Recommendations Summary

Pediatric Weight Management (PWM) Optimal Length of Weight Management Therapy in Children and Adolescents

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: Optimal Length of Treatment

    During the intensive treatment phase, Medical Nutrition Therapy for pediatric obesity should last at least three months or until initial weight-management goals are achieved. Because overweight and obesity are chronic, often life-long, conditions, it is critical that a weight-management plan be implemented after the intensive phase of treatment. A greater frequency of contacts between the patient and practitioner may lead to more successful weight loss and maintenance.

    Rating: Consensus
    Imperative

    • Risks/Harms of Implementing This Recommendation

      Pediatric weight management can affect growth, development, metabolic parameters and sometimes produce unintended effects such as excessive weight loss and nutritional deficiencies. Therefore, continued monitoring by health-care professionals is warranted.

    • Conditions of Application

      None.

    • Potential Costs Associated with Application

      • If program costs are passed on directly to patients, this may limit access to the program for less affluent patients and their families
      • Absence of health insurance coverage for weight management could limit program access.

    • Recommendation Narrative

      The large majority of studies we analyzed included a treatment phase for pediatric obesity that was at least three months long. The range of length of programs varied from a few weeks to over a year. We were not able, in this phase of the project, to determine if there were any systematic differences in outcomes based on length of treatment. However, since the programs that demonstrated longer-term (more than one year) outcomes were at least three months long, we consider this the minimum general recommendation for length of time.

      In addition to the evidence analysis carried out directly for this guideline, the work group consulted two other sets of recommendations:

      Because the ADA Pediatric Weight Management Guideline focuses on treatment within the context of a multi-disciplinary program, the Expert Committee recommendations for Stage Three: Comprehensive Multidisciplinary Intervention are most relevant here:

      "Frequent office visits should be scheduled; weekly visits for a minimum of 8 to 12 weeks seem to be most efficacious (Consistent Evidence). Subsequently, monthly visits can help maintain new behaviors" (pp. S183-S184).

      Additionally, this recommendation was also made with reverence to The Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults: The Evidence Report, NIH Publication No. 98-4083, September 1998, produced by the National Heart, Lung, and Blood Institute in cooperation with the National Institute of Diabetes and Digestive and Kidney Diseases.

      Although the NHLBI guidelines for adults recommends a six-month treatment program, growth and development issues in children and adolescents argue for more flexibility in length of treatment. Also, weight loss may not be appropriate for all children, so the practitioner should use their clinical judgment when applying the NHLBI criteria.

    • Recommendation Strength Rationale

       

    • Minority Opinions

      None.