Cognitive Behavioral Interventions for Children and Adolescents With Overweight or Obesity: A Systematic Review and Component Network Meta-Analysis

Abstract

Background

The efficacy of individual cognitive behavioral therapy (CBT) components for managing pediatric obesity remains unclear. This study systematically evaluated the impacts of CBT and its constituent techniques in this population.

Method

We searched PubMed, Embase, and Cochrane CENTRAL from inception to July 17, 2024, for randomized controlled trials comparing CBT techniques or usual care targeting obesity management in children and adolescents with overweight or obesity. Component network meta-analyses provided estimates of effects of each component on obesity-related outcomes. We rated the certainty of evidence using modified GRADE approaches.

Results

We included 125 trials with 16,513 children and adolescents. For conceptual level components, compared with minimal education, behavioral therapy probably reduces body fat percentage (MD, −1.16%; 95% CI, −1.68% to −0.64%), waist circumference (MD, −1.70 cm; 95% CI, −2.74 to −0.67 cm), and improves quality of life (SMD, 0.16; 95% CI, 0.03–0.30). For technical-level components, when compared with minimal education, parental involvement (MD, −0.09; 95% CI, −0.16 to −0.03) and stimulus control (MD, −0.07; 95% CI, −0.12 to −0.01) probably reduce body mass index (BMI) z-score. Preplanning (MD, −3.05%; 95% CI, −5.82% to −0.28%) and feedback (MD, −2.73%; 95% CI, −5.31% to −0.14%) probably reduce body fat percentage, whereas device monitoring, problem-solving, rule-setting, and relaxation training might increase body fat percentage.

Interpretation

Behavioral therapy alone is likely effective for pediatric obesity management, irrespective of cognitive therapy integration. Techniques such as parental involvement, stimulus control, preplanning, and feedback should be prioritized in CBT.