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Recommendations Summary

Pediatric Weight Management (PWM) Coordination of Care in Pediatric Weight Management

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.


  • Recommendation(s)

    PWM: Coordination of Care

    The dietitian should collaborate with members of the health-care team (as available) in planning and implementing behavior, physical activity and adjunct therapy strategies. Effective multi-component pediatric weight management interventions benefit from the diverse expertise of different health-care professionals.

    Rating: Consensus
    Imperative

    • Risks/Harms of Implementing This Recommendation

      Within each component area, particular risks exist that must be monitored by the appropriate professionals:

    • 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
        • Physical activity interventions
        • In some cases, pharmacological or surgical interventions.
      • To provide a multi-component weight-management intervention, the RD may need to establish a practice network with other health-care professionals with complementary expertise
      • 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 is critical for success
      • Program success is conditioned by the above factors.

    • Potential Costs Associated with Application

      Multi-component weight-management programs may require a substantial organizational infrastructure to be implemented 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.

      If organizational and program costs are passed on to participants, this could limit program access. Additionally, parent commitment to program participation is required.

      Absence of health insurance coverage for weight management could limit program access.

    • Recommendation Narrative

      Multi-Component Program

      Research on multi-component weight-management programs indicate strong support for:

      • Including a nutrition component that includes an individualized diet prescription to promotes an energy deficit
      • Including a physical activity component
      • Including a behavioral intervention component.

      To see the evidence analysis on the above pediatric weight management components, 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. Direct parent participation in weight-management programs appears to be less critical for adolescents (see Pediatric Weight Management (PWM) Family Participation in Treating Pediatric Obesity in Children and Adolescents).

    • Recommendation Strength Rationale

      Research is strongly in support of the effectiveness of a multi-component pediatric weight-management program. None of the research analyzed indicated that interventions were carried out exclusively by a single health-care professional.

      Research comparing the inclusion of each of the three program components (dietary, physical activity and behavioral interventions) consistently shows improved outcomes in both short-term and longer-term child and adolescent adiposity. ADA Evidence Category Grade I (six- to 12-year-olds) and Grade II (adolescents, 13 to 18 years old).

    • Minority Opinions

      None.