Background
For about three decades, childhood and adolescent obesity estimates have been at alarming levels [
1]. In 2016, estimates show that more than 40 million children under 5 years of age across the globe are either overweight or obese [
1‐
3]. In addition, around 340 million individuals up to the age of 18 years are overweight or obese. More than 85% of these children are from high-income countries. This suggests that approximately as high as one-third of the children in high-income countries and around one-tenth in middle and low-income countries are either overweight or obese [
4].
Overweight and/or obese children and adolescents are more likely to develop asthma, sleep apnea, bone and joint problems, type-2 diabetes, and heart problems [
5‐
7]. Childhood obesity is associated with adverse consequences on the cardiovascular system suggesting initiation of atherosclerotic changes in vessels in early life [
8,
9], a higher risk of high blood pressure [
10,
11] and about seven times higher risk of triglycerides in 5–10-year-old obese children as compared to non-obese [
12,
13]. These children are also more likely to experience social and psychological problems such as bullying, social isolation, and low self-esteem as compared to their normal-weight peers [
14].
Importantly, outcomes of childhood obesity are not only limited to childhood. Obese children are approximately 17 times more likely to become obese during adulthood. They are more likely to grow up as obese adults and develop chronic diseases such as cardiovascular diseases and diabetes comparatively at an early stage [
15,
16], with higher incidence of non-communicable diseases such as type-2 diabetes, heart problems, metabolic syndrome, and certain types of cancers at a younger age [
17‐
19].
There is a wide range of risk factors which start from the antenatal period until late childhood. Moreover, risk factors also affect others, such as the mother or father in terms of their physical or mental health, and their behaviors related to smoking, drugs, and alcohol. Antenatal depression and depression are also associated with a 2–3-fold increased risk of childhood obesity [
20‐
22].
Literature suggests that maternal factors play a significant role in the development of childhood overweight and obesity. These factors could be pre-pregnancy BMI or gestational weight gain physical activity or smoking, or maternal physical and mental health [
23‐
26]. Among these factors, maternal mental health influences the lifestyle which puts a child at a higher risk of being overweight or obese. Prenatal mental problems may impact the care of self and meet the needs of the pregnancy. Similarly, postnatal depression depending upon the age of the newborn may affect breastfeeding, hygiene and cleanliness, timing and contents of initiation solids, physical activity of the child and screen time, and use of junk food. Childhood obesity is not a result of one or two factors but results from a multitude of causes. For optimum results, it is not wrong to address the issue of overweight and obesity in this age group by designing and implementing interventions for as many factors as possible, including maternal mental health.
Maternal mental health issues may exist any time from the antenatal period until late childhood to adolescent, potentially leading a child toward overweight and obesity. There is a dearth of evidence on the assessment of mental health interventions in relation to weight or adiposity in pediatric age groups. To our knowledge, there are three systematic reviews conducted on childhood obesity treatment and interventions [
27‐
29]. None of these reviews had a study on maternal mental health. Staniford et al. identified articles on cognitive behavioral therapy (CBT), but therapy was related to coaching and motivation for goal setting and becoming more disciplined toward diet and physical activity [
27]. Literature shows the role of maternal depression and distress in childhood obesity without any systematic assessment of related interventions. It seems high time to design and conduct a systematic review for assessing the role of maternal mental health in addressing the issue of pediatric obesity. The findings will guide us as to where to focus as far as mental health is concerned.
Objectives
The objective of this systematic review and meta-analysis is to evaluate the effectiveness of the programs implemented to prevent childhood obesity by improving maternal mental health.
Discussion
This protocol is the first in the series of our planned systematic reviews and meta-analyses. The findings of this systematic review and meta-analysis will inform the level of body evidence which will eventually guide us if more research is needed. At the same time, this review will provide us the strength of programs with a variety of intervention by contents and duration. All efforts will be made to capture as many related databases as possible, including theses and dissertations. The core purpose is to determine which intervention package was effective to what extent. To make best use of the outcome, we will disseminate findings to the related audience such as academia, clinicians, and communities in addition to the peer-reviewed publications.
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