A systematic review of psychometric scales that assess familial, lifestyle, and behavioural factors for children living with overweight or obesity, or at risk of developing obesity

Over the past four decades, global childhood obesity rates have risen significantly. Modifiable factors such as diet, physical activity, family dynamics, and screen time play an important role in childhood obesity and are often targeted in interventions. However, no comprehensive review of instruments assessing these factors has been published, prompting this study. A systematic review following PRISMA guidelines was conducted to identify validated multidimensional lifestyle assessment instruments (defined as those assessing at least two constructs) for children aged 2-12 years living with overweight or obesity. Four databases (Pubmed, PsychINFO, CINAHL, and Embase) were searched for studies from 1980 to 2024. First, 7844 studies were screened by title and abstract by two independent reviewers. The resultant 141 full-text studies were also independently reviewed by 2 reviewers. Study quality was assessed and data on psychometric properties were extracted. Thirteen papers covering eight instruments were included: Healthy Kids (Niños Sanos), Family Health Behaviour Scale, Lifestyle Behaviour Checklist, Family Nutrition Physical Activity screening tool, Family Eating and Activity Habits Questionnaire, Home Environment Survey, Child Obesity Risk Questionnaire 2-5, and Energy Retention Behaviour Scale for Children. These instruments assessed various factors, including diet, mealtime routines, physical activity, sedentary behaviour, sleep, parental beliefs and the home environment. The instruments showed significant heterogeneity, with no single instrument covering the entire 2-12 years age range or measuring the same constructs comprehensively. The quality of the reviewed studies varied, particularly in the range of psychometric properties examined. Based on the results of this review, there is no one measure shown to be validated specifically for children living with overweight/obesity that addresses a broad range of domains that respond to change over time.Level II: Evidence obtained from well-designed controlled trials without randomisation.