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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.


  • 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.

    • 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.

    • 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.

    • 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.
      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 nonrandomized controlled trials: Nowicka et al, 2009; Reinehr et al, 2006.
      These studies were included in the analysis because they included weight status outcomes at 6 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 months months vs. less than 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 patterns were reviewed to determine whether, and under what conditions, including the above;components in the treatment mix was consistently associated with positive outcomes. 

      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.

    • Recommendation Strength Rationale

      Conclusion statement is Grade II.

    • Minority Opinions

      None.