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Recommendations Summary

Pediatric Weight Management (PWM) Nutrition Prescription in the Treatment of Pediatric 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.


  • Recommendation(s)

    PWM: Nutrition Prescription

    A nutrition prescription should be formulated as part of the dietary intervention in a multi-component pediatric weight-management program. The exact specification of nutrients and energy is often translated into a specific eating plan. Nutrition interventions are selected based on the nutrition prescription. Research shows that when an individualized nutrition prescription is included, improvements in weight status in children and adolescents are consistent. When an individualized nutrition prescription is not included, results are less consistent.

    Rating: Strong
    Imperative

    • Risks/Harms of Implementing This Recommendation

      None.

    • Conditions of Application

      The patient's or client’s individualized recommended dietary intake of energy and selected foods or nutrients should be based on current reference standards and dietary guidelines and the patient's or client's health condition and nutrition diagnosis.

      Before starting a prescribed diet plan that will be hypocaloric, the child or adolescent should have a complete medical exam performed by a qualified medical provider, who should also approve of the child or adolescent being placed on this individualized diet.

      To be able to provide a prescribed diet plan, the registered dietitian needs to have accurate measurements of height and weight. The registered dietitian should be familiar with ways of estimating energy needs of children and adolescents who suffer from pediatric overweight or pediatric obesity. Whenever possible, direct measurement of energy requirements should be obtained through indirect calorimetry, although this technique may not be readily available to most dietitians (see Determining Energy Needs in Overweight Children and Adolescents).

      The prescribed diet plan should be discussed with the child as well as his or her caregivers, and the family’s habits as well as any cultural or religious restrictions should be taken into account when prescribing dietary changes.

      Close follow-up of the child or adolescent is essential when prescribing an individualized diet plan, with scheduled visits with the registered dietitian to discuss progress and measure weight. Depending on the child's or adolescent’s progress, changes should be made to the prescribed diet plan.

    • Potential Costs Associated with Application

      Designing, providing and following-up on a prescribed diet plan will require additional time from the registered dietitian, thus adding to the cost of the program. This additional time and costs may stress the budget of existing programs.

      If program costs are passed on directly to patients, this may limit access for patients and their families who do not have health insurance coverage.

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

    • Recommendation Narrative

      The majority of research identified on multi-component weight-management programs for children and adolescents appeared to include individualized dietary recommendations (that is, dietary recommendations which were based on differences in sex, age, weight, etc.).

      • When both a decrease as well as stabilization in weight status are taken together as positive outcomes, the large majority of the 39 studies analyzed indicates that a prescribed diet plan is associated with positive outcomes in children ages six to 12. Research on adiposity outcomes one year or more from post-treatment indicate that the use of a prescribed a diet plan is associated with longer-term improvement in adiposity outcomes (Grade I).
      • All seven studies (13 treatment arms) of outcomes with adolescents indicate that the use of a prescribed diet plan is associated with positive longer-term outcomes, with the majority of treatment arms demonstrating a longer-term (more than one year) decrease in adiposity (Grade I).

    • Recommendation Strength Rationale

      The evidence for positive outcomes was much stronger when a prescribed diet plan was used (Grade I for both children and adolescents). In contrast, the evidence of the effectiveness of diet interventions that did not include prescribed diet plans (but only nutrition education) was weak (Grade III for children and Grade II for adolescents).

    • Minority Opinions

      None.