A systematic review and meta‐analysis of randomized controlled trials of behavioral interventions for the management of overweight and obesity in children that are delivered or referred to by health providers in primary care

Introduction

Reducing childhood overweight and obesity prevalence is a global public health priority. This systematic review and meta-analysis evaluated the effectiveness of behavioral weight management interventions delivered or referred to by health care providers in primary care settings.

Methods

Randomized controlled trials (RCTs) of behavioral interventions published up to 05/01/2026, involving participants < 18 years with overweight or obesity, were identified through Cochrane, MEDLINE, PubMed, and PsychINFO. Two reviewers independently screened studies, extracted data, and assessed risk of bias. Meta-analyses calculated pooled mean differences in zBMI and BMI using random effects models. The primary outcome was zBMI change at 12 months; secondary outcomes included zBMI changes at program end, last follow-up, and BMI at 12 months.

Results

Fifty-nine RCTs (n = 10,454) were included; 23 trials (n = 3241) contributed to the primary outcome. At 12 months, the pooled mean difference in zBMI was −0.08 (95% CI −0.13 to −0.03, p < 0.01), favoring intervention groups. At program end (n = 30), the mean difference was −0.15 (95% CI −0.22 to −0.08), and at last follow-up (n = 37), −0.08 (95% CI −0.15 to −0.02). BMI at 12 months showed a mean difference of −0.37 (95% CI −0.72 to −0.01). Interventions referred to community settings achieved greater zBMI reductions (−0.14 [95% CI −0.2 to −0.08]) than those delivered within primary care (0.04 [95% CI −0.10 to 0.18]).

Conclusions

Behavioral weight management interventions for children delivered or referred to by health care professionals in primary care led to modest reductions in zBMI. Referrals to community-based interventions (e.g., HENRY) may yield greater improvements.