TY - JOUR
T1 - The effects of hypothetical behavioral interventions on the 13-year incidence of overweight/obesity in children and adolescents
AU - Börnhorst, C.
AU - Pigeot, I.
AU - de Henauw, S.
AU - Formisano, A.
AU - Lissner, L.
AU - Molnár, D.
AU - Moreno, L. A.
AU - Tornaritis, M.
AU - Veidebaum, T.
AU - Vrijkotte, T.
AU - Didelez, V.
AU - Wolters, M.
N1 - Funding Information: Open Access funding enabled and organized by Projekt DEAL. The GrowH! project is funded by the Joint Programming Initiative ‘A Healthy Diet for a Healthy Life’ (JPI HDHL), a research and innovation initiative of EU member states and associated countries. The funding agencies supporting this work are (in alphabetical order of participating countries): Belgium: Research Foundation – Flanders (FWO); Germany: Federal Ministry of Education and Research (BMBF; grant no. 01EA2102A); Spain: Spanish State Research Agency (AEI); The Netherlands: The Netherlands Organisation for Health Research and Development (ZonMw). This project has received funding from the European Union’s Horizon 2020 research and innovation programme under the ERA-NET Cofund action N° 727565. The funders had no role in the execution of the work, nor in the interpretation of the results. Funding Information: The data have been made available for this publication by the IDEFICS ( http://www.idefics.eu ) and I.Family studies ( http://www.ifamilystudy.eu/ ). The IDEFICS Study was funded by the European Community within the Sixth RTD Framework Programme Contract No. 016181 (FOOD). The I.Family Study was funded by the European Community within the Seventh RTD Framework Programme Contract No. 266044. Publisher Copyright: © 2023, BioMed Central Ltd., part of Springer Nature.
PY - 2023/12/1
Y1 - 2023/12/1
N2 - Background: In view of the high burden of childhood overweight/obesity (OW/OB), it is important to identify targets for interventions that may have the greatest effects on preventing OW/OB in early life. Using methods of causal inference, we studied the effects of sustained behavioral interventions on the long-term risk of developing OW/OB based on a large European cohort. Methods: Our sample comprised 10 877 children aged 2 to < 10 years at baseline who participated in the well-phenotyped IDEFICS/I.Family cohort. Children were followed from 2007/08 to 2020/21. Applying the parametric g-formula, the 13-year risk of developing OW/OB was estimated under various sustained hypothetical interventions on physical activity, screen time, dietary intake and sleep duration. Interventions imposing adherence to recommendations (e.g. maximum 2 h/day screen time) as well as interventions ‘shifting’ the behavior by a specified amount (e.g. decreasing screen time by 30 min/day) were compared to ‘no intervention’ (i.e. maintaining the usual or so-called natural behavior). Separately, the effectiveness of these interventions in vulnerable groups was assessed. Results: The 13-year risk of developing OW/OB was 30.7% under no intervention and 25.4% when multiple interventions were imposed jointly. Meeting screen time and moderate-to-vigorous physical activity (MVPA) recommendations were found to be most effective, reducing the incidence of OW/OB by -2.2 [-4.4;-0.7] and -2.1 [-3.7;-0.8] percentage points (risk difference [95% confidence interval]), respectively. Meeting sleep recommendations (-0.6 [-1.1;-0.3]) had a similar effect as increasing sleep duration by 30 min/day (-0.6 [-0.9;-0.3]). The most effective intervention in children of parents with low/medium educational level was being member in a sports club; for children of mothers with OW/OB, meeting screen time recommendations and membership in a sports club had the largest effects. Conclusions: While the effects of single behavioral interventions sustained over 13 years were rather small, a joint intervention on multiple behaviors resulted in a relative reduction of the 13-year OW/OB risk by between 10 to 26%. Individually, meeting MVPA and screen time recommendations were most effective. Nevertheless, even under the joint intervention the absolute OW/OB risk remained at a high level of 25.4% suggesting that further strategies to better prevent OW/OB are required.
AB - Background: In view of the high burden of childhood overweight/obesity (OW/OB), it is important to identify targets for interventions that may have the greatest effects on preventing OW/OB in early life. Using methods of causal inference, we studied the effects of sustained behavioral interventions on the long-term risk of developing OW/OB based on a large European cohort. Methods: Our sample comprised 10 877 children aged 2 to < 10 years at baseline who participated in the well-phenotyped IDEFICS/I.Family cohort. Children were followed from 2007/08 to 2020/21. Applying the parametric g-formula, the 13-year risk of developing OW/OB was estimated under various sustained hypothetical interventions on physical activity, screen time, dietary intake and sleep duration. Interventions imposing adherence to recommendations (e.g. maximum 2 h/day screen time) as well as interventions ‘shifting’ the behavior by a specified amount (e.g. decreasing screen time by 30 min/day) were compared to ‘no intervention’ (i.e. maintaining the usual or so-called natural behavior). Separately, the effectiveness of these interventions in vulnerable groups was assessed. Results: The 13-year risk of developing OW/OB was 30.7% under no intervention and 25.4% when multiple interventions were imposed jointly. Meeting screen time and moderate-to-vigorous physical activity (MVPA) recommendations were found to be most effective, reducing the incidence of OW/OB by -2.2 [-4.4;-0.7] and -2.1 [-3.7;-0.8] percentage points (risk difference [95% confidence interval]), respectively. Meeting sleep recommendations (-0.6 [-1.1;-0.3]) had a similar effect as increasing sleep duration by 30 min/day (-0.6 [-0.9;-0.3]). The most effective intervention in children of parents with low/medium educational level was being member in a sports club; for children of mothers with OW/OB, meeting screen time recommendations and membership in a sports club had the largest effects. Conclusions: While the effects of single behavioral interventions sustained over 13 years were rather small, a joint intervention on multiple behaviors resulted in a relative reduction of the 13-year OW/OB risk by between 10 to 26%. Individually, meeting MVPA and screen time recommendations were most effective. Nevertheless, even under the joint intervention the absolute OW/OB risk remained at a high level of 25.4% suggesting that further strategies to better prevent OW/OB are required.
KW - Causal inference
KW - Childhood obesity
KW - IDEFICS/I.Family cohort
KW - Modifiable risk factor
KW - Observational data
KW - Parametric g-formula
UR - http://www.scopus.com/inward/record.url?scp=85168707470&partnerID=8YFLogxK
U2 - https://doi.org/10.1186/s12966-023-01501-6
DO - https://doi.org/10.1186/s12966-023-01501-6
M3 - Article
C2 - 37620898
SN - 1479-5868
VL - 20
JO - international journal of behavioral nutrition and physical activity
JF - international journal of behavioral nutrition and physical activity
IS - 1
M1 - 100
ER -