• Grade I means there is Good/Strong evidence supporting the statement;
• Grade II is Fair;
• Grade III is Limited/Weak;
• Grade IV is Expert Opinion Only;
• Grade V is Not Assignable.
• High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
• Moderate (B) means we are moderately confident in the effect estimate;
• Low (C) means our confidence in the effect estimate is limited;
• Very Low (D) means we have very little confidence in the effect estimate.
• Ungraded means a grade is not assignable.

• Detail
• Quality Rating Summary
  For a summary of the Quality Rating results, click here.
• Worksheets
  • Brown R, Sothern M, Suskind R, Udall J, Blecker U. Racial differences in the lipid profiles of obese children and adolescents before and after significant weight loss. Clinical Pediatrics 2000; 39: 427-431.
  • Figueroa-Colon R, von Almen TK, Franklin FA, Schuftan C, Suskind RM. Comparison of two hypocaloric diets in obese children. Am J Dis Child. 1993 Feb;147(2):160-6.
  • Sothern, M., Hunter, S., Suskind R., Brown, R., Udall, J. and Blecker, U. Motivating the obese child to move: the role of structured exercise in pediatric weight management. Southern Medical Journal 1999; 92: 577-584.
  • Sothern, M., Despinasse, B., Brown, R., Suskind, R., Udall, J. and Blecker, U. Lipid profiles of obese children and adolescents before and after significant weight loss: differences according to sex. Southern Medical Journal 2000; 93: 278-282.
  • Sothern, M., Loftin, M., Udall, J., Suskind R., Ewing, T., Tang, S., & Blecker, U. Safety, feasibility and efficacy of a resistance training program in preadolescent obese children. American Journal of the Medical Sciences, 2000; 319: 370-375. 
  • Sothern, M., Schumacher, H., von Almen, T., Carlisle, L., & Udall, J. Committed to Kids: an integrated, four level team approach to weight management in adolescents. Journal of the American Dietetic Association 2002;102:S81-S85.
  • Sothern, M., Udall, J. Suskind, R., Vargas, A., & Blecker, U. Weight loss and growth velocity in obese children after very low calorie diet, exercise and behavior modification. Acta Paediatrica, 2000; 89(9): 1036-43.

There is insufficient evidence to determine whether the short-term use of protein-sparing modified-fast diets preserve fat-free body mass in children any more or less effectively than balanced macronutrient diets at the same energy intake level.

• Grade I means there is Good/Strong evidence supporting the statement;
• Grade II is Fair;
• Grade III is Limited/Weak;
• Grade IV is Expert Opinion Only;
• Grade V is Not Assignable.
• High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
• Moderate (B) means we are moderately confident in the effect estimate;
• Low (C) means our confidence in the effect estimate is limited;
• Very Low (D) means we have very little confidence in the effect estimate.
• Ungraded means a grade is not assignable.

• Detail
• Quality Rating Summary
  For a summary of the Quality Rating results, click here.
• Worksheets
  • Figueroa-Colon R, von Almen TK, Franklin FA, Schuftan C, Suskind RM. Comparison of two hypocaloric diets in obese children. Am J Dis Child. 1993 Feb;147(2):160-6.
  • Sothern, M., Loftin, M., Udall, J., Suskind R., Ewing, T., Tang, S., & Blecker, U. Safety, feasibility and efficacy of a resistance training program in preadolescent obese children. American Journal of the Medical Sciences, 2000; 319: 370-375. 
  • Sothern, M., Udall, J. Suskind, R., Vargas, A., & Blecker, U. Weight loss and growth velocity in obese children after very low calorie diet, exercise and behavior modification. Acta Paediatrica, 2000; 89(9): 1036-43.

There is insufficient evidence to determine whether or not high-protein, low-carbohydrate, very-low-calorie diets provide a greater level of satiety for children in weight loss programs than balanced macronutrient diets at the same level of energy intake.

• Grade I means there is Good/Strong evidence supporting the statement;
• Grade II is Fair;
• Grade III is Limited/Weak;
• Grade IV is Expert Opinion Only;
• Grade V is Not Assignable.
• High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
• Moderate (B) means we are moderately confident in the effect estimate;
• Low (C) means our confidence in the effect estimate is limited;
• Very Low (D) means we have very little confidence in the effect estimate.
• Ungraded means a grade is not assignable.

• Detail
• Quality Rating Summary
  For a summary of the Quality Rating results, click here.
• Worksheets
  • Figueroa-Colon R, von Almen TK, Franklin FA, Schuftan C, Suskind RM. Comparison of two hypocaloric diets in obese children. Am J Dis Child. 1993 Feb;147(2):160-6.

Using a reduced-calorie diet (over 1,200-DRI kcal per day) in the acute treatment phase of adolescent obesity is generally effective for short-term improvement in weight status. However, without continuing intervention, weight is regained.

All the studies reviewed had treatment programs lasting less than one year (three weeks to nine months) and evidence on longer-term treatment trials was not available.

• Grade I means there is Good/Strong evidence supporting the statement;
• Grade II is Fair;
• Grade III is Limited/Weak;
• Grade IV is Expert Opinion Only;
• Grade V is Not Assignable.
• High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
• Moderate (B) means we are moderately confident in the effect estimate;
• Low (C) means our confidence in the effect estimate is limited;
• Very Low (D) means we have very little confidence in the effect estimate.
• Ungraded means a grade is not assignable.

• Detail
• Quality Rating Summary
  For a summary of the Quality Rating results, click here.
• Worksheets
  • Ebbeling CB, Leidig MM, Sinclair KB, Hangen JP, and Ludwig DS. A Reduced–Glycemic Load Diet in the Treatment of Adolescent Obesity. Arch Pediatr Adolesc Med 2003;157:773-779.
  • Maffiuletti NA, De Col A, Agosti F, Ottolini S, Moro D, Genchi M, Massarini M, Lafortuna CL, Sartorio A. Effect of a 3-week body mass reduction program on body composition, muscle function and motor performance in pubertal obese boys and girls. J Endocrinol Invest. 2004 Oct;27(9):813-20.
  • Rolland-Cachera MF, Thibault H, Souberbielle JC, Soulie D, Carbonel P, Deheeger M, Roinsol D, Longueville E, Bellisle F, Serog P. Massive obesity in adolescents: dietary interventions and behaviours associated with weight regain at 2 y follow-up. Int J Obes Relat Metab Disord. 2004 Apr;28(4):514-9.
  • Saelens B, Sallis J, Wilfley D, Patrick K, Cella J, and Buchta R. Behavioral Weight Control for Overweight Adolescents Initiated in Primary Care. Obesity Research 2002;10:22-32
  • Sondike SB, Copperman N, Jacobson MS. Effects of a low-carbohydrate diet on weight loss and cardiovascular risk factor in overweight adolescents. J Pediatr 2003; 142: 253-8.
  • Wadden, T., Stunkard, A., Rich, L., Rubin, C., Sweidel, G, McKinney, S. Obesity in black adolescent girls: a controlled clinical trial of treatment by diet, behavior modification, and parental support. Pediatrics. 1990, 85(3): 345-352.

Using a low-calorie diet (900 to 1,200kcal per day) as part of a clinically supervised, multi-component weight-loss program is associated with both short-term and longer-term reduction in adiposity among six- to 12-year-old children.

• Grade I means there is Good/Strong evidence supporting the statement;
• Grade II is Fair;
• Grade III is Limited/Weak;
• Grade IV is Expert Opinion Only;
• Grade V is Not Assignable.
• High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
• Moderate (B) means we are moderately confident in the effect estimate;
• Low (C) means our confidence in the effect estimate is limited;
• Very Low (D) means we have very little confidence in the effect estimate.
• Ungraded means a grade is not assignable.

• Detail
• Quality Rating Summary
  For a summary of the Quality Rating results, click here.
• Worksheets
  • Chen W, Chen SC, Hsu HS, Lee C. Counseling clinic for pediatric weight reduction: program formulation and follow-up. J Formos Med Assoc 1997; 96 59-62.
  • Ebbeling CB, Leidig MM, Sinclair KB, Hangen JP, and Ludwig DS. A Reduced–Glycemic Load Diet in the Treatment of Adolescent Obesity. Arch Pediatr Adolesc Med 2003;157:773-779.
  • Eliakim A, Friedland O, Kowen G, Wolach B, Nemet D. Parental obesity and higher pre-intervention BMI reduce the likelihood of a multidisciplinary childhood obesity program to succeed--a clinical observation. J Pediatr Endocrinol Metab. 2004 Aug;17(8):1055-61.
  • Eliakim A, Kaven G, Berger I, Friedland O, Wolach B, Nemet D. The effect of a combined intervention on body mass index and fitness in obese children and adolescents-a clinical experience.  Eur J Pediatr. 2002; 161:449-454
  • Epstein LH, Gordy CC, Raynor HA, Beddome M, Kilanowski CK, Paluch R. Increasing fruit and vegetable intake and decreasing fat and sugar intake in families at risk for childhood obesity. Obes Res. 2001 Mar;9(3):171-8.
  • Epstein LH, Paluch RA, Gordy CC, Dorn J. Decreasing sedentary behaviors in treating pediatric obesity. Arch Pediatr Adolesc Med 2000; 154 (3):220-6.
  • Epstein LH, Paluch RA, Gordy CC, Saelens BE, Ernst MM. Problem solving in the treatment of childhood obesity.  J Consult Clin Psychol 2000;68:717-21.
  • Epstein LH, Paluch RA, and Raynor HA. Sex Differences in Obese Children and Siblings in Family-based Obesity Treatment. Obesity Research 2001;9:746-753 
  • Epstein LH, Valoski A, Wing RR, McCurley J. Ten-year follow-up of behavioral, family-based treatment for obese children. JAMA 1990; 264: 2519-2523.
  • Epstein LH, Valoski A, Wing RR, McCurley J. Ten-year outcomes of behavioral family-based treatment for childhood obesity. Health Psychology. 1994, 13:373-383.
  • Epstein LH, Valoski AM, Vara LS, McCurley J, Wisniewski L, Kalarchian MA, Klein KR, Shrager LR. Effects of decreasing sedentary behavior and increasing activity on weight change in obese children.  Health Psychol 1995;14:109-15.
  • Epstein LH, Wing RR, Koeske R, and Valoski A. Effect of parent weight on weight loss in obese children.  Journal of Consulting and Clinical Psychology.  54(3):  400-401, 1986.
  • Epstein LH, Wing RR, Koeske R, Valoski A. Effects of diet plus exercise on weight change in parents and children. Journal of Consulting and Clinical Psychology 1984; 52:429-437.
  • Epstein LH, Wing RR, Koeske R, Valoski A. A Comparison of Lifestyle Exercise, Aerobic Exercise, and Calisthenics on Weight Loss in Obese Children. Behavior Therapy 1985;16;345-56.
  • Epstein LH, Wing RR, Penner BC, Kress MJ. Effect of diet and controlled exercise on weight loss in obese children.  J Pediatr 1985;107:358-61.
  • Epstein, L, Valoski A, Kalarchian M, et al. Do children lose and maintain weight easier than adults: a comparison of child and parent weight changes from six months to ten years. Obes Res 1995; 3:411-417.
  • Figueroa-Colon R, von Almen TK, Franklin FA, Schuftan C, Suskind RM. Comparison of two hypocaloric diets in obese children. Am J Dis Child. 1993 Feb;147(2):160-6.
  • Flodmark CE, Ohlsson T, Ryden O, Sveger T. Prevention of progression to severe obesity in a group of obese schoolchildren treated with family therapy. Pediatrics 1993; 91: 880-84.
  • Golan M, Crow S. Targeting parents exclusively in the treatment of childhood obesity: long-term results. Obes Res 2004;12:357-361.
  • Golan M, Weizman A, Apter A, Fainaru M. Parents as the exclusive agents of change in the treatment of childhood obesity. Am J Clin Nutr 1998;67:1130-1135.
  • Goldfield GS, Epstein LH, Kilanowski CK, Paluch RA, Kogut-Bossler B. Cost-effectiveness of group and mixed family-based treatment for childhood obesity. Int J Obes Relat Metab Disord. 2001 Dec;25(12):1843-9.
  • Graves T, Meyers AW, Clark L. An evaluation of parental problem-solving training in the behavioral treatment of childhood obesity. Journal of Consulting and Clinical Psychology 1988; 56:246-250.
  • Levine, M., Ringham, R., Kalarchian, M., Wisniewski, L., and Marcus, M. Is family-based behavioral weight control appropriate for severe pediatric obesity? Int J Eat Disord. 2001 Nov;30(3):318-28.
  • Maffiuletti NA, De Col A, Agosti F, Ottolini S, Moro D, Genchi M, Massarini M, Lafortuna CL, Sartorio A. Effect of a 3-week body mass reduction program on body composition, muscle function and motor performance in pubertal obese boys and girls. J Endocrinol Invest. 2004 Oct;27(9):813-20.
  • Nuutinen O. Long-term effects of dietary counseling on nutrient intake and weight loss in obese children. Eur J Clin Nutr. 1991 Jun;45(6):287-97.
  • Rolland-Cachera MF, Thibault H, Souberbielle JC, Soulie D, Carbonel P, Deheeger M, Roinsol D, Longueville E, Bellisle F, Serog P. Massive obesity in adolescents: dietary interventions and behaviours associated with weight regain at 2 y follow-up. Int J Obes Relat Metab Disord. 2004 Apr;28(4):514-9.

Reduced calorie diets (over 1,200kcal-DRI) may be an effective part of a multi-component weight-management (weight-loss or weight-stabilization) program in children ages six to 12 in both the short-term and longer-term (one to two years).

• Grade I means there is Good/Strong evidence supporting the statement;
• Grade II is Fair;
• Grade III is Limited/Weak;
• Grade IV is Expert Opinion Only;
• Grade V is Not Assignable.
• High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
• Moderate (B) means we are moderately confident in the effect estimate;
• Low (C) means our confidence in the effect estimate is limited;
• Very Low (D) means we have very little confidence in the effect estimate.
• Ungraded means a grade is not assignable.

• Detail
• Quality Rating Summary
  For a summary of the Quality Rating results, click here.
• Worksheets
  • Chen W, Chen SC, Hsu HS, Lee C. Counseling clinic for pediatric weight reduction: program formulation and follow-up. J Formos Med Assoc 1997; 96 59-62.
  • Ebbeling CB, Leidig MM, Sinclair KB, Hangen JP, and Ludwig DS. A Reduced–Glycemic Load Diet in the Treatment of Adolescent Obesity. Arch Pediatr Adolesc Med 2003;157:773-779.
  • Eliakim A, Friedland O, Kowen G, Wolach B, Nemet D. Parental obesity and higher pre-intervention BMI reduce the likelihood of a multidisciplinary childhood obesity program to succeed--a clinical observation. J Pediatr Endocrinol Metab. 2004 Aug;17(8):1055-61.
  • Eliakim A, Kaven G, Berger I, Friedland O, Wolach B, Nemet D. The effect of a combined intervention on body mass index and fitness in obese children and adolescents-a clinical experience.  Eur J Pediatr. 2002; 161:449-454
  • Epstein LH, Gordy CC, Raynor HA, Beddome M, Kilanowski CK, Paluch R. Increasing fruit and vegetable intake and decreasing fat and sugar intake in families at risk for childhood obesity. Obes Res. 2001 Mar;9(3):171-8.
  • Epstein LH, Paluch RA, Gordy CC, Dorn J. Decreasing sedentary behaviors in treating pediatric obesity. Arch Pediatr Adolesc Med 2000; 154 (3):220-6.
  • Epstein LH, Paluch RA, Gordy CC, Saelens BE, Ernst MM. Problem solving in the treatment of childhood obesity.  J Consult Clin Psychol 2000;68:717-21.
  • Epstein LH, Paluch RA, and Raynor HA. Sex Differences in Obese Children and Siblings in Family-based Obesity Treatment. Obesity Research 2001;9:746-753 
  • Epstein LH, Valoski A, Wing RR, McCurley J. Ten-year follow-up of behavioral, family-based treatment for obese children. JAMA 1990; 264: 2519-2523.
  • Epstein LH, Valoski A, Wing RR, McCurley J. Ten-year outcomes of behavioral family-based treatment for childhood obesity. Health Psychology. 1994, 13:373-383.
  • Epstein LH, Valoski AM, Vara LS, McCurley J, Wisniewski L, Kalarchian MA, Klein KR, Shrager LR. Effects of decreasing sedentary behavior and increasing activity on weight change in obese children.  Health Psychol 1995;14:109-15.
  • Epstein LH, Wing RR, Koeske R, and Valoski A. Effect of parent weight on weight loss in obese children.  Journal of Consulting and Clinical Psychology.  54(3):  400-401, 1986.
  • Epstein LH, Wing RR, Koeske R, Valoski A. Effects of diet plus exercise on weight change in parents and children. Journal of Consulting and Clinical Psychology 1984; 52:429-437.
  • Epstein LH, Wing RR, Koeske R, Valoski A. A Comparison of Lifestyle Exercise, Aerobic Exercise, and Calisthenics on Weight Loss in Obese Children. Behavior Therapy 1985;16;345-56.
  • Epstein LH, Wing RR, Penner BC, Kress MJ. Effect of diet and controlled exercise on weight loss in obese children.  J Pediatr 1985;107:358-61.
  • Epstein, L, Valoski A, Kalarchian M, et al. Do children lose and maintain weight easier than adults: a comparison of child and parent weight changes from six months to ten years. Obes Res 1995; 3:411-417.
  • Figueroa-Colon R, von Almen TK, Franklin FA, Schuftan C, Suskind RM. Comparison of two hypocaloric diets in obese children. Am J Dis Child. 1993 Feb;147(2):160-6.
  • Flodmark CE, Ohlsson T, Ryden O, Sveger T. Prevention of progression to severe obesity in a group of obese schoolchildren treated with family therapy. Pediatrics 1993; 91: 880-84.
  • Golan M, Crow S. Targeting parents exclusively in the treatment of childhood obesity: long-term results. Obes Res 2004;12:357-361.
  • Golan M, Weizman A, Apter A, Fainaru M. Parents as the exclusive agents of change in the treatment of childhood obesity. Am J Clin Nutr 1998;67:1130-1135.
  • Goldfield GS, Epstein LH, Kilanowski CK, Paluch RA, Kogut-Bossler B. Cost-effectiveness of group and mixed family-based treatment for childhood obesity. Int J Obes Relat Metab Disord. 2001 Dec;25(12):1843-9.
  • Graves T, Meyers AW, Clark L. An evaluation of parental problem-solving training in the behavioral treatment of childhood obesity. Journal of Consulting and Clinical Psychology 1988; 56:246-250.
  • Levine, M., Ringham, R., Kalarchian, M., Wisniewski, L., and Marcus, M. Is family-based behavioral weight control appropriate for severe pediatric obesity? Int J Eat Disord. 2001 Nov;30(3):318-28.
  • Maffiuletti NA, De Col A, Agosti F, Ottolini S, Moro D, Genchi M, Massarini M, Lafortuna CL, Sartorio A. Effect of a 3-week body mass reduction program on body composition, muscle function and motor performance in pubertal obese boys and girls. J Endocrinol Invest. 2004 Oct;27(9):813-20.
  • Nuutinen O. Long-term effects of dietary counseling on nutrient intake and weight loss in obese children. Eur J Clin Nutr. 1991 Jun;45(6):287-97.
  • Rolland-Cachera MF, Thibault H, Souberbielle JC, Soulie D, Carbonel P, Deheeger M, Roinsol D, Longueville E, Bellisle F, Serog P. Massive obesity in adolescents: dietary interventions and behaviours associated with weight regain at 2 y follow-up. Int J Obes Relat Metab Disord. 2004 Apr;28(4):514-9.

No studies were identified that used a reduced-calorie, balanced-macronutrient intervention to treat pediatric obesity in pre-school children (ages two to five).

• Grade I means there is Good/Strong evidence supporting the statement;
• Grade II is Fair;
• Grade III is Limited/Weak;
• Grade IV is Expert Opinion Only;
• Grade V is Not Assignable.
• High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
• Moderate (B) means we are moderately confident in the effect estimate;
• Low (C) means our confidence in the effect estimate is limited;
• Very Low (D) means we have very little confidence in the effect estimate.
• Ungraded means a grade is not assignable.