Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Mar 20, 2026
Date Accepted: Oct 13, 2026
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Effects of Parent-Involved Digital Health Interventions on Adiposity-related Outcomes and Behaviors in Overweight/Obese Children and Adolescents: A Systematic Review and Meta-Analysis
ABSTRACT
Background:
Parental involvement in obesity interventions is considered essential for sustainable behavior change in children and adolescents with obesity, yet the effectiveness of parent-involved digital health interventions (DHIs) and the influence of different delivery modalities remain unclear.
Objective:
This study aimed to synthesiz the effects of parent-involved DHIs on adiposity-related outcomes and behaviors and explored potential moderators.
Methods:
Nine databases were searched from inception to December 2025 to identify eligible randomized controlled trials (RCTs). Primary outcomes were adiposity-related outcomes such as BMI; secondary outcomes were adiposity-related behaviors including dietary behavior, physical activity, and sedentary behavior. Standardized mean differences (SMDs, Hedges’ g) on primary outcomes were pooled using random-effects models. Prespecified subgroup analyses examined DHI delivery modalities and parental involvement strategies. Secondary outcomes were synthesized narratively. Risk of bias was assessed using the revised Cochrane Risk of Bias tool for randomized trials (RoB 2), and certainty of evidence was evaluated using Grading of Recommendations Assessment, Development and Evaluation (GRADE).
Results:
Twenty-nine RCTs (4192 participants) were included, of which 22 contributed to meta-analysis. Parent-involved DHIs produced a small but statistically significant reduction in BMI outcomes compared with controls (SMD=–0.17, 95% CI: –0.29 to –0.04; P=.009; I²=51%). When stratified by control type, the pooled effect remained significant in trials using inactive controls (SMD=–0.15, 95% CI: –0.25 to –0.04; P=.006; I²=0%) but not in trials using active controls (SMD=–0.23, 95% CI: –0.47 to 0.01; P=.06; I²=70%). Subgroup differences on DHI delivery modalities and parental involvement strategies were not statistically significant. For adiposity-related behaviors, significant improvements were reported in 5 of 16 trials for dietary behaviors, 2 of 17 for physical activity, and 2 of 12 for sedentary behavior. Risk of bias was generally low to moderate, and overall certainty of evidence for BMI outcomes was low.
Conclusions:
There is low evidence supporting that parent-involved DHIs may improve BMI outcomes for pediatric overweight and obesity when compared to inactive controls. However, evidence for changes in adiposity-related behaviors remains limited. Future research should refine these interventions to identify optimal strategies and confirm their effectiveness. Clinical Trial: PROSPERO CRD420251239829. https://www.crd.york.ac.uk/PROSPERO/view/CRD420251239829
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