Pediatric Weight Management

PWM: Executive Summary of Recommendations (2015)

Executive Summary of Recommendations

Below are the major recommendations and ratings for the Academy of Nutrition and Dietetics Pediatric Weight Management (PWM) Evidence-Based Nutrition Practice Guideline 2015. View the Guideline Overview from the Introduction section. More detail (including the evidence analysis supporting these recommendations) is available on this website to Academy members and EAL subscribers under the Major Recommendations section. 

To see a description of the Academy Recommendation Rating Scheme (Strong, Fair, Weak, Consensus, Insufficient Evidence), click here.

The PWM 2015 Recommendations are listed below. [Note: If you mouse-over underlined acronyms and terms, a definition will pop up.]

 
  • Nutrition Assessment
    PWM: Assessment of Fast Food Meal Frequency in Children and Teens
    The registered dietitian nutritionist (RDN) should assess the frequency of fast-food intake of overweight or obese children and teens. Limited evidence in populations eight years to 16 years of age at baseline suggests that higher frequency of fast-food consumption, particularly more than twice a week is associated with increased adiposity; BMI Z-score; or risk of obesity during childhood, adolescence and during the transition from adolescence into adulthood.  
    Weak
    Imperative
  • Nutrition Intervention
    PWM: RDN in Multi-component Pediatric Weight Management Interventions
    The registered dietitian nutritionist (RDN) should be an integral part of multi-component pediatric weight management interventions. A strong body of research indicates that short-term (six-month) and long-term (two-year) decreases in body mass index (BMI) and BMI Z-scores for all age categories were more likely to be achieved when an RDN or psychologist/mental health provider were involved in multi-component weight management interventions that included diet and nutrition [including medical nutrition therapy (MNT)], physical activity and behavioral components.
    Strong
    Imperative
    PWM: Multicomponent Pediatric Weight Management Interventions
    When providing pediatric weight management, the registered dietitian nutritionist (RDN) should ensure the multi-component interventions include diet/nutrition [medical nutrition therapy (MNT)], physical activity and behavioral components. A strong body of research indicates that short-term (six-month) and long-term (two-year) decreases in body mass index (BMI) and BMI Z-scores for all age categories were more likely to be achieved when an RDN or mental health professional were involved in the multi-component pediatric weight management interventions that included the above three major components.
     
    Strong
    Imperative
    PWM: Family Participation in Multicomponent Pediatric Weight Management Interventions
    The registered dietitian nutritionist (RDN) should encourage family participation as an integral part of a multi-component pediatric weight management intervention for children of all ages, including teens. A strong body of research indicates that family involvement as part of a multi-component pediatric weight management intervention is highly consistent with positive weight status outcomes at both six months and 12 months.
    Strong
    Imperative
    PWM: Length of Treatment in Multi-component 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.
    Fair
    Imperative
    PWM: Treatment Setting in Multi-component Pediatric Weight Management Interventions
    The registered dietitian nutritionist (RDN) can provide multi-component pediatric weight management interventions either within the clinic or outside the clinic setting. Research indicates that positive weight status outcomes occur in either setting, especially when the interventions are multi-component, include group pediatric weight management sessions and have family involvement.
    Fair
    Imperative
    PWM: Group Sessions in Multicomponent Pediatric Weight Management Interventions
    The registered dietitian nutritionist (RDN) can include group sessions and family participation as part of the multi-component pediatric weight management interventions. Multi-component intensive interventions that included group pediatric weight management sessions and included family participation were consistently associated with shorter-term (six-month) and longer-term (12-month) positive weight status outcomes.   
    Fair
    Imperative
    PWM: Individual Sessions in Multicomponent Pediatric Weight Management Interventions
    The registered dietitian nutritionist (RDN) can include individual sessions as part of the multi-component pediatric weight management intervention. Treatment that relied exclusively on individual pediatric weight management sessions with or without family participation was associated with shorter-term positive weight status outcomes. Information about the longer-term impact on weight status are mixed. 
    Fair
    Imperative
    PWM: Fast Food Meal Frequency in Children and Teens
    If the overweight or obese child or teen consumes fast-food meals, the registered dietitian nutritionist (RDN) should encourage reduction in the frequency of fast-food intake to less than twice a week. Limited evidence in populations eight to 16 years of age at baseline, suggests that higher frequency of fast-food consumption, particularly more than twice a week is associated with increased adiposity; BMI Z-score; or risk of obesity during childhood, adolescence and during the transition from adolescence into adulthood.  
    Weak
    Conditional