Pediatric Overweight/Obesity: Treatment (2021)

Assessment
In multi-component interventions including nutrition, which BMI outcome (BMI z-score or %BMIp95) is more responsive to interventions for specified age groups (2-5 years, 6-12 years and 13-17 years)?
- Conclusion
  In pediatric individuals 2-17 years of age with overweight or obesity, three systematic reviews reported multi-component weight management interventions reduced BMI z-scores compared to controls, but effects were small. There were no systematic reviews that reported %BMIp95 as an outcome of interest.
- Grade: Ungraded
  - 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: In multi-component interventions including nutrition, which BMI outcome (BMI z-score or %BMIp95) is more responsive to interventions for specified age groups (2-5 years, 6-12 years and 13-17 years)?
- Search Plan and Results: PWM: Pediatric Overweight and Obesity Treatment (2021)
Intervention
In pediatric individuals (2-5 years, 6-12 years and 13-17 years) with overweight or obesity, what is the efficacy of multi-component interventions including nutrition, compared to no intervention, on BMI z-score, %BMIp95, HbA1C, TG, and ALT levels?
- Conclusion
  In pediatric individuals 2-17 years of age with overweight or obesity, three systematic reviews reported multi-component weight management interventions including nutrition reduced BMI z-scores compared to controls. No current systematic reviews reported the outcomes of %BMIp95, HbA1c, or triglyceride or ALT levels.
- Grade: Moderate (B)
  - 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: In pediatric individuals (2-5 years, 6-12 years and 13-17 years) with overweight or obesity, what is the efficacy of multi-component interventions including nutrition, compared to no intervention, on BMI z-score, %BMIp95, HbA1C, TG, and ALT levels?
- Search Plan and Results: PWM: Pediatric Overweight and Obesity Treatment (2021)
In pediatric individuals (2-5 years, 6-12 years and 13-17 years) with overweight or obesity, what is the efficacy of multi-component interventions including nutrition, compared to no intervention, on quality of life, anxiety/depression, eating disorder symptoms or diagnosis, or other adverse events?
- Conclusion
  In pediatric individuals with overweight or obesity, there is no evidence to suggest that weight management interventions result in worsening of quality of life, anxiety or depression, eating disorder risk or bulimia symptoms short-term, self-esteem or adverse events. However, the long-term risk (>27 months) of developing eating disorder symptoms post-treatment remains a concern. There is low quality evidence that these measures may be improved following pediatric weight management interventions, and moderate evidence that quality of life may be improved for adolescents.
- Grade: Moderate (B)
  - 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: In pediatric individuals (2-5 years, 6-12 years and 13-17 years) with overweight or obesity, what is the efficacy of multi-component interventions including nutrition, compared to no intervention, on quality of life, anxiety/depression, eating disorder symptoms or diagnosis, or other adverse events?
- Search Plan and Results: PWM: Pediatric Overweight and Obesity Treatment (2021)
In pediatric individuals (2-5 years, 6-12 years and 13-17 years) with overweight/obesity, what is the efficacy of multi-component interventions including nutrition in clinical settings, compared to no intervention, on BMI z-score, %BMIp95, HbA1C, TG, ALT, quality of life, anxiety/depression, eating disorder symptoms or diagnosis, or other adverse events?
- Conclusion
  In the clinical setting, multi-component pediatric weight management interventions were modestly effective in reducing BMI z-scores in 6–17-year-old participants. Clinical decision support tools and inclusion of a nutrition professional were identified as effective intervention methods to reduce BMI z-score. No current systematic reviews reported the outcomes of %BMIp95, HbA1c, or triglyceride or ALT levels.
- Grade: Moderate (B)
  - 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: In pediatric individuals (2-5 years, 6-12 years and 13-17 years) with overweight/obesity, what is the efficacy of multi-component interventions including nutrition in healthcare settings, compared to no intervention, on BMI z-score, %BMIp95, HbA1C, TG, ALT, quality of life, anxiety/depression, eating disorder symptoms or diagnosis, or other adverse events?
- Search Plan and Results: PWM: Pediatric Overweight and Obesity Treatment (2021)
In pediatric individuals (2-5 years, 6-12 years and 13-17 years) with overweight or obesity, what is the efficacy of multi-component, family-based interventions including nutrition, compared to no intervention, on BMI z-score, %BMIp95, HbA1C, TG, ALT, quality of life, anxiety/depression, eating disorder symptoms or diagnosis, or other adverse events?
- Conclusion
  In pediatric individuals 2-17 years of age with overweight or obesity, weight management interventions with parental involvement reduced BMI z-score to a greater extent than interventions without parental involvement. In children 6-11 years of age, weight management interventions in the home setting were among the most efficacious in reducing BMI z-score. There was no evidence available reporting the outcomes of %BMIp95, HbA1C, TG, ALT, quality of life, anxiety/depression, eating disorder symptoms or diagnosis in family-based interventions specifically.
- Grade: Moderate (B)
  - 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: In pediatric individuals (2-5 years, 6-12 years and 13-17 years) with overweight or obesity, what is the efficacy of multi-component, family-based interventions including nutrition, compared to no intervention, on BMI z-score, %BMIp95, HbA1C, TG, ALT, quality of life, anxiety/depression, eating disorder symptoms or diagnosis, or other adverse events?
- Search Plan and Results: PWM: Pediatric Overweight and Obesity Treatment (2021)
In pediatric individuals (2-5 years, 6-12 years and 13-17 years) with overweight/ or obesity, what is the efficacy of multi-component nutrition interventions delivered using eHealth, mHealth or telehealth, compared to no intervention or interventions delivered by other means, on BMI z-score, %BMIp95, HbA1C, TG, ALT, quality of life, anxiety/depression, eating disorder symptoms or diagnosis, or other adverse events?
- Conclusion
  In individuals 2-17 years of age with overweight or obesity, there were no systematic reviews identified that met inclusion criteria and examined the effects of eHealth, mHealth or telehealth delivered weight management interventions.
- Grade: Ungraded
  - 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.
- Search Plan and Results: PWM: Pediatric Overweight and Obesity Treatment (2021)
In pediatric individuals (2-5 years, 6-12 years and 13-17 years) with overweight/obesity and who are [Black, Latinx or other racial/ethnic minority; low SES, have SDH that increase risk, have special needs; LGBTQ, have Adverse Childhood Events], what is the efficacy of multi-component nutrition interventions, compared to no intervention, on BMI z-score, %BMIp95, HbA1C, TG, ALT, quality of life, anxiety/depression, eating disorder symptoms or diagnosis, or other adverse events?
- Conclusion
  Evidence is lacking regarding pediatric weight management interventions that are specific and relevant to sub-populations including, but not limited to, individuals who identify as racial or ethnic minorities, have low socioeconomic status or high-risk social determinants of health, who are gender diverse, and those who have experienced adverse child events.
- Grade: Ungraded
  - 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: In pediatric individuals (2-5 years, 6-12 years and 13-17 years) with overweight/obesity and who are [Black, Latinx or other racial/ethnic minority; low SES, have SDH that increase risk, have special needs; LGBTQ, have Adverse Childhood Events], what is the efficacy of multi-component nutrition interventions, compared to no intervention, on BMI z-score, %BMIp95, HbA1C, TG, ALT, quality of life, anxiety/depression, eating disorder symptoms or diagnosis, or other adverse events?
  - Detail
- Search Plan and Results: PWM: Pediatric Overweight and Obesity Treatment (2021)
In pediatric individuals (2-5 years, 6-12 years and 13-17 years) with overweight or obesity, what is the cost-effectiveness of multi-component nutrition interventions to treat overweight and obesity?
- Conclusion
  Evidence describing the cost-effectiveness of pediatric overweight and obesity treatment interventions was limited. One systematic review identified two primary studies reporting that multi-component interventions were cost-effective compared to usual care.
- Grade: Very Low (D)
  - 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: In pediatric individuals (2-5 years, 6-12 years and 13-17 years) with overweight or obesity, what is the cost-effectiveness of multi-component nutrition interventions to treat overweight and obesity?
- Search Plan and Results: PWM: Pediatric Overweight and Obesity Treatment (2021)