Pediatric Weight Management (PWM) Comprehensive, Multicomponent Weight Management Program for Treating Childhood Obesity
Click here to see the explanation of recommendation ratings (Strong, Fair, Weak, Consensus, Insufficient Evidence) and labels (Imperative or Conditional). To see more detail on the evidence from which the following recommendations were drawn, use the hyperlinks in the Supporting Evidence Section below.
PWM: Multicomponent Program
Interventions to reduce pediatric obesity should be multi-component and include diet, physical activity, nutrition counseling and parent or caregiver participation. A large body of strong research indicates that clinically supervised, multi-component weight-management programs are more successful than single component programs for short-term and longer-term (more than one year) improvement in child and adolescent obesity.
Risks/Harms of Implementing This Recommendation
Within each component area, particular risks exist that must be monitored by the appropriate professionals:
- Nutrition interventions should be monitored by a registered dietitian to ensure adequate nutrition and growth and to prevent micronutrient deficiencies (see PWM Energy Restricted Diets Recommendation)
- Intense physical activity, in some overweight and obese individuals, may contribute to disability or death. Thus, consultation with a physician prior to beginning an exercise program should be recommended (see PWM Physical Activity in the Treatment of Childhood and Adolescent Obesity Recommendation)
- Adequate screening for eating disorders, depression and family risk factors is critical (see PWM Assessing Family Climate Factors Recommendation and PWM Assessing Child and Family Diet Behaviors in Pediatric Obesity Recommendation)
- Program success is conditioned by the above factors.
Conditions of Application
Clinically supervised multi-component weight management programs require the participation of professional staff with expertise in distinct areas: Behavioral interventions, dietary interventions and physical activity interventions. Adequate screening processes are also needed to address and assess the above factors.
Organizational barriers may limit options for multi-component programs, including lack of space for physical activity and trained staff to conduct components of the intervention program.
Adequate screening for eating disorders, depression and family risk factors are necessary. Program success may be limited by the above factors.
Potential Costs Associated with Application
Costs to Program or Organization
Multi-component weight-management programs may require substantial organizational infrastructure to implement well. Organizational costs are associated with:
- Access to qualified professional staff to determine and supervise interventions
- Access to adequate clinical space and instruments for treatment.
Costs to Patient and Family
Costs of MNT sessions and reimbursement vary. The absence of health insurance coverage for weight management could limit program access.
Additionally, parent commitment to program participation is required.
Research on multi-component weight-management programs indicate strong support for:
- Including a nutrition component that includes an individualized diet prescription that promotes an energy deficit
- Including a physical activity component
- Including a behavioral intervention component.
For evidence analysis on the above topics, see the Supporting Evidence section below.
Additionally, when the focus is on children (ages six to 12), research indicates that weight management in children without parents is not effective. See, Is counseling children (ages 6 to 12) for weight loss in the absence of their parents effective? (Evidence: Grade III). Direct parent participation in weight-management programs appears to be less critical for adolescents (see Is counseling of adolescents for weight loss in the absence of their parents effective?) (Evidence: Grade II).
Weight Loss vs. Weight Stabilization
Because of growth occurring within children and adolescents, the goal of pediatric weight management programs may be weight stabilization rather than weight loss. Research indicates that weight stabilization in children and adolescents may be associated with improvements in BMI and other measures of adiposity.
Goals for weight status should be individualized for the child. While weight loss may be appropriate in some cases, weight stabilization in growing children and adolescents may be more appropriate.
Recommendation Strength Rationale
Research comparing the inclusion of each of the three program components (dietary, physical activity and behavioral interventions) consistently show improved outcomes in both short-term and longer-term improvement in child and adolescent adiposity.
- Risks/Harms of Implementing This Recommendation
The recommendations were created from the evidence analysis on the following questions. To see detail of the evidence analysis, click the blue hyperlinks below (recommendations rated consensus will not have supporting evidence linked).
In children ages 6-12, what is the effectiveness of using balanced macronutrient, low calorie (900-1200 kcal per day) dietary interventions for treating childhood obesity?
In children ages 6-12, what is the effectiveness of using balanced macronutrient, reduced calorie (>1200 kcal-DRI per day) dietary interventions for treating childhood obesity?
In adolescents, what balanced macronutrient dietary interventions are effective in treating obesity?
What is the effectiveness of using a program to increase physical activity as a part of an intervention program to treat childhood obesity?
What is the effectiveness of using a program to decrease sedentary behaviors as a part of an intervention program to treat childhood obesity?
What is the effectiveness of using behavioral counseling as part of a multicomponent pediatric weight management program to treat childhood obesity?
What is the effectiveness of family-based counseling including parent training or modeling as part of a multicomponent pediatric weight management program to treat obesity in children (ages 6-12)?
What is the effectiveness of family-based counseling including parent training or modeling as part of a multicomponent pediatric weight management program to treat obesity in adolescents (ages 13-18)?
References not graded in Academy of Nutrition and Dietetics Evidence Analysis Process
Links to supporting recommendations and evidence are located in Recommendation Narrative.