PWM: Multicomponent Interventions (2015)
-
Intervention
What is the effectiveness of multi-component pediatric weight management interventions to treat overweight in children and teens?
-
Conclusion
Multi-component weight management interventions that include diet or nutrition [including medical nutrition therapy (MNT)], physical activity and behavioral components and involve a registered dietitian nutritionist (RDN) or psychologist or mental health provider are more likely to be effective in treating overweight in children and teens, compared to interventions that are missing at least one of these major components.
Multi-component interventions were associated with shorter-term (six months) and longer-term (two years) decreases in body mass index (BMI) and BMI Z-scores for all age categories. Conversely, the absence of one or more of these components was associated with in an increase in BMI measures in the longer term. Shorter-term and longer-term BMI-Z scores were reduced with both types of interventions. However, significantly greater reduction was reported in the multi-component interventions. BMI percentile reductions at six months were also observed in the multi-component interventions, but were reported in fewer studies.
-
Grade: I
- 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.
-
Evidence Summary: What is the effectiveness of multi-component pediatric weight management interventions to treat overweight in children and teens?
- Detail
- Quality Rating Summary
For a summary of the Quality Rating results, click here.
- Worksheets
- Adam S, Westenhofer J, Rudolphi B, Kraaibeek H. Effects of a combined inpatient-outpatient treatment of obese children and adolescents. Obesity Facts 2009; 2:286-293
- Atabek M, Pirgon O. Use of metformin in obese adolescents with hyperinsulinemia: a 6-month, randomized, double-blind, placebo-controlled clinical trial. Journal of Pediatric Endocrinology & Metabolism: JPEM 2008; 21:339-348
- 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
- Bravender T, Russell A, Chung R, Armstrong S.. A "novel" intervention: a pilot study of children's literature and healthy lifestyles. Pediatrics. 2010; 125:e513-e517
- 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
- Burgert T, Duran E, Goldberg-Gell R, Dziura J, Yeckel C, Katz S, Tamborlane W, Caprio S.. Short-term metabolic and cardiovascular effects of metformin in markedly obese adolescents with normal glucose tolerance. Pediatric Diabetes. 2008; 9:567-576.
- 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.
- Clarson C, Mahmud F, Baker J, Clark H, McKay W, Schauteet V, Hill D.. Metformin in combination with structured lifestyle intervention improved body mass index in obese adolescents, but did not improve insulin resistance. Endocrine. 2009; 36:141-146.
- Collins C, Okely A, Morgan P, Jones R, Burrows T, Cliff D, Colyvas K, Warren J, Steele J, Baur L.. Parent diet modification, child activity, or both in obese children: An RCT. Pediatrics. 2011; 127:619-627.
- 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.
- Croker H, Viner R, Nicholls D, Haroun D, Chadwick P, Edwards C, Wells J, Wardle J.. Family-based behavioural treatment of childhood obesity in a UK National Health Service setting: Randomized controlled trial. International Journal of Obesity (Lond). 2012; 36:16-26.
- Demol S, Yackobovitch-Gavan M, Shalitin S, Nagelberg N, Gillon-Keren M, Phillip M.. Low-carbohydrate (low and high-fat) vs. high-carbohydrate low-fat diets in the treatment of obesity in adolescents. Acta Paediatrica (Oslo, Norway). 2009; 98:346-351.
- 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.
- Doyle A, Goldschmidt A, Huang C, Winzelberg A, Taylor C, Wilfley D.. Reduction of overweight and eating disorder symptoms via the Internet in adolescents: A randomized controlled trial. The Journal of Adolescent Health. 2008; 43:172-179.
- Doyle-Baker P, Venner A, Lyon M, Fung T.. Impact of a combined diet and progressive exercise intervention for overweight and obese children: The B.E. H.I.P. study. Applied Physiology, Nutrition, and Metabolism (Physiologie Appliquée, Nutrition et Métabolisme). 2011; 36:515-525.
- Eliakim A, Nemet D, Balakirski Y, Epstein Y.. The effects of nutritional-physical activity school-based intervention on fatness and fitness in preschool children. Journal of Pediatric Endocrinology and Metabolism. 2007; 20:711-718.
- Epstein L, Roemmich J, Stein R, Paluch R, Kilanowski C. The challenge of identifying behavioral alternatives to food: clinic and field studies. Annals of Behavioral Medicine: A publication of the Society of Behavioral Medicine 2005; 30:201-209
- Epstein LH, Roemmich JN, Stein RI, Paluch RA, Kilanowski CK. The challenge of identifying behavioral alternatives to food: clinic and field studies. Annals of behavioral medicine : a publication of the Society of Behavioral Medicine 2005; 30:201-209
- Epstein LH, Paluch RA, Beecher MD, Roemmich JN.. Increasing healthy eating vs. reducing high energy-dense foods to treat pediatric obesity. Obesity (Silver Spring, Md.). 2008; 16:318-326.
- 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.
- Godoy-Matos A, Carraro L, Vieira A, Oliveira J, Guedes E, Mattos L, Rangel C, Moreira R, Coutinho W, Appolinario J.. Treatment of obese Adolescents with sibutramine: A randomized, double-blind, controlled study. The Journal of Clinical Endocrinology and Metabolism. 2005; 90:1460-1465.
- Golan M, Kaufman V, Shahar D.. Childhood obesity treatment: Targeting parents exclusively vs. parents and children. The British Journal of Nutrition. 2006; 95:1008-1015.
- Goldschmidt A,Stein R,Saelens B,Theim K,Epstein L,Wilfley D. Importance of early weight change in a pediatric weight management trial. Pediatrics 2011; 128:e33-9
- Hart C, Jelalian E, Raynor H, Mehlenbeck R, Lloyd-Richardson E, Kaplan J, Flynn-O'Brien K, Wing R.. Early patterns of food intake in an adolescent weight loss trial as predictors of BMI change. Eating Behaviors. 2010; 11:217-222.
- 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.
- Jelalian E, Hart C, Mehlenbeck R, Lloyd-Richardson E, Kaplan J, Flynn-O'Brien K, Wing R.. Predictors of attrition and weight loss in an adolescent weight control program. Obesity. 2008; 16:1318-1323.
- Jelalian E, Mehlenbeck R, Lloyd-Richardson E, Birmaher V, Wing R.. 'Adventure therapy' combined with cognitive-behavioral treatment for overweight adolescents. International Journal of Obesity (Lond). 2006; 30:31-39.
- 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.
- Jones M, Luce K, Osborne M, Taylor K, Cunning D, Doyle A, Wilfley D, Taylor C. Randomized, controlled trial of an internet-facilitated intervention for reducing binge eating and overweight in adolescents. Pediatrics. 2008; 121:453-462
- 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
- Kalavainen M,Korppi M,Nuutinen O. Long-term efficacy of group-based treatment for childhood obesity compared with routinely given individual counselling. International journal of obesity (Lond) 2011; 35:530-3
- Kalavainen M, Korppi M, Nuutinen O.. Clinical efficacy of group-based treatment for childhood obesity compared with routinely given individual counseling. International Journal of Obesity (Lond). 2007; 31:1500-1508.
- 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.
- Krebs N, Gao D, Gralla J, Collins J, Johnson S.. Efficacy and safety of a high protein, low carbohydrate diet for weight loss in severely obese adolescents. The Journal of Pediatrics. 2010; 157:252-258.
- 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.
- Munsch S, Roth B, Michael T, Meyer A, Biedert E, Roth S, Speck V, Zumsteg U, Isler E, Margraf J.. Randomized controlled comparison of two cognitive behavioral therapies for obese children: Mother vs. mother-child cognitive behavioral therapy. Psychotherapy and Psychosomatics. 2008; 77:235-246.
- Naar-King S, Ellis D, Kolmodin K, Cunningham P, Jen K, Saelens B, Brogan K.. A randomized pilot study of multisystemic therapy targeting obesity in African-American adolescents. The Journal of Adolescent Health. 2009; 45:417-419.
- 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
- Nemet D, Barzilay-Teeni N, Eliakim A. Treatment of childhood obesity in obese families. Journal of Pediatric Endocrinology & Metabolism: JPEM 2008; 21:461-467
- 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
- Rezvanian H, Hashemipour M, Kelishadi R, Tavakoli N, Poursafa P.. A randomized, triple masked, placebo-controlled clinical trial for controlling childhood obesity. World Journal of Pediatrics. 2010; 6:317-322.
- Ribeiro M, Silva A, Santos N, Guazzelle I, Matos L, Trombetta I, Halpern A, Negrão C, Villares S.. Diet and exercise training restore blood pressure and vasodilatory responses during physiological maneuvers in obese children. Circulation. 2005; 111:1915-1923.
- 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.
- Rooney B, Gritt L, Havens S, Mathiason M, Clough E . Growing healthy families: family use of pedometers to increase physical activity and slow the rate of obesity. WMJ: Official publication of the State Medical Society of Wisconsin 2005; 104:54-60
- Rosado J, del R Arellano M, Montemayor K, García O, Caamaño M. An increase of cereal intake as an approach to weight reduction in children is effective only when accompanied by nutrition education: a randomized controlled trial. Nutrition Journal. 2008; 7:28
- 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.
- Saelens B, Grow H, Stark L, Seeley R, Roehrig H. Efficacy of increasing physical activity to reduce children's visceral fat: a pilot randomized controlled trial. International Journal of Pediatric Obesity: IJPO: An official journal of the International Association for the Study of Obesity 2011; 6:102-112
- Sato A, Jelalian E, Hart C, Lloyd-Richardson E, Mehlenbeck R, Neill M, Wing R. Associations between parent behavior and adolescent weight control. Journal of Pediatric Psychology 2011; 36:451-460
- 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.
- Simon C, Schweitzer B, Oujaa M, Wagner A, Arveiler D, Triby E, Copin N, Blanc S, Platat C.. Successful overweight prevention in adolescents by increasing physical activity: A four-year randomized controlled intervention. International Journal of Obesity. 2008; 32:1489-1498.
- 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.
- Van Mil E, Westerterp K, Kester A, Delemarre-van de Waal H, Gerver W, Saris W.. The effect of sibutramine on energy expenditure and body composition in obese adolescents. The Journal of Clinical Endocrinology and Metabolism. 2007; 92:1409-1414.
- Wafa S, Talib R, Hamzaid N, McColl J, Rajikan R, Ng L, Ramli A, Reilly J.. Randomized controlled trial of a good practice approach to treatment of childhood obesity in Malaysia: Malaysian Childhood Obesity Treatment Trial (MASCOT). International Journal of Pediatric Obesity. 2011; 6:e62-e69.
- 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.
- Williams C, Strobino B, Brotanek J.. Weight control among obese adolescents: A pilot study. International Journal of Food Sciences and Nutrition. 2007; 58:217-230.
- Williamson D, Martin P, White M, Newton R, Walden H, York-Crowe E, Alfonso A, Gordon S, Ryan D.. Efficacy of an Internet-based behavioral weight loss program for overweight adolescent African-American girls. Eating and Weight Disorders. 2005; 10:193-203.
- Williamson D, Walden H, White M, York-Crowe E, Newton R, Alfonso A, Gordon S, Ryan D.. Two-year Internet-based randomized controlled trial for weight loss in African-American girls. Obesity. 2006; 14:1231-1243.
- 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.
- Yackobovitch-Gavan M, Nagelberg N, Demol S, Phillip M, Shalitin S.. Influence of weight-loss diets with different macronutrient compositions on health-related quality of life in obese youth. Appetite. 2008; 51:697-703.
- Yu C, Sung R, So R, Lui K, Lau W, Lam P, Lau E.. Effects of strength training on body composition and bone mineral content in children who are obese. Journal of Strength and Conditioning Research. 2005; 19:667-672.
- Detail
-
Search Plan and Results: PWM: Multicomponent Weight Management and Treatment Context 2012
-
Conclusion