Introduction: Children and adolescents with obesity are at increased risk of impaired psychological wellbeing. Physical activity and dietary interventions are first-line treatments for overweight and obesity, however, the impact on psychological wellbeing is not well understood. This review assessed the impact of physical activity interventions, with (PA+diet) or without (PA-only) a nutrition component, on depression, self-esteem and body image in children and adolescents with overweight or obesity.
Methods: MEDLINE, EMBASE, Cochrane Library and PsycINFO were searched up to August 2018. Eligibility criteria included: obesity treatment interventions conducted in free-living children or adolescents; minimum weekly supervised physical activity of at least moderate intensity; reporting depression, self-esteem or body image pre- and post-intervention using validated tools. Studies were grouped according to inclusion of a nutrition component. Meta-analysis was completed where possible.
Findings: Of 3078 articles screened, 32 studies were included for review including nine PA-only and 23 PA+diet studies. Meta-analysis indicated that physical activity interventions, with or without a nutrition component (duration ranging from 6-weeks to 1-year), lead to a small-to-medium increase in self-esteem (21 studies (n=7722), standardised mean difference, SMD [SE]: 0.34 [0.04], p<0.001, I2=78%), reduction in depression (10 studies (n=833), -0.34 [0.06], p<0.001, I2=77%) and increase in body image (17 studies (n=833), 0.46 [0.04], p<0.001, I2=53%) pre- to post-intervention. Inclusion of a nutrition component did not significantly influence outcomes. Moderator analyses showed that longer interventions (R2=0.15, p=0.03) and studies conducted in schools (p=0.004), compared with community and hospital outpatient settings, had a greater effect on improving self-esteem. There were no significant moderators for change in depression or body image.
Conclusion: Physical activity interventions for the treatment of pediatric obesity, with or without a nutrition component, improve psychological wellbeing, including depression, self-esteem and body image. Longer interventions and those conducted in schools appear to be particularly beneficial for improving self-esteem.