Recommendations Summary
PWM: Length of Treatment 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.
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Recommendation(s)
PWM: Length of Treatment in Multicomponent Pediatric Weight Management Interventions
The registered dietitian nutritionist (RDN) should ensure the multi-component pediatric weight management intervention is at least six months in duration. Research indicates that shorter term (less than six months) interventions were not consistently associated with positive weight status at 12 months. At least six months of treatment was associated with longer-term positive weight status outcomes, especially when group pediatric weight management sessions were included and it occurred in a clinic.
Rating: Fair
Imperative-
Risks/Harms of Implementing This Recommendation
There are no risks or harms associated with the application of this recommendation.
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Conditions of Application
- The number of treatment sessions and duration of each session within a given time period may vary. The optimal model for frequency and duration of a single session could not be determined, as interventions varied widely.
- The length of treatment sessions and the frequency and duration of each session may impact regular participation
- The RDN should be aware of and refer to community resources and programs to support pediatric weight management.
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Potential Costs Associated with Application
- The costs and resources required are dependent upon the duration of intervention
- The duration, frequency or length of sessions may require addition costs to parents, such as costs related to child care for other family members or lost wages if a parent must take time off from work to attend sessions.
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Recommendation Narrative
Length of Treatment 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 nonrandomized 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 months months vs. less than months
- Whether the intervention was intensive multi-component in contrast to minimal or no intervention.
Length of Treatment in Pediatric Weight Management- Consistency: Length of treatment of at least 6 months (≥6 months) was consistently associated with positive weight status outcomes—though this consistency was weak. The majority of configurations consistent with positive weight status outcomes at both 6 and 12 months did not include treatment ≥6 months as a component. Treatment <6 months was present in one configuration consistently associated with positive outcomes at 6 months, but, in contrast, was also consistently associated with negative weight status outcomes in two configurations at 12 months. Treatment lasting at least 6 months is consistent with positive weight status outcomes under limited conditions, but does not appear to be consistently associated with negative weight status outcomes under any conditions. In contrast, treatment lasting <6 months is consistently associated with shorter term positive weight status outcomes under limited conditions, and more consistently associated with negative weight status outcomes in longer time periods.
- Coverage: At 12 months, length of treatment of at least 6 months was included in 61% of arms (n=11) in configurations with consistent positive weight status outcomes, and in 62% (n=18) of all arms with positive weight status outcomes. Thus, length of treatment ≥6 months was in slightly over half arms and configurations with positive outcomes: coverage was moderate.
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Recommendation Strength Rationale
Conclusion statement is Grade II.
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Minority Opinions
None.
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Risks/Harms of Implementing This Recommendation
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Supporting Evidence
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).
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References
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.
Wilfley D, Stein R, Saelens B, Mockus D, Matt G, Hayden-Wade H, Welch R, Schechtman K, Thompson P, Epstein L.. Efficacy of maintenance treatment approaches for childhood overweight: A randomized controlled trial. JAMA. 2007; 298:1661-1673.
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
None.
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References