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Recommendations Summary

PWM: Treatment Setting 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: Treatment Setting in Multicomponent Pediatric Weight Management Interventions

    The registered dietitian nutritionist (RDN) can provide multi-component pediatric weight management interventions either within the clinic or outside the clinic setting. Research indicates that positive weight status outcomes occur in either setting, especially when the interventions are multi-component, include group pediatric weight management sessions and have family involvement.

    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/outdoor)
      • The RDN should be aware of and refer to community resources and programs to support pediatric weight management. 

    • Potential Costs Associated with Application

      Both within clinic and outside the clinic settings have different costs and resources associated with them, including clinical and non-clinical space.

    • Recommendation Narrative

      Treatment Settings 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 neutral quality 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. 

      Treatment Settings in Multi-component Pediatric Weight Management
      • Consistency: Delivering treatment within a clinic setting was not consistently associated with positive weight status outcomes, especially at 12 months. That is, whether clinic-only treatment was associated with positive or negative weight status outcomes depended on its combination with other components. Treatment outside a clinic was consistent with positive weight status outcomes in one configuration at six months. There were no configurations that occurred outside a clinic consistent with negative outcomes. Treatment in a clinic-only setting is not consistently associated with positive weight status outcomes. Thus, the association between clinic-only treatment and weight status outcomes is complex, depending on the presence of other treatment components. In contrast, treatment outside a clinic is not consistent with negative outcomes in the configuration and is consistent with positive weight status outcomes at 12 months in one configuration of treatment components.
      • Coverage: At 12 months, treatment in a clinic-only setting was included in 83% of arms (N=15) in configurations with consistent positive weight status outcomes, and 13% of arms consistent with negative weight status outcomes. Clinic-only treatment was present in 79% (N=23) of all arms with positive weight status outcomes. Thus, clinic-only treatment was present 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.