Comparative effectiveness of lifestyle interventions on children's body composition management: A systematic review and network meta-analysis

•Multi-component approaches incorporating elements such as physical activity, diet, behavioral therapy, and informational support have been shown to be more effective in reducing children's BMI and improving body composition than single-component approaches.•Among various single-component lifestyle interventions, physical activity has proven to be the most effective.•Children with a higher baseline BMI demonstrated a significant association with a larger effect size in response to lifestyle interventions. To provide comparative evidence on the effectiveness of various lifestyle interventions on body composition management for preschool and school-aged children. PubMed (Medline), Embase, CINAHL, and Web of Science were systematically searched for this network meta-analysis. Randomized controlled studies (RCTs) that included children aged 4–12 years with no physical or mental conditions; performed at least 1 type of lifestyle intervention; reported change in body mass index (BMI), BMI z-score, or body fat percentage (BFP); and were published between January 2010 and August 2023 were included. The final analysis included 91 RCTs with aggregate data for 58,649 children. All interventions were categorized into single-arm approaches (physical activity, diet, behavioral and informational support) and combined arms approaches (bicomponent and multicomponent treatment). Multicomponent treatment showed significant effectiveness on the reduction of BMI (mean deviation (MD) = 0.49, 95% confidence interval (95%CI): –0.88 to –0.12), BMI z-score (MD = –0.11, 95%CI: –0.18 to –0.04), and BFP (MD = –1.69, 95%CI: –2.97 to –0.42) compared to the usual care condition. Bicomponent treatment also significantly reduced BMI (MD = –0.28, 95%CI: –0.54 to –0.04) and BMI z-score (MD = –0.07, 95%CI: –0.12 to –0.02) compared to usual care. Interventions targeting multiple lifestyle components achieved greater reductions in children's BMI and BFP. Among single-component approaches, physical activity engagement emerged as the most effective. These findings should guide practitioners in recommending comprehensive lifestyle modifications for children. Moreover, children with higher initial BMI and body fat levels tend to exhibit more positive responses to lifestyle interventions aimed at managing obesity. [Display omitted]