Pediatric Weight Management

PWM: Prescribed Diet Plan and Nutrition Education (2006)

Pediatric Weight Management: Prescribed Diet Plan and Nutrition Education

Pediatric obesity treatment programs use different methods for altering dietary behaviors:

• Some programs develop prescribed diet plans (recommendations specific to the age, height, gender, etc.) for each child or adolescent. We use the term "prescribed diet plan" to designate this approach.
• Some programs provide the child or adolescent (and sometimes their families) with more general nutrition information without explicitly individualizing each participant’s daily dietary pattern. Se use the term "Nutrition Education" to indicate this approach.
• Most programs we reviewed combine the above approaches

What contributions do each of these approaches make to the outcomes of multicomponent pediatric obesity treatment programs?

• Intervention
  What is the effectiveness of using a prescribed dietary plan as part of an intervention program for child (ages 6-12) obesity?

  • Conclusion

    Including a prescribed diet plan as part of a multi-component weight-management program results in improvements in adiposity in children in both the short-term and longer-term (more than one year).

  • 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.
  • Evidence Summary: Using a prescribed diet plan as a part of an intervention program to treat childhood obesity
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • 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.
      • 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, 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.
      • Nuutinen O, and Knip M. Long-term weight control in obese children: persistence of treatment outcome and metabolic changes. International Journal of Obesity 1992;16:279-287.
      • 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.
      • 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. 
      • Young P, West S, Ortiz K, Carlson J. A pilot study to determine the feasibility of the low glycemic diet as a treatment for overweight children in primary care practice. Ambulatory Pediatrics 2004;4:28-33.
  • Search Plan and Results: Treatment Format: Prescribed Diet Plan 2003
     
  What is the effectiveness of using a prescribed dietary plan as part of an intervention program for adolescent (ages 13-18) obesity?

  • Conclusion

    Including a prescribed diet plan as part of a multi-component weight management program results in improvements in adiposity in adolescents in both the short-term and longer-term (more than one year).

  • 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.
  • Evidence Summary: Using a prescribed diet plan as a part of an intervention program to treat adolescent obesity
    • 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.
      • 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
      • Golan M, Crow S. Targeting parents exclusively in the treatment of childhood obesity: long-term results. Obes Res 2004;12:357-361.
      • 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.
      • Rocchini AP, Katch V, Anderson J, Hinderliter J, Becque D, Martin M, Marks C. Blood Pressure in Obese Adolescents: Effect of Weight Loss. Pediatrics 1988;82:16-23.
      • 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
      • Schwingshandl J, Sudi K, et al. Effect of an individualized training programme during weight reduction on body composition: a randomized trial. Arch Dis Child 1999; 81:426-8.
      • 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.
      • 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., 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.
      • Spieth L, Harnish J, Lenders C, Raezer L, Pereira M, Hangen SJ, Ludwig D. A Low-Glycemic Index Diet in the Treatment of Pediatric Obesity Arch Pediatr Adolesc Med 2000;154:947-951
      • 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.
  • Search Plan and Results: Treatment Format: Prescribed Diet Plan 2003
     
  What is the effectiveness of using nutrition education without a prescribed diet plan as the dietary component of a multicomponent pediatric weight management program in children (ages 6-12)?

  • Conclusion

    In children (ages six to 12), using nutrition education alone (without some form of individualized diet plan with the child or child and family) as part of a multi-component weight-management program may be associated with short-term improvement in adiposity measures. Longer-term results (more than one year) are less consistent.

  • Grade: III
    • 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.
  • Evidence Summary: Nutrition education without a prescribed diet plan as a part of an intervention program to treat childhood obesity
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Brownell KD, Kelman JH, Stunkard AJ. Treatment of obese children with and without their mothers: changes in weight and blood pressure. Pediatrics 1983; 71: 515-23.
      • Brownell KD, Kelman JH, Stunkard AJ. Treatment of obese children with and without their mothers: changes in weight and blood pressure. Pediatrics 1983; 71: 515-23.
      • Coates TJ, Killen JD, Slinkard LA. Parent participation in a treatment program for overweight adolescents. Int J Eat Disord 1982; 1: 37-48.
      • Coates TJ, Killen JD, Slinkard LA. Parent participation in a treatment program for overweight adolescents. Int J Eat Disord 1982; 1: 37-48.
      • de Mello ED, Luft VC, Meyer F. Individual outpatient care versus group education programs. Which leads to greater change in dietary and physical activity habits for obese children? J Pediatr (Rio J). 2004 Nov-Dec;80(6):468-74.
      • de Mello ED, Luft VC, Meyer F. Individual outpatient care versus group education programs. Which leads to greater change in dietary and physical activity habits for obese children? J Pediatr (Rio J). 2004 Nov-Dec;80(6):468-74.
      • 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.
      • 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.
      • Gutin B, Barbeau P, Owens S, Lemmon C, Bauman M, Allison J, Kang H, Litaker M. Effects of exercise intensity on cardiovascular fitness, total body composition, and visceral adiposity of obese adolescents Am J Clin Nutr 2002;75:818-26.
      • Gutin B, Barbeau P, Owens S, Lemmon C, Bauman M, Allison J, Kang H, Litaker M. Effects of exercise intensity on cardiovascular fitness, total body composition, and visceral adiposity of obese adolescents Am J Clin Nutr 2002;75:818-26.
      • Israel AC, Guile CA, Baker JE. An evaluation of enhanced self-regulation training in the treatment of childhood obesity. J Pediatr Psychol 1994; 19:737-49.
      • Israel AC, Guile CA, Baker JE. An evaluation of enhanced self-regulation training in the treatment of childhood obesity. J Pediatr Psychol 1994; 19:737-49.
      • Kirschenbaum DS, Harris ES, Tomarken AJ. Effects of parental involvement in behavioral weight loss therapy for preadolescents. Behavior Therapy 1984;15:485-500. 
      • Kirschenbaum DS, Harris ES, Tomarken AJ. Effects of parental involvement in behavioral weight loss therapy for preadolescents. Behavior Therapy 1984;15:485-500. 
      • Mellin LM, Slinkard LA, Irwin CE. Adolescent obesity intervention: validation of the SHAPEDOWN program. J Am Diet Assoc 1987; 87:333-8.
      • Mellin LM, Slinkard LA, Irwin CE. Adolescent obesity intervention: validation of the SHAPEDOWN program. J Am Diet Assoc 1987; 87:333-8.
      • Resnicow K, Yaroch AL, Davis A, Wang DT, Carter S, Slaughter L, Coleman D, Baranowski T. GO GIRLS!: results from a nutrition and physical activity program for low-income, overweight African American adolescent females. Health Education & Behavior 2000;27:616-31.
      • Resnicow K, Yaroch AL, Davis A, Wang DT, Carter S, Slaughter L, Coleman D, Baranowski T. GO GIRLS!: results from a nutrition and physical activity program for low-income, overweight African American adolescent females. Health Education & Behavior 2000;27:616-31.
  • Search Plan and Results: Treatment Format: Prescribed Diet Plan 2003
     
  What is the effectiveness of using nutrition education without a prescribed diet plan as the dietary component of a multicomponent pediatric weight management program in adolescents (ages 13-18)?

  • Conclusion

    In adolescents (ages 13-18), using nutrition education alone (without some form of individualized diet plan with the child or child and family) as part of a multicomponent weight management program is associated with short term and longer term (>1 year) improvement in adiposity measures.

  • Grade: II
    • 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.
  • Evidence Summary: Nutrition education without a prescribed diet plan as a part of an intervention program to treat childhood obesity
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Brownell KD, Kelman JH, Stunkard AJ. Treatment of obese children with and without their mothers: changes in weight and blood pressure. Pediatrics 1983; 71: 515-23.
      • Coates TJ, Killen JD, Slinkard LA. Parent participation in a treatment program for overweight adolescents. Int J Eat Disord 1982; 1: 37-48.
      • de Mello ED, Luft VC, Meyer F. Individual outpatient care versus group education programs. Which leads to greater change in dietary and physical activity habits for obese children? J Pediatr (Rio J). 2004 Nov-Dec;80(6):468-74.
      • 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.
      • Gutin B, Barbeau P, Owens S, Lemmon C, Bauman M, Allison J, Kang H, Litaker M. Effects of exercise intensity on cardiovascular fitness, total body composition, and visceral adiposity of obese adolescents Am J Clin Nutr 2002;75:818-26.
      • Israel AC, Guile CA, Baker JE. An evaluation of enhanced self-regulation training in the treatment of childhood obesity. J Pediatr Psychol 1994; 19:737-49.
      • Kirschenbaum DS, Harris ES, Tomarken AJ. Effects of parental involvement in behavioral weight loss therapy for preadolescents. Behavior Therapy 1984;15:485-500. 
      • Mellin LM, Slinkard LA, Irwin CE. Adolescent obesity intervention: validation of the SHAPEDOWN program. J Am Diet Assoc 1987; 87:333-8.
      • Resnicow K, Yaroch AL, Davis A, Wang DT, Carter S, Slaughter L, Coleman D, Baranowski T. GO GIRLS!: results from a nutrition and physical activity program for low-income, overweight African American adolescent females. Health Education & Behavior 2000;27:616-31.
  • Search Plan and Results: Treatment Format: Prescribed Diet Plan 2003