Gonçalves Ana, Simões Pedro Augusto, Sousa-Pinto Bernardo, Taveira-Gomes Tiago
Faculty of Medicine University of Porto, Alameda Prof. Hernâni Monteiro, Porto, PT.
Faculty of Health Sciences University of Beira Interior, Covilhã, PT.
J Med Internet Res. 2024 Oct 14;26. doi: 10.2196/57458.
The prevalence of overweight and obesity is increasing at an alarming rate in children and adolescents worldwide. Given the dimension of the problem, treatments of childhood obesity are recognized as of extreme importance. Current evidence indicates that behavioural and cognitive behavioural strategies combined with diet and physical activity approaches may assist in reducing adolescent obesity.
The purpose of this systematic review is to evaluate the use of extrinsic motivators in improving the BMI of obese or overweight adolescents.
The inclusion criteria were as follows: 1) overweight or obese adolescents, 2) intervention using extrinsic motivators, 3) outcome variables related to weight status. The exclusion criteria were associated chronic disease. The search process was conducted in PubMed and Web of Science (last searched on 23/04/2023). The risk of bias was evaluated independently by two authors with the Cochrane's tools: RoB2 (RCT), ROBINS-I and ROBINS-E.
From 3,163 studies identified, 20 articles (corresponding to 18 studies) were included in the analysis. The studies differ in study design, sample size, follow-up duration, outcomes reported, and extrinsic motivators used. Most of the studies had videogames or apps as intervention. Nine studies (50%) showed a statistically significant decrease of BMI. The most used extrinsic motivators were "Motivation" (n=13), "Feedback" (n=10) and "Rewards" (n=9), and the ones that seem to have a higher impact on decreasing BMI are "Reminders" (100%) and "Peer-support" (80%).
The heterogeneity of studies makes analysis difficult. No study has evaluated the extrinsic motivators in isolation. Most of the studies have a moderate or high risk of bias. The extrinsic motivators that seem to be more useful are "Reminders" and "Peer-support", but more studies are needed, namely well designed RCTs, homogeneity in BMI measure and extrinsic motivators definitions, and longer duration to better understand long-term impact of extrinsic motivators on weight management success.
全球儿童和青少年超重及肥胖的患病率正以惊人的速度上升。鉴于该问题的规模，儿童肥胖的治疗被认为极为重要。目前的证据表明，行为和认知行为策略与饮食及体育活动方法相结合，可能有助于降低青少年肥胖率。
本系统评价的目的是评估使用外部激励因素对改善肥胖或超重青少年体重指数（BMI）的作用。
纳入标准如下：1）超重或肥胖青少年；2）使用外部激励因素的干预措施；3）与体重状况相关的结果变量。排除标准为相关慢性病。检索过程在PubMed和科学网（最后检索日期为2023年4月23日）中进行。由两位作者使用Cochrane工具独立评估偏倚风险：RoB2（随机对照试验）、ROBINS - I和ROBINS - E。
在识别出的3163项研究中，有20篇文章（对应18项研究）纳入分析。这些研究在研究设计、样本量、随访时间、报告的结果以及使用的外部激励因素方面存在差异。大多数研究以电子游戏或应用程序作为干预措施。9项研究（50%）显示BMI有统计学意义的下降。最常用的外部激励因素是“动机”（n = 13）、“反馈”（n = 10）和“奖励”（n = 9），而对降低BMI似乎有更大影响的是“提醒”（100%）和“同伴支持”（80%）。
研究的异质性使得分析困难。没有研究单独评估外部激励因素。大多数研究存在中度或高度偏倚风险。似乎更有用的外部激励因素是“提醒”和“同伴支持”，但需要更多研究，即设计良好的随机对照试验、BMI测量和外部激励因素定义的同质性，以及更长的时间来更好地理解外部激励因素对体重管理成功的长期影响。
