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Recommendations Summary

PWM: Sessions 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: Group Sessions in Multicomponent Pediatric Weight Management Interventions

    The registered dietitian nutritionist (RDN) can include group sessions and family participation as part of the multi-component pediatric weight management interventions. Multi-component intensive interventions that included group pediatric weight management sessions and included family participation were consistently associated with shorter-term (six-month) and longer-term (12-month) positive weight status outcomes.   

    Rating: Fair
    Imperative

    PWM: Individual Sessions in Multicomponent Pediatric Weight Management Interventions

    The registered dietitian nutritionist (RDN) can include individual sessions as part of the multi-component pediatric weight management intervention. Treatment that relied exclusively on individual pediatric weight management sessions with or without family participation was associated with shorter-term positive weight status outcomes. Information about the longer-term impact on weight status are mixed. 

    Rating: Fair
    Imperative

    • Risks/Harms of Implementing This Recommendation

      Group pediatric weight management sessions conducted in school settings may lead to stigmatization of some children and teens (Barlow, 2007).

    • Conditions of Application

      • Organizational barriers may include lack of space to conduct counseling and for physical activity (indoor and outdoor)
      • Group options will vary by program and participant needs
      • For additional conditions of application regarding family involvement, see the following recommendation: PWM: Family Participation in Multi-component Pediatric Weight Management
      • The RDN should be aware of and refer to community resources and programs to support pediatric weight management.

    • Potential Costs Associated with Application

      Both individual and group interventions have different costs and resources associated with them.
       

    • Recommendation Narrative

      Sessions 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 the 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. 

      Sessions in Multi-component Pediatric Weight Management
      • Consistency: Including group pediatric weight management sessions in the configuration of treatment components was consistent with positive weight status outcomes at both six months and 12 months. Including only individual pediatric weight management sessions was consistent with positive weight status outcomes in one configuration at six months and consistent with one with negative weight status outcomes in one of three configurations at 12 months. There were no configurations that included group sessions consistent with negative outcomes. Thus, including group sessions as part of a multi-component pediatric weight management intervention is consistent with positive weight status outcomes. In contrast, individual only treatment may be consistent with either positive or negative weight status outcomes dependent on other components in the configuration.
      • Coverage: At 12 months, group sessions were included in 83% of arms (N=15) in configurations with consistent positive weight status outcomes, and 79% (N=23) of all arms with positive weight status outcomes. Thus, group sessions included in the majority of both arms and configurations with positive outcomes. Coverage was high.

    • Recommendation Strength Rationale

      Conclusion statement is Grade II.

    • Minority Opinions

      None.