UNLABELLED

Childhood obesity, driven by an obesogenic environment, remains a public health priority. To review the effectiveness of non-pharmacological interventions for treating childhood obesity, with a focus on weight reduction and consideration of social determinants of health (SDOH). The review included randomized and quasi-experimental studies, published between August 2016 and December 2021, that evaluated the effectiveness of interventions aimed at reducing body weight in children aged 2 to 14 years with obesity. (PROSPERO ID: CRD42022301191). A total of 59 interventions were identified, showing wide variability in design, duration, components and settings. Most included physical activity (93%) and nutrition (81%), while fewer incorporated psychological support (46%) or digital tools (25%). Despite the diversity of approaches, 56% of the interventions were effective, particularly those implemented in healthcare or school settings, involving physical activity, and delivered by multidisciplinary teams. However, only six demonstrated sustained effects beyond 6 months. Risk of bias was high in over half of the studies, and only a small proportion (22%) reported participants' social characteristics such as family structure, race, or socioeconomic status. Importantly, very few interventions were designed or evaluated with explicit consideration of SDOH.

CONCLUSION

Overall, effective interventions tended to target both children and parents, include multiple components-especially physical activity-and be delivered in accessible settings such as schools or primary care. Yet, the generalizability of findings is limited, as most studies involved children from relatively advantaged backgrounds. Future interventions should integrate SDOH in both design and evaluation to ensure equity and long-term effectiveness in diverse populations.

WHAT IS KNOWN

• Childhood obesity remains a critical public health issue, heavily influenced by obesogenic environments and social determinants of health (SDOH). • Non-pharmacological interventions, particularly those incorporating physical activity and nutritional guidance, have been commonly used to address childhood obesity, though with varying degrees of success.

WHAT IS NEW

• This review highlights that interventions delivered in healthcare or school settings by multidisciplinary teams, and involving both physical activity and parental engagement, show higher effectiveness in reducing childhood obesity. • The study identifies a significant gap in the integration of social determinants of health in both the design and evaluation of interventions, limiting their long-term impact and equity across diverse populations.