A landmark project co-led by the University of Sydney and Flinders University has found that family-focused early obesity prevention programs, such as group sessions with health professionals or mobile apps, have limited impact on standardised body mass index (BMI) in young children.
Published in The Lancet, the study was led by Dr Kylie Hunter from the University of Sydney as part of the TOPCHILD collaboration, alongside Dr Brittany Johnson and Professor Rebecca Golley from Flinders’ Caring Futures Institute.
Early growth is a strong predictor of future growth trajectory, with one in four children in Australia living with overweight or obesity by the time they start school.
“We found that early parent-focused obesity prevention programs did not improve BMI in children,” says Dr Kylie Hunter, lead author and research fellow at the NHMRC Clinical Trials Centre.
“To shift the dial, we need to stop putting the onus on families alone. Governments, health officials and local authorities must show stronger leadership and commitment to addressing the social and environmental drivers of obesity.”
The scientists analysed data from 31 international studies evaluating different types of family-based childhood obesity prevention programs commencing during pregnancy up to the age of one.
Of these, the researchers focused on 17 studies, which assessed children’s standardised BMI at the age of two, after the obesity programs had concluded.
The academics found that despite the range of programs tested, there was no meaningful difference in the standardised BMI of children whose families participated in any of the programs compared to those who did not.
A key challenge with complex, multicomponent programs is describing what specific content they actually include. The Flinders Caring Futures Institute team led the work pulling apart and describing the different types of programs.
The programs analysed in the study aimed to help parents build healthy habits for their children, focusing on breast-feeding, nutrition, physical activity, sleep and screen time. They were delivered in a variety of ways including home visits from health professionals and peer educators, community parent groups or via mobile apps.
“We looked to see if there were any differences in the findings when programs were delivered in different settings or were shorter or longer in program duration, and found there was no difference in child growth based on the ways programs were delivered,” says Dr Brittany Johnson, Senior Research Fellow at the Flinders Caring Futures Institute.
The researchers emphasised that the programs studied were well-designed and delivered by passionate and skilled professionals, but argued that without wider systemic change, both health professionals and parents were fighting a losing battle.
Ongoing research at Flinders with caregivers of children aged under 5 years, led by Dr Brittany Johnson, is exploring what caregivers want in programs and services to support child health and growth.
These findings will inform development of new programs, along with supports to address the social and environmental drivers of obesity.
“A key learning from this project is that researchers and health professionals need to work with caregivers to better understand what’s going to help them do their best,” says Professor Rebecca Golley from Flinders Caring Futures Institute.
“It is often assumed that it’s just a matter of educating parents, or teaching caregivers new skills. But until we understand things from the perspective of contemporary parents and families, the effective solutions will remain elusive.
“In Australia, our National Obesity Strategy highlights the package of strategies that together will curb obesity and associated rates of chronic disease. It is great to see Australian states responding, including South Australia, with action plans, that tackle the social, commercial and system determinants of health. A package of policy levers is needed, the magic bullet is that the sum is greater than its parts.”
The paper, ‘Parent-focused behavioural interventions for the prevention of early childhood obesity (TOPCHILD): a systematic review and individual participant data meta-analysis’ by the TOPCHILD collaboration is published today in The Lancet. DOI: 10.1016/S0140-6736(25)01144-4
About the TOPCHILD Collaboration
The TOPCHILD Collaboration is a global initiative that unites more than 70 researchers from 47 institutions, contributing original data to create the largest early childhood obesity prevention database to date, encompassing nearly 30,000 children.
Flinders Caring Futures Institute researchers have worked with these 70 global experts to code the program content of 31 trials, to look into the ‘black box’ of behaviour change programs and better understand how to streamline these for use in routine practice.
Funded by the Ian Potter Foundation and The Hospital Research Foundation Group, this information is being developed as an interactive website. A hub to give policy makers and program planners better visibility and access to evidence that can be utilised in routine public health, early education and social care.