Abstract Context Overweight and obesity among children and adolescents are increasing globally, requiring effective treatment strategies to mitigate future health risks. Objective This systematic review and meta-analysis with meta-regressions evaluated the impact of Mediterranean diet (MD)–based dietary interventions, with or without physical activity (PA), on anthropometric parameters and adherence to the MD in children and adolescents with overweight or obesity. Data Sources Scopus, PubMed/Medline, ISI/Web of Science, Embase, and Cochrane Central Register of Controlled Trials were searched as data sources for intervention studies, either designed as randomized controlled trials (RCTs) or non-RCTs. Primary outcomes were changes in body weight and body mass index (BMI); secondary outcomes included body fat, waist circumference, and adherence to the MD. Data Extraction Eighteen studies involving 1539 participants aged 2–18 years were analyzed. Nine and 2 of the included studies were RCTs and randomized trials without a control group, respectively, whereas the others were non-RCT studies without a control group. Four exclusively presented an MD-based dietary intervention without a PA addition. Data Analysis Mediterranean diet–based interventions improved BMI (effect size ES = 0.34; 95% CI, 0.13–0.56) and body fat (ES = 0.64; 95% CI, 0.19–1.08). Waist circumference changes were smaller but significant (ES = 0.22; 95% CI, 0.06–0.38). Changes in body weight (ES = 0.22; 95% CI, −0.04 to 0.48) were not significant. Combining these outcomes, the overall ES was computed at 0.42 (95% CI, 0.14-0.70). Adherence to the MD significantly increased in all studies reporting it. Interventions combining an MD and PA showed stronger effects compared with an MD alone. Conclusion Mediterranean diet–based interventions, particularly with PA, significantly improve BMI and body fat in children and adolescents with obesity, offering a promising strategy for early-life obesity management. However, high study heterogeneity and nonsignificant results in some outcomes underscore the need for more robust research. Systematic Review Registration PROSPERO registration no. CRD42020179868
Rosi et al. (Thu,) studied this question.