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.
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.
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.
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.
- 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.
- 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).
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.
- Risks/Harms of Implementing This Recommendation
The recommendations were created from the evidence analysis on the following questions. To see detail of the evidence analysis, click the blue hyperlinks below (recommendations rated consensus will not have supporting evidence linked).
Berkowitz R, Fujioka K, Daniels S, Hoppin A, Owen S, Perry A, Sothern M, Renz C, Pirner M, Walch J, Jasinsky O, Hewkin A, Blakesley V.. Effects of sibutramine treatment in obese adolescents: A randomized trial. Annals of Internal Medicine. 2006; 145:81-90.
Berkowitz R, Wadden T, Gehrman C, Bishop-Gilyard C, Moore R, Womble L, Cronquist J, Trumpikas N, Levitt Katz L, Xanthopoulos M. Meal replacements in the treatment of adolescent obesity: a randomized controlled trial. Obesity (Silver Spring, MD) 2011; 19:1,193-1,199
Budd G, Hayman L, Crump E, Pollydore C, Hawley K, Cronquist J, Berkowitz R. Weight loss in obese African American and Caucasian adolescents: secondary analysis of a randomized clinical trial of behavioral therapy plus sibutramine. The Journal of Cardiovascular Nursing. 2007; 22:288-296
Chanoine J, Richard M.. Early weight loss and outcome at one year in obese adolescents treated with orlistat or placebo. International Journal of Pediatric Obesity (IJPO: an official journal of the International Association for the Study of Obesity). 2011; 6:95-101.
Coppins D, Margetts B, Fa J, Brown M, Garrett F, Huelin S.. Effectiveness of a multi-disciplinary family-based programme for treating childhood obesity (the Family Project). European Journal of Clinical Nutrition. 2011; 65:903-909.
Díaz R, Esparza-Romero J, Moya-Camarena S, Robles-Sardín A, Valencia M.. Lifestyle intervention in primary care settings improves obesity parameters among Mexican youth. Journal of the American Dietetic Association. 2010; 110:285-290.
Ford A, Bergh C, Södersten P, Sabin M, Hollinghurst S, Hunt L, Shield J.. Treatment of childhood obesity by retraining eating behaviour: Randomised controlled trial. BMJ. 2010; 340:b5388
Garipagaoglu M, Sahip Y, Darendeliler F, Akdikmen O, Kopuz S, Sut N.. Family-based group treatment vs. individual treatment in the management of childhood obesity: Randomized, prospective clinical trial. European Journal of Pediatrics. 2009; 168:1091-1099.
Hughes A, Stewart L, Chapple J, McColl J, Donaldson M, Kelnar C, Zabihollah M, Ahmed F, Reilly J.. Randomized, controlled trial of a best-practice individualized behavioral program for treatment of childhood overweight: Scottish Childhood Overweight Treatment Trial (SCOTT). Pediatrics. 2008; 121:e539-e546.
Jelalian E, Lloyd-Richardson E, Mehlenbeck R, Hart C, Flynn-O'Brien K, Kaplan J, Neill M, Wing R.. Behavioral weight control treatment with supervised exercise or peer-enhanced adventure for overweight adolescents. The Journal of Pediatrics. 2010; 157:923-928.e1.
Jiang J, Xia X, Greiner T, Lian G, Rosenqvist U.. A two-year family based behaviour treatment for obese children. Archives of Disease in Childhood. 2005; 90:1235-1238.
Johnston C, Tyler C, Palcic J, Stansberry S, Gallagher M, Foreyt J.. Smaller weight changes in standardized body mass index in response to treatment as weight classification increases. The Journal of Pediatrics. 2011; 158:624-627.
Kalarchian M, Levine M, Arslanian S, Ewing L, Houck P, Cheng Y, Ringham R, Sheets C, Marcus M. Family-based treatment of severe pediatric obesity: randomized, controlled trial. Pediatrics. 2009; 124:1,060-1,068
Klesges R, Obarzanek E, Kumanyika S, Murray D, Klesges L, Relyea G, Stockton M, Lanctot J, Beech B, McClanahan B, Sherrill-Mittleman D, Slawson D.. The Memphis Girls' Health Enrichment Multi-site Studies (GEMS): An evaluation of the efficacy of a two-year obesity prevention program in African American girls. Archives of Pediatrics and Adolescent Medicine. 2010; 164:1007-1014.
Magarey A, Perry R, Baur L, Steinbeck K, Sawyer M, Hills A, Wilson G, Lee A, Daniels L.. A parent-led family-focused treatment program for overweight children aged 5 to 9 years: The PEACH RCT. Pediatrics. 2011; 127:214-222.
Nemet D,Barkan S,Epstein Y,Friedland O,Kowen G,Eliakim A. Short- and long-term beneficial effects of a combined dietary-behavioral-physical activity intervention for the treatment of childhood obesity. Pediatrics 2005; 115:e443-9
Nowicka P, Lanke J, Pietrobelli A, Apitzsch E, Flodmark C. Sports camp with six months of support from a local sports club as a treatment for childhood obesity. Scandinavian Journal of Public Health. 2009; 37:793-800
O'Brien P, Sawyer S, Laurie C, Brown W, Skinner S, Veit F, Paul E, Burton P, McGrice M, Anderson M, Dixon J.. Laparoscopic adjustable gastric banding in severely obese adolescents: A randomized trial. JAMA. 2010; 303:519-526.
Okely A, Collins C, Morgan P, Jones R, Warren J, Cliff D, Burrows T, Colyvas K, Steele J, Baur L. Multi-site randomized controlled trial of a child-centered physical activity program, a parent-centered dietary-modification program, or both in overweight children: the HIKCUPS study. The Journal of Pediatrics 2010; 157:388-394, 394.e1.
Pedrosa C, Oliveira B, Albuquerque I, Simões-Pereira C, Vaz-de-Almeida M, Correia F.. Metabolic syndrome, adipokines and ghrelin in overweight and obese schoolchildren: Results of a one-year lifestyle intervention programme. European Journal of Pediatrics. 2011; 170:483-492.
Reinehr T, de Sousa G, Toschke A, Andler W.. Long-term follow-up of cardiovascular disease risk factors in children after an obesity intervention. The American Journal of Clinical Nutrition. 2006; 84:490-496.
Reinehr T,Kleber M,Toschke A. Lifestyle intervention in obese children is associated with a decrease of the metabolic syndrome prevalence. Atherosclerosis 2009; 207:174-80
Robinson T, Matheson D, Kraemer H, Wilson D, Obarzanek E, Thompson N, Alhassan S, Spencer T, Haydel K, Fujimoto M, Varady A, Killen J.. A randomized controlled trial of culturally tailored dance and reducing screen time to prevent weight gain in low-income African American girls: Stanford GEMS. Archives of Pediatrics and Adolescent Medicine. 2010; 164:995-1004.
Sacher P, Kolotourou M, Chadwick P, Cole T, Lawson M, Lucas A, Singhal A.. Randomized controlled trial of the MEND program: A family-based community intervention for childhood obesity. Obesity (Silver Spring, Md.). 2010; 18:S62-568.
Savoye M, Nowicka P, Shaw M, Yu S, Dziura J, Chavent G, O'Malley G, Serrecchia J, Tamborlane W, Caprio S. Long-term results of an obesity program in an ethnically diverse pediatric population. Pediatrics 2011; 127:402-410
Shalitin S,Ashkenazi-Hoffnung L,Yackobovitch-Gavan M,Nagelberg N,Karni Y,Hershkovitz E,Loewenthal N,Shtaif B,Gat-Yablonski G,Phillip M. Effects of a twelve-week randomized intervention of exercise and/or diet on weight loss and weight maintenance, and other metabolic parameters in obese preadolescent children. Hormone research 2009; 72:287-301
Stice E, Marti C, Spoor S, Presnell K, Shaw H.. Dissonance and healthy weight eating disorder prevention programs: Long-term effects from a randomized efficacy trial. Journal of Consulting and Clinical Psychology. 2008; 76:329-340.
Tjønna A, Stølen T, Bye A, Volden M, Slørdahl S, Odegård R, Skogvoll E, Wisløff U.. Aerobic interval training reduces cardiovascular risk factors more than a multitreatment approach in overweight adolescents. Clinical Science. 2009; 116:317-326.
Wake M, Baur L, Gerner B, Gibbons K, Gold L, Gunn J, Levickis P, McCallum Z, Naughton G, Sanci L, Ukoumunne O.. Outcomes and costs of primary care surveillance and intervention for overweight or obese children: The LEAP 2 randomised controlled trial. BMJ. 2009; 339:b3308.
Weigel C, Kokocinski K, Lederer P, Dötsch J, Rascher W, Knerr I.. Childhood obesity: Concept, feasibility, and interim results of a local group-based, long-term treatment program. Journal of Nutrition Education and Behavior. 2008; 40:369-373.
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Wilson D, Abrams S, Aye T, Lee P, Lenders C, Lustig R, Osganian S, Feldman H.. Metformin extended release treatment of adolescent obesity: A 48-week randomized, double-blind, placebo-controlled trial with 48-week follow-up. Archives of Pediatrics and Adolescent Medicine. 2010; 164:116-123.
References not graded in Academy of Nutrition and Dietetics Evidence Analysis Process
Barlow SE; Expert Committee. Expert committee recommendations regarding the prevention, assessment, and treatment of child and adolescent overweight and obesity: Summary report.
Pediatrics. 2007 Dec; 120(Suppl 4): S164-S192. PMID: 18055651.