This is a somewhat older review but still very relevant published by Reilly and McDowell in the Proceedings of the Nutrition Society in 2003.
The emergence of the childhood obesity epidemic, was not apparent in the UK until 1999.
Interventions for prevention and treatment of childhood obesity typically target increases in physical activity and. more recently, reductions in physical inactivity (sedentary behaviour such as television viewing). However, the evidence base for such strategies is extremely limited. Randomised controlled trials that targeted activity or inactivity, that followed up children or adolescents for at least 1 year and that included an objective weight-related outcome measure were included.
The evidence base has increased markedly since the completion of earlier reviews, although high-quality evidence is still lacking. This position reflects a combination of factors; limitations in trial design before the advent of the Cochrane and CONSORT processes; the major difficulties (methodological, financial, practical, ethical) presented by carrying out long-term research in this area.
The evidence on childhood obesity prevention is not encouraging, although promising targets for prevention are now clear, notably reduction in sedentary behaviour.
There is stronger evidence that targeting activity and/or inactivity might be effective in paediatric obesity treatment, but doubts as to interventions, and the clinical relevance of the interventions is unclear..
A number of previous studies have noted the possibility that the large-scale changes in society that have driven the obesity epidemic may be beyond the reach of interventions aimed only at the family or school environment
Large-scale policy or strategic initiatives, employing macroenvironmental or “ecological’ approaches, may be essential if the public health impact of the childhood obesity epidemic is to be addressed However, any such initiatives should also be evidence based and should be evaluated rigorously
Reilly and McDowell 2003 Physical activity interventions in the prevention and treatment of paediatric obesity: systematic review and critical appraisal Proceedings of the Nutrition Society vol 62 pp 611-619

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