deprived environments. The educational, societal and economic argument for implementing effective childhood obesity prevention and treatment programmes could be substantial.Longer-term follow-up trials are needed to
childhood obesity 164298 research is needed to further investigate associations, two-way interactions and causal pathways between childhood obesity , lifestyle behaviour, cognitive abilities and academic outcomes
metabolic syndrome 18089 cardiovascular conditions (e.g. hyperlipidaemia, hypertension), endocrinologic conditions (e.g. Type 2 diabetes, metabolic syndrome ), gastrointestinal conditions (non-alcoholic fatty liver disease), respiratory conditions (e.g. obstructive
metabolic syndrome 22909 obesity-related disordered breathing ([105]; [176]); hypertension ([131]); Type 2 diabetes ([164]); metabolic syndrome ([185]); decreased school attendance due to adverse physical and mental health ([156]); and social isolation
obesity 190 behavioural interventions for improving cognition and school achievement in children and adolescents with obesity or overweightAnne MartinJosephine N BoothYvonne LairdJohn SprouleJohn J ReillyDavid H SaundersPublication
obesity 391 SaundersPublication date (epub): 3/2018AbstractBackgroundThe global prevalence of childhood and adolescent obesity is high. Lifestyle changes towards a healthy diet, increased physical activity and reduced sedentary
obesity 548 diet, increased physical activity and reduced sedentary activities are recommended to prevent and treat obesity . Evidence suggests that changing these health behaviours can benefit cognitive function and school achievement
obesity 1133 cognitive function (e.g. executive functions) and/or future success in children and adolescents with obesity or overweight, compared with standard care, waiting-list control, no treatment, or an attention placebo
obesity 1687 controlled trials (RCTs) of behavioural interventions for weight management in children and adolescents with obesity or overweight. We excluded studies in children and adolescents with medical conditions known to affect
obesity 2716 single-study outcomes.Main resultsWe included 18 studies (59 records) of 2384 children and adolescents with obesity or overweight. Eight studies delivered physical activity interventions, seven studies combined physical
obesity 5864 targeting the improvement of the school food environment compared to standard practice in adolescents with obesity (SMD 0.46, 95% CI 0.25 to 0.66; 2 studies, 382 adolescents, low-quality evidence), but not with overweight.
obesity 6457 children, low-quality evidence).Authors' conclusionsDespite the large number of childhood and adolescent obesity treatment trials, we were only able to partially assess the impact of obesity treatment interventions
obesity 6535 childhood and adolescent obesity treatment trials, we were only able to partially assess the impact of obesity treatment interventions on school achievement and cognitive abilities. School and community-based physical
obesity 6687 achievement and cognitive abilities. School and community-based physical activity interventions as part of an obesity prevention or treatment programme can benefit executive functions of children with obesity or overweight
obesity 6778 part of an obesity prevention or treatment programme can benefit executive functions of children with obesity or overweight specifically. Similarly, school-based dietary interventions may benefit general school
obesity 6916 Similarly, school-based dietary interventions may benefit general school achievement in children with obesity . These findings might assist health and education practitioners to make decisions related to promoting
obesity 7083 practitioners to make decisions related to promoting physical activity and healthy eating in schools. Future obesity treatment and prevention studies in clinical, school and community settings should consider assessing
obesity 7358 weight interventions for improving thinking skills and school performance in children and teenagers with obesity What is the aim of this review?The aim of this Cochrane Review was to find out if healthy weight interventions
obesity 7558 weight interventions can improve thinking skills and school performance in children and teenagers with obesity . Cochrane researchers collected and analysed all relevant studies to answer this question.What are the
obesity 8079 as well as health outcomes.What was studied in this review?The number of children and teenagers with obesity is high worldwide. Some children and teenagers with obesity have health issues or are bullied because
obesity 8139 review?The number of children and teenagers with obesity is high worldwide. Some children and teenagers with obesity have health issues or are bullied because of their body weight. These experiences have been linked to
obesity 8580 performance in children with a healthy weight. Studies found that healthy-weight interventions can reduce obesity in children and teenagers, but it is unknown if and how well healthy-weight interventions can improve
obesity 8760 healthy-weight interventions can improve thinking skills and school performance in children and teenagers with obesity .What are the main results of this review?The review authors found 18 studies which included a total
obesity 8904 review?The review authors found 18 studies which included a total of 2384 children and teenagers with obesity . Five studies assigned individual children to intervention or control groups. Thirteen studies allocated
obesity 10070 physical activity interventions do not improve mathematics and reading achievement in children with obesity . Very low-quality evidence also suggested no benefits of physical activity interventions for improving
obesity 10946 offered in schools can lead to moderate improvements in general school achievement of teenagers with obesity , when compared to standard school practice. Replacing packed school lunch with a nutrient-rich diet
obesity 11148 diet plus nutrition education did not improve mathematics and reading achievement of children with obesity . However, the quality of evidence for general school achievement, mathematics and reading was low. This
obesity 11894 to standard practice for improving cognition and school achievement in children and adolescents with obesity or overweightPatient or population: Children and adolescents with obesity or overweightSetting: Classroom
obesity 11968 children and adolescents with obesity or overweightPatient or population: Children and adolescents with obesity or overweightSetting: Classroom and school environment or as after-school activity in the USA, Norway,
obesity 16098 confidence intervals) due to a low sample size.BackgroundDescription of the conditionOverweight and obesity are conditions of excessive body fat accumulation. In clinical practice, child and adolescent overweight
obesity 16215 conditions of excessive body fat accumulation. In clinical practice, child and adolescent overweight and obesity are commonly identified by age- and gender-specific body mass index (BMI) percentiles, BMI standard
obesity 16483 relative to a reference population ([161]; [165]).The primary criteria used to define overweight and obesity include:overweight: BMI or WC ≥ 85th percentile to 95th percentile, BMI = one standard deviation above
obesity 16608 include:overweight: BMI or WC ≥ 85th percentile to 95th percentile, BMI = one standard deviation above the average; obesity : BMI or WC = 95th percentile, BMI = two standard deviations above the average.Also, BMI cut-offs from
obesity 16811 cut-offs from the International Obesity Task Force (IOTF) are often used as a definition of overweight and obesity . These age-specific BMI cut-offs were constructed to match the definition for overweight and obesity
obesity 16912 obesity. These age-specific BMI cut-offs were constructed to match the definition for overweight and obesity in adults (BMI ≥ 25 kg/m2 and BMI ≥ 30 kg/m2, respectively) ([88]). Recently, the IOTF BMI cut-offs
obesity 17208 ([89]).A recent analysis of population data of children aged five to 19 years estimated that in 2016 obesity was identified in 50 million girls and 74 million boys worldwide ([146]). In the USA in 2014, the prevalence
obesity 17349 girls and 74 million boys worldwide ([146]). In the USA in 2014, the prevalence of child and adolescent obesity (BMI = 95th centile) was 9.4% (two to five years), 17.4% (six to 11 years), and 20.6% (12 to 19 years)
obesity 17480 was 9.4% (two to five years), 17.4% (six to 11 years), and 20.6% (12 to 19 years) ([152]). In Europe, obesity prevalence was on average 4.0% in adolescents, with vast differences between countries ([119]). For
obesity 17686 For example, in Scotland the prevalence was 15% in adolescents aged 12 to 15 years ([168]). Childhood obesity prevalence is increasing in middle- and low-income countries ([146]), for example, up to 40% of children
obesity 17826 middle- and low-income countries ([146]), for example, up to 40% of children in Mexico were living with obesity or overweight, 32% in Lebanon and 28% in Argentina ([111]).Health problems are common in children and
obesity 17953 in Lebanon and 28% in Argentina ([111]).Health problems are common in children and adolescents with obesity . These include cardiovascular conditions (e.g. hyperlipidaemia, hypertension), endocrinologic conditions
obesity 18523 adolescents ([84]; [95]; [135]; [139]; [187]) and academic deficits in adolescents associated with obesity have been observed ([81]; [140]). Cognitive skills such as the ability to suspend prepotent or default
obesity 19042 abilities are known as executive functions. Evidence from prospective cohort studies suggests that obesity -related deficits in school achievement are more prevalent in adolescent girls than in boys and younger
obesity 19210 adolescent girls than in boys and younger children ([140]).The academic consequences of adolescent obesity are shown to persist beyond schooling negatively influencing socioeconomic success. A Finnish longitudinal
obesity 19387 socioeconomic success. A Finnish longitudinal study (N = 9754, follow-up 17 years) suggests that adolescent obesity predicts unemployment in later life, with educational achievement as a mediating factor ([130]). A British
obesity 19560 as a mediating factor ([130]). A British birth cohort study (N = 12,537) indicates that adolescent obesity (at age 16 years) is associated with fewer years of schooling and predicts lower income in young women
obesity 20474 income).Description of the interventionClinical guidelines for prevention and treatment of childhood obesity from countries such as the UK ([150]; [172]), Australia ([149]), Canada ([133]) and Malaysia ([120])
obesity 20993 self-regulation).The recently updated series of Cochrane Reviews on the treatment of childhood and adolescent obesity concluded that interventions aiming to alter eating habits, physical activity, and sedentary behaviour
obesity 21428 interventions could benefit cognition, school achievement and future success of children and adolescents with obesity or overweight differently compared to children and adolescents with a healthy weight. The mechanisms
obesity 21676 psychosocial consequences, cognitive-behavioural regulation and lifestyle concerns associated with obesity (Figure 1).Figure 1.Potential causal links between obesity and impaired cognitive function, school achievement
obesity 21735 regulation and lifestyle concerns associated with obesity (Figure 1).Figure 1.Potential causal links between obesity and impaired cognitive function, school achievement and future success. Reverse causation may also occur
obesity 21987 achievement and future success can impact the 'mediating factors', and both in turn may cause worsening of obesity .Brain developmentEmerging evidence has linked obesity in children and adolescents to lower brain grey
obesity 22041 factors', and both in turn may cause worsening of obesity.Brain developmentEmerging evidence has linked obesity in children and adolescents to lower brain grey and white matter volume in brain regions associated
obesity 22332 healthy weight ([73]; [74]; [127]; [137]; [153]; [186]). This suggests a direct association between obesity and reduced cognitive and academic abilities, and is consistent with findings from animal models where
obesity 22617 result of inflammatory mechanisms.Health and psychosocial consequencesResearch has also identified obesity -related health consequences and psychosocial concerns to be associated with lower school achievement
obesity 22809 school achievement and cognitive function. These potential indirect factors include poor sleep due to obesity -related disordered breathing ([105]; [176]); hypertension ([131]); Type 2 diabetes ([164]); metabolic
obesity 23148 bullying ([110]; [128]). Reducing the risk of these health and psychosocial concerns, through reduction of obesity or increasing physical activity levels, or both, and improving diet and other obesity-related behaviours,
obesity 23234 reduction of obesity or increasing physical activity levels, or both, and improving diet and other obesity -related behaviours, could have beneficial effects on cognitive function, school achievement and future
obesity 23386 effects on cognitive function, school achievement and future success in children and adolescents with obesity .Cognitive-behavioural regulationThe association between lifestyle interventions for weight management
obesity 23595 and cognition and school achievement might be bidirectional. Research indicates that children with obesity show higher impulsivity and inattention and lower reward sensitivity, self-regulation and cognitive
obesity 23994 predict weight gain ([104]; [113]; [129]; [134]; [147]; [173]) or reduction of weight status after an obesity treatment intervention ([40]; [148]). Lifestyle interventions for weight management might positively
obesity 24261 food intake. A randomised controlled trial conducted in 44 children (eight to 14 years of age) with obesity or overweight suggested that specific training of self-regulatory abilities improved weight-loss maintenance
obesity 28348 particularly television-viewing for two or more hours a day, is associated with the development of obesity or overweight (review of 71 studies; [163]) and may replace opportunities to engage in activities that
obesity 30777 might therefore improve cognitive function and school achievement in children and adolescents with obesity or overweight.Multicomponent interventionsIn this review, the term 'multicomponent interventions' refers
obesity 30932 this review, the term 'multicomponent interventions' refers to interventions that target at least two obesity -related behaviours. Multicomponent lifestyle interventions may benefit cognitive function and school
obesity 31180 i.e. a study population that includes both children and adolescents of normal weight and those with obesity or overweight. For example, after the implementation of an uncontrolled intervention involving healthy
obesity 32208 classroom education) ([169]).Why it is important to do this reviewThe current global trend in childhood obesity ([146]; [183]) suggests that the prevalence of cognitive and educational problems among children is
obesity 32650 physical activity, sedentary behaviour and thinking patterns for prevention and treatment of childhood obesity are well established ([72]; [90]; [142]; [182]) and are reflected in clinical guidelines for the management
obesity 32769 established ([72]; [90]; [142]; [182]) and are reflected in clinical guidelines for the management of obesity ([120]; [133]; [149]; [150]; [172]).Animal models and human studies suggest that both obesity and obesity-related
obesity 32863 management of obesity ([120]; [133]; [149]; [150]; [172]).Animal models and human studies suggest that both obesity and obesity-related lifestyle behaviours have the potential to impair cognitive function, learning,
obesity 32875 obesity ([120]; [133]; [149]; [150]; [172]).Animal models and human studies suggest that both obesity and obesity -related lifestyle behaviours have the potential to impair cognitive function, learning, and school achievement
obesity 33224 fatness or both can improve cognitive function and learning/school achievement. We would expect that obesity prevention or treatment interventions benefit children with obesity differently from children with a
obesity 33292 achievement. We would expect that obesity prevention or treatment interventions benefit children with obesity differently from children with a healthy weight by mitigating cognitive deficits which are associated
obesity 33931 cognitive function (e.g. executive functions) and/or future success in children and adolescents with obesity or overweight, compared with standard care, waiting-list control, no treatment, or an attention placebo
obesity 34423 when data from the first period were obtainable.Types of participantsChildren and adolescents with obesity or overweight aged three to 18 years attending preschool or school, and whose body weight status was
obesity 35143 interventionsStudies were eligible for inclusion when the interventions aimed to prevent or reduce obesity . For inclusion, interventions had to be lifestyle interventions of any frequency and duration provided
obesity 35867 to improve cognitive and academic outcomes without a stated intention to prevent or treat childhood obesity . Where any measure or proxy of adiposity was included as a covariate only, the study was not eligible
obesity 39102 x-ray absorptiometry (DXA) and bioelectrical impedance analysis (BIA). We included studies reporting obesity indices only when measures of school achievement, cognitive function and/or future success were also
obesity 39418 performance, cognitive function and/or future success variables occur independently from changes in obesity (see How the intervention might work). It was not our intention to assess the effect of interventions
obesity 39555 might work). It was not our intention to assess the effect of interventions for treatment of childhood obesity on adiposity or body weight status. This has recently been examined in three other Cochrane Reviews
obesity 43849 missing data, selective data reporting.Population: age, gender, ethnicity, proportion of children with obesity or overweight; inclusion and exclusion criteria; number of participants recruited, included and followed
obesity 44033 recruited, included and followed (total and in comparison groups); diagnostic criteria of overweight or obesity ; comparability of groups at baseline; comorbidities.Intervention: type(s), frequency, mode of delivery,
obesity 44793 contacted the study authors to obtain unpublished data for children and adolescents with overweight or obesity , which were a subgroup of the study sample. AM therefore extracted the result data for each outcome
obesity 52203 Where separate data for children and adolescents with overweight and for children and adolescents with obesity were available, we included them separately in the meta-analysis. This was done with the intention to
obesity 57035 heterogeneity. However, we performed a subgroup analysis for body weight status (overweight versus obesity ), where possible.Sensitivity analysisWe investigated the influence of study characteristics on the robustness
obesity 57348 when studies:used different criteria or variations in the thresholds of criteria to define childhood obesity and overweight (e.g. clinical versus public health thresholds);were judged at 'high risk of bias' in
obesity 59859 diagram.Included studiesFor 14 of the 18 included studies, outcome data for children and adolescents with obesity or overweight were not published separately from data for the total study population. We therefore contacted
obesity 61186 study population in [2] included adolescents from 11 to 18 years.The overall proportions of girls with obesity or overweight were 64%, 57% and 53% in [14], [15] and [18], respectively. These three studies did not
obesity 67523 language achievement, and health class grades. Intervention effects for children and adolescents with obesity or overweight were available for the following cognitive functions: composite executive functions, inhibition
obesity 70614 Backward Test ([7]).Visuo-spatial abilitiesFour studies assessed visuo-spatial abilities in children with obesity or overweight using different scales: Simultaneous processing scale of the Das-Naglieri-CAS ([5]; [10]),
obesity 73133 delivering the intervention.[6] assessed inhibition control, non-verbal memory, visuo-spatial abilities, and obesity indices immediately after completion of the six-week intensive day camp versus standard practice/attention
obesity 73813 a non-randomised trial ([30]);Seven studies did not report the disaggregated data for children with obesity or overweight ([23]; [24]; [29]; [33]; [38]; [43]; [44]);Two studies employed lifestyle interventions
obesity 73966 [43]; [44]);Two studies employed lifestyle interventions without the intention to prevent or reduce obesity ([21]; [42]);Eight studies used non-eligible tools to assess school or cognitive outcomes (e.g. self-reported
obesity 75006 we are not able to determine the eligibility of the studies, namely, whether data for children with obesity or overweight would be available. See Characteristics of studies awaiting classification for further
obesity 75743 place in Spain, and compares an exercise intervention with wait-list control aimed at children with obesity or overweight aged eight to 12 years. Cognitive outcomes are executive functions including inhibition
obesity 79378 science achievement in fourth-grade children. The intervention is not solely aimed at children with obesity or overweight but waist circumference and body mass status are being assessed, yielding data to be included
obesity 79897 addition, body weight status is being assessed, allowing the researchers to provide data for children with obesity or overweight specifically.Risk of bias in included studiesThe Characteristics of included studies table
obesity 86561 to standard practice for improving cognition and school achievement in children and adolescents with obesity or overweight; Summary of findings 2 Physical activity plus healthy lifestyle education interventions
obesity 86781 to standard practice for improving cognition and school achievement in children and adolescents with obesity or overweight; Summary of findings 3 Dietary interventions compared to standard practice for improving
obesity 86958 to standard practice for improving cognition and school achievement in children and adolescents with obesity and overweightWe summarised and analysed the three intervention groups in separate comparisons and generated
obesity 87393 lifestyle education, and dietary interventions. We reported the secondary outcomes (future success and obesity indices) combined for all three comparisons, due to the low number of studies providing suitable data.Primary
obesity 90916 standard practice on reading achievement in children aged seven to 11 years with overweight, including obesity (SMD 0.10, 95% CI -0.30 to 0.49; 2 studies, 308 children, I2 = 63%, Tau2 = 0.05). This finding was of
obesity 92064 ([14]; see Table 8 for details) on native language achievement in children aged four to seven years with obesity or overweight (MD 2.38, 95% CI -4.75 to 9.51, scale range 0 to 36; SMD 0.23, 95% CI -0.50 to 0.95; 1
obesity 92717 assessed using standardised national tests, in 217 children aged 10 to 11 years with overweight (including obesity ) compared to standard practice: MD 1.52, 95% CI -0.02 to 3.06; scale mean (SD) = 50 (10), see Analysis
obesity 92985 assessing the effect of physical activity interventions compared to standard practice in children with obesity or overweight reported findings on additional educational support needs.1.2. Cognitive functionComposite
obesity 93862 compared to sedentary activities such as art and board games in 175 children aged eight to 11 years with obesity or overweight.The two studies included in the meta-analysis used different scales: Planning scale of
obesity 95110 physical activity intervention group compared to standard practice in children aged eight to 11 years with obesity or overweight (1 study, 116 children). This evidence was of high quality. There was no evidence of a
obesity 95752 control using the Stroop Colour Word Test ([7]). The authors provided unpublished data for children with obesity or overweight for a mid-term assessment at six-month follow-up and post-intervention data at 18-month
obesity 96358 active mathematics and language lessons on inhibition control in children aged seven to nine years with obesity or overweight at either follow-up time point. At six-month follow-up, the mean inhibition control was
obesity 97721 compared to sedentary activities in favour of the intervention in 175 children aged eight to 11 years with obesity or overweight ([10]).Meta-analysis findings (see Analysis 1.7)[8] provided unpublished data for the
obesity 97843 ([10]).Meta-analysis findings (see Analysis 1.7)[8] provided unpublished data for the subgroup with obesity /overweight for three measures of attention: processing speed, concentration, and performance quality.
obesity 98611 of the physical activity interventions compared to standard practice for eight to 11 year-olds with obesity or overweight (SMD 0.46, 95% CI -0.16 to 1.08; 2 studies, 157 children, I2 = 41%, Tau2 = 0.14). The
obesity 98916 study, 116 children).Working memoryOnly [7] provided data (unpublished specifically for children with obesity /overweight) for verbal working memory at six-month follow-up (mid-term) and 18-month follow-up (post-intervention
obesity 99389 mathematics and language lessons on verbal working memory in children aged seven to nine years with obesity or overweight compared to standard practice at either follow-up time point. At six-month follow-up,
obesity 100333 (83 children) .Visuo-spatial abilitiesThree studies assessed visuo-spatial abilities of children with obesity or overweight using different scales: Simultaneous processing scale of the Das-Naglieri-Cognitive Assessment
obesity 100911 after school compared to sedentary activities on visuo-spatial abilities in eight to 11 year-olds with obesity or overweight. We did not combine the two studies that provided data because [5] provided baseline-adjusted
obesity 101399 range 0 to 36) in the Movi-Kids intervention group compared to standard practice in 39 children with obesity or overweight (SMD 0.70, 95% CI 0.03 to 1.37; [14]; Analysis 1.10). There was no evidence of a beneficial
obesity 103532 1.12) mean non-verbal memory compared to standard practice in children aged eight to 11 years with obesity or overweight (SMD 0.43, 95% CI 0.07 to 0.80, 116 children). This effect estimate suggested a small
obesity 105956 group ('Action Schools! BC') compared to standard practice in 31 children aged seven to 11 years with obesity or overweight (SMD -0.18, 95% CI -0.93 to 0.58; Analysis 2.1). [1] was at high risk of attrition bias
obesity 106977 mean difference. We included data for children with overweight separately from data of children with obesity ([2]), and also included the two intervention arms in [16] separately. We divided the sample size of
obesity 107963 imprecision of estimates. [2] provided separate data for 64 children with overweight and 35 children with obesity . The single study effect estimates were statistically non-significant for both subgroups.Sensitivity
obesity 109865 provided unpublished change-from-baseline data for native language achievement of children with overweight/ obesity . We calculated standardised mean differences due to the difference in scales used. We included the data
obesity 110998 197 participants).Two studies provided separate data for children with overweight and children with obesity ([2]; [17]). For children with obesity, mean change in language achievement was 0.28 standard deviations
obesity 111037 separate data for children with overweight and children with obesity ([2]; [17]). For children with obesity , mean change in language achievement was 0.28 standard deviations higher (95% CI -0.20 to 0.77) in the
obesity 111789 provided unpublished post-intervention data separately for adolescents with overweight and adolescent with obesity , which we entered as two comparisons in the meta-analysis. We calculated the between-group mean difference.The
obesity 112286 There was no between-group difference between 108 adolescents with overweight and 155 adolescents with obesity . We judged this study to be of moderate quality and reduced the quality rating due to high risk of bias
obesity 112688 lifestyle education interventions on additional educational support needs for children and adolescents with obesity or overweight.2.2. Cognitive functionsInhibition controlWe included two studies which measured inhibition
obesity 113627 intervention compared to standard practice/attention control in 110 children aged six to 13 years with obesity or overweight. We downgraded the evidence for high risk of attrition bias and selective reporting. The
obesity 114529 active school breaks combined with healthy lifestyle education for one school year in 27 children with obesity or overweight aged six to eight years. The mean attention ability was 4.47 lower (95% CI -8.55 to -0.39,
obesity 114985 estimate.Visuo-spatial abilities[6] was the only study that measured visuo-spatial abilities in children with obesity or overweight, and used the copy trial of the Rey Complex Figure Test at six-week follow-up (mid-term)
obesity 117950 effects of the intervention on non-verbal memory compared to attention control in 86 children with obesity or overweight aged 12 to 13 years (SMD -0.005, 95% CI -0.35 to 0.34).2.3. Adverse outcomesNo study reported
obesity 118667 (one study). All studies were cluster-RCTs and two studies provided unpublished data for children with obesity or overweight ([4]; [12]).3.1. School achievementAverage achievement across subjects taught at school[9]
obesity 119237 change-from-baseline data. [12] provided separate data for children with overweight and children with obesity , which we have included as separate subgroups in the meta-analysis. We conducted a sensitivity analysis
obesity 119651 intervention groups compared to standard practice for 439 children and adolescents aged 7 to 17 years with obesity or overweight, suggesting a small statistically non-significant difference between the experimental
obesity 119953 performed a subgroup analysis for body weight status, classifying [9] under the subgroup ‘children with obesity ’. Considering data of children with obesity only, there was a moderate effect estimate of 0.45 standard
obesity 119999 status, classifying [9] under the subgroup ‘children with obesity’. Considering data of children with obesity only, there was a moderate effect estimate of 0.45 standard deviation in favour of the intervention
obesity 121087 20%) in the intervention group compared to standard practice. The effect estimate for children with obesity decreased from moderate to small (SMD 0.34, 95% CI 0.05 to 0.63; 2 studies, 380 children). The effect
obesity 121598 national tests. This study provided unpublished data for children with overweight and for children with obesity , which we entered separately in the meta-analysis (see Analysis 3.2). For comparability with the effect
obesity 122107 1.47, scale range: 0 to 69; SMD -0.26, 95% CI -0.72 to 0.20) in 76 children aged nine to 11 years with obesity or overweight. We downgraded the quality for a high risk of detection bias and imprecision of the effect
obesity 122478 estimate. There was no difference in effect estimates for children with overweight and children with obesity .Reading achievement[4] also measured reading achievement using standardised national tests. The mean
obesity 123135 estimate, probably due to the small sample size. Inspection of the effect estimates for overweight and obesity suggested statistically non-significantly higher standardised reading achievement in favour of the control
obesity 123274 non-significantly higher standardised reading achievement in favour of the control group for children with obesity , while for children with overweight the effect estimate was in favour of the intervention.Additional
obesity 123515 studies assessing the effect of dietary interventions compared to standard practice in children with obesity or overweight reported findings on additional educational support needs.3.2. Cognitive functionsAttentionAttention
obesity 124368 inconsistency in the effect estimates for children aged nine to 11 years with overweight and children with obesity : statistically non-significant higher attention performance of children with obesity in the intervention
obesity 124453 children with obesity: statistically non-significant higher attention performance of children with obesity in the intervention group, and higher attention performance in control group children with overweight.The
obesity 125280 success, such as years of schooling, college enrolment or income for children and adolescents with obesity or overweight.2. Obesity indicesWe assessed the effects of behavioural interventions on change from
obesity 125530 and waist circumference for studies that provided suitable data. We reported the effect estimates on obesity indices by the following subgroups:Beneficial intervention effect on school achievement;No beneficial
obesity 128259 education intervention by [16] (ASCEND) resulted in no beneficial effect on BMI z-scores in children with obesity or overweight compared to standard practice. This study also showed no beneficial effect on school achievement
obesity 129461 Total body fat (%).One study, which showed improved cognitive function in some domains of children with obesity or overweight after a six-week day camp, indicated a mean reduction of 5.2% (95% CI -8.1% to -2.3%,
obesity 130406 standard practice.Waist circumferenceSuitable data on change of waist circumference in children with obesity or overweight were available from only one study ([6]). Improvements in cognitive function in favour
obesity 131019 to standard practice for improving cognition and school achievement in children and adolescents with obesity or overweightPatient or population: Children and adolescents with obesity or overweightSetting: Classroom
obesity 131093 children and adolescents with obesity or overweightPatient or population: Children and adolescents with obesity or overweightSetting: Classroom and school/preschool environment or in another community setting in
obesity 135901 control for improving cognition and school achievement in children and adolescents with overweight and obesity Patient or population: Children and adolescents with obesity or overweightSetting: Classroom and school
obesity 135961 children and adolescents with overweight and obesityPatient or population: Children and adolescents with obesity or overweightSetting: Classroom and school environment in the USA and DenmarkIntervention: Dietary interventionsComparison:
obesity 139608 behavioural interventions for improving cognition and school achievement in children and adolescents with obesity or overweight. Eight studies offered a physical activity-only intervention, seven studies combined physical
obesity 141403 average achievement across subjects taught at school compared to standard practice in adolescents with obesity , but not in adolescents with overweight. However, the evidence was of low quality. There was no evidence
obesity 141712 and seafood (New Nordic Diet) improved attention, mathematics or reading achievement in children with obesity or overweight. This finding was also of low quality and further research is very likely to change the
obesity 141849 was also of low quality and further research is very likely to change the effect estimates.Change in obesity by intervention effectiveness on school or cognitive outcomesBased on our descriptive analysis, we were
obesity 142067 able to detect a conclusive pattern linking improved school or cognitive outcomes with a reduction in obesity . Three studies indicated that highly-intense interventions that involve daily exposure to physical activity
obesity 142257 exposure to physical activity or nutrition education, or both, can result in both significant change in obesity indicators and cognitive and academic outcomes compared to standard practice. However, one high-intensity
obesity 143811 currently exist on whether lifestyle interventions for weight management of children and adolescents with obesity or overweight influence the need for additional educational support and indices of future success once
obesity 144066 completeness and applicability of evidenceOur population group of interest - children and adolescents with obesity or overweight - is a very specific yet substantial and globally increasing subgroup of the general population.
obesity 144288 the 18 included studies, the study population of only six studies were children or adolescents with obesity or overweight. Most of the identified studies aimed to prevent obesity in the general population and
obesity 144359 children or adolescents with obesity or overweight. Most of the identified studies aimed to prevent obesity in the general population and did not report cognitive and academic outcomes of the subgroup with obesity
obesity 144465 obesity in the general population and did not report cognitive and academic outcomes of the subgroup with obesity or overweight separately from those of children in the healthy weight category. This was surprising,
obesity 146439 ([56]; [65]) which assessed intervention effects on cognitive and academic outcomes in participants with obesity or overweight.All but one ([2]) of the included studies were conducted in high-income countries and
obesity 146889 activity, diet and other behavioural interventions on cognition and school achievement of children with obesity or overweight growing up in a socio-economically deprived environment remains to be investigated. The
obesity 147035 socio-economically deprived environment remains to be investigated. The evidence on the association between obesity and poverty ([117]; [136]; [181]), and the associations between lower education and cognitive skills
obesity 147237 skills and poverty ([91]; [138]) support further efforts in identifying who could benefit most from obesity -related health behaviour interventions.There was no evidence available on the effect of interventions
obesity 147454 targeting the quality and duration of sleep, or sedentary behaviour, or both, despite its association with obesity and impaired cognitive or academic performance or both. However, the healthy lifestyle education component
obesity 148119 (‘Stand Up For Health’ study, trial register: ACTRN12614001001684). Although this trial listed obesity /overweight as a target health condition, the trial register entry did not mention assessment of change
obesity 148685 for weight management on school achievement and cognitive functions in children and adolescents with obesity or overweight. Nevertheless, the findings of [6] indicate that the beneficial effect of the day-camp
obesity 149065 unclear whether changes in academic and cognitive abilities were connected to changes in indices of obesity , due to the small amount of suitable data, and variations in study architecture ([5]; [6]; [9]).Quality
obesity 152815 detect an intervention effect. Studies which provided unpublished data for the subgroup of children with obesity or overweight may have been powered for the total study sample.Included studies used a wide range of
obesity 153032 achievement and cognitive function test tools. Previous reviews, such as that of [173], suggest that obesity might have a detrimental impact on some aspects of cognition, so we conducted a categorisation of outcome
obesity 154688 synthesised the evidence of physical activity interventions on cognitive and academic outcomes in youth with obesity or overweight. The authors included quasi-experimental and randomised controlled trials published in
obesity 156897 outcomes in the general population. Although these systematic reviews may include some children with obesity or overweight, they lack a separate analysis of the effect estimates in our population groups of interest.
obesity 157051 of the effect estimates in our population groups of interest. Research suggests a greater benefit of obesity -related health behaviour interventions in children with obesity or overweight compared to children with
obesity 157115 Research suggests a greater benefit of obesity-related health behaviour interventions in children with obesity or overweight compared to children with healthy weight ([21]; [27]; [177]). These reviews are therefore
obesity 157550 composite executive functions and non-verbal memory in primary/elementary school-aged children with obesity or overweight specifically. However, this evidence is based on a small number of studies. On current
obesity 158459 physical activity or dietary interventions on school achievement and cognitive functions in children with obesity or overweight conducted in clinical settings (e.g. hospitals, outpatient clinics, primary care) is missing,
obesity 159066 activity interventions on cognitive outcomes, namely cognitive executive functions, in children with obesity or overweight. Cognitive executive functions have been associated with the ability to control food intake
obesity 159536 management could be informed when linking cognitive abilities with behaviour change. Secondly, children with obesity or overweight are the target population of weight management programmes in clinical settings. If studies
obesity 159950 areas. Similarly, community-based interventions which directly target children and adolescents with obesity and which assess cognitive and academic outcomes are needed to advance the evidence. In addition, the
obesity 160211 assessment of a differential intervention effect for participants with overweight and participants with obesity in relation to school achievement and cognitive functions.In terms of the targeted obesity-related health
obesity 160302 participants with obesity in relation to school achievement and cognitive functions.In terms of the targeted obesity -related health behaviours, evidence was available for solely physical activity interventions, physical
obesity 161547 the school personnel manageable. While interventions with multiple strategies appear successful for obesity prevention and treatment ([72]; [90]; [142]; [182]), a sufficient intensity and quality of the effective
obesity 162313 addition, the evidence is insufficient for adolescents who have reached puberty. The effectiveness of obesity -related behaviour change interventions on cognition and school achievement in this age group is of particular
obesity 162731 activity and dietary interventions on cognition and school achievement in children and adolescents with obesity or overweight remains unknown, and should be addressed in future research.Future multicomponent obesity
obesity 162835 obesity or overweight remains unknown, and should be addressed in future research.Future multicomponent obesity prevention and treatment programmes should consider implementing physical activity programmes which
obesity 163210 differential intervention effects on cognition and school achievement for children and adolescents with obesity or overweight living in socio-economically deprived environments. The educational, societal and economic
obesity 163369 environments. The educational, societal and economic argument for implementing effective childhood obesity prevention and treatment programmes could be substantial.Longer-term follow-up trials are needed to
obesity 163762 common problem in lifestyle interventions, particularly those involving children and adolescents with obesity or overweight. To reduce the risk of attrition bias, researchers might wish to consider methods to impute
obesity 164308 needed to further investigate associations, two-way interactions and causal pathways between childhood obesity , lifestyle behaviour, cognitive abilities and academic outcomes

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