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Recommendations Summary

PWM: Family Participation in Multicomponent Pediatric Weight Management Interventions 2015

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: Family Participation in Multicomponent Pediatric Weight Management Interventions

    The registered dietitian nutritionist (RDN) should encourage family participation as an integral part of a multi-component pediatric weight management intervention for children of all ages, including teens. A strong body of research indicates that family involvement as part of a multi-component pediatric weight management intervention is highly consistent with positive weight status outcomes at both six months and 12 months.

    Rating: Strong
    Imperative

    • Risks/Harms of Implementing This Recommendation

      There are no potential risks or harms associated with the application of this recommendation.
       

    • Conditions of Application

      • The following may impact success of counseling:
        • Awareness and sensitivity to parental style in limit setting and creating healthy boundaries and ability to support child’s weight loss efforts 
        • Family dynamics (e.g., parent-child relationship, parenting techniques, parental attitude towards food and weight, etc.) 
        • Family unit differences and circumstances at home (i.e., single parent, lives part of the time with other parent) 
        • Parent or family commitment to program participation (during sessions and at home) 
        • Parent or family unable or unwilling to actively participate (i.e., no child care for younger children at home, disinterest).
      • To maximize participation, scheduling counseling during parents' off-work hours should be considered 
      • The location of counseling (distance from home or workplace), the duration and the length of sessions may affect family participation
      • The RDN should be aware of and refer to community resources and programs to support pediatric weight management.

    • Potential Costs Associated with Application

      The duration, frequency and length of sessions may require additional costs to parents such as costs related to child care for other family members or lost wages if a parent or parents must take time off from work to attend sessions.
       

    • Recommendation Narrative

      Family Participation in Multi-component Pediatric Weight Management and Weight Status Outcomes 

      A total of 32 studies were included in the treatment context multivariate analysis and provide support for this recommendation.

      Positive Quality Studies (17)

      • A total of 16 randomized controlled trials (RCTs): Budd et al, 2007; Chanoine and Richard, 2011; Díaz et al, 2010; Ford et al, 2010; Jelalian et al, 2010; Jiang et al, 2005; Klesges et al, 2010; Nemet et al, 2005; O'Brien et al, 2010; Okely et al, 2010; Robinson et al, 2010; Sacher et al, 2010; Savoye et al, 2011; Shalitin et al, 2009; Stice et al, 2008; Wilfley et al 2007
      • One randomized crossover trial: Coppins et al, 2011.
      Neutral Quality Studies (15)
      • A total of 13 RCTs: Berkowitz et al, 2006; Berkowitz et al, 2011; Garipagaoglu et al, 2009; Hughes et al, 2008; Johnston et al, 2011; Kalarchian et al, 2009; Magarey et al, 2011; Pedrosa et al, 2011; Reinehr et al, 2009; Tjønna et al, 2009; Wake et al, 2009; Weigel et al, 2008; Wilson et al, 2010
      • Two non-randomized controlled trials: Nowicka et al, 2009; Reinehr et al, 2006.
      These studies were included in the analysis because they included weight status outcomes at six months and 12 months and all six treatment characteristics below: 
      • Family involvement vs. no family involvement
      • Whether Group pediatric weight management sessions were included vs. exclusively individual pediatric weight management sessions
      • Whether the intervention was on teens only vs. children or mixed children and teens
      • Whether the intervention took place in a clinic vs. any other setting
      • The intervention lasted six or more months vs. less than six months
      • Whether the intervention was Intensive multi-component in contrast to minimal or no intervention.
      Because the effect of one component (e.g., including family involvement or treatment outside a clinic setting) may depend on the presence of other components, the analysis focused on configurations of components. In addition, consistency and coverage patterns were reviewed to determine whether, and under what conditions (including the above components in the treatment mix) was consistently associated with positive outcomes. 

      Family Participation in Multi-component Pediatric Weight Management
      • Consistency: Including family involvement as part of a multi-component pediatric weight management intervention is highly consistent with positive weight status outcomes. Multi-component pediatric weight management interventions that include family involvement were consistent with positive weight status outcomes at both six months and 12 months. Not including family involvement was consistent with negative weight status outcomes in one of three configurations at 12 months. There were no configurations that included family involvement consistent with negative outcomes and no configurations that did not include family involvement consistent with positive outcomes. Thus, including family involvement as part of a multi-component pediatric weight management intervention is highly consistent with positive weight status outcomes.
      • Coverage: At 12 months, family involvement was included in 83% of arms (N=15) in configurations with consistent positive weight status outcomes, and 90% (N=26) of all arms with positive weight status outcomes. Thus, family involvement was included in the large majority of both arms and configurations with positive outcomes. Coverage was high.

    • Recommendation Strength Rationale

      Conclusion statement is Grade I.


       

    • Minority Opinions

      None.