Pediatric Weight Management

PWM: Scope of Guideline (2007)

Pediatric Weight Management Guideline Scope Characteristics

Below you will find a list of characteristics that describe the Scope of this Guideline.

Disease/Condition(s)

The purpose of this guideline is to provide a summary of evidence-based practice in the nutrition management of pediatric weight management.

Recommendations have been formulated for pediatric weight management within the context of the Nutrition Care Process. The major focus of this guideline is on nutrition screening, nutrition assessment, nutrition intervention (including multicomponent treatment, family interventions, nutrition therapy, physical activity interventions, behavioral interventions, pharmacotherapy, and surgery for pediatric weight management), and monitoring and evaluation. 

While the Pediatric Weight Management work group views this guideline as part of a broader emphasis on pediatric health promotion, the explicit focus of the guideline is on the treatment of pediatric obesity. Issues such as the prevention of obesity, while critical, are beyond the scope of this guideline. 

This guideline is intended for use by registered dietitians involved in pediatric weight management. It may also be a valuable resource for registered dietitians involved in the care of children and adolescents with other chronic conditions or disease states, such as coronary heart disease, metabolic syndrome, type 2 diabetes, hypertension, sleep apnea, osteoarthritis, gallstones and stress incontinence. It is hoped that the information in this guideline will be used to provide individualized nutrition care with practical nutrition recommendations that are based on the current state of the science for pediatric weight management.

While other stakeholders (e.g., teachers, school nurses, and community outreach workers) may find the information in this guideline helpful, the primary purpose of this practice guideline is to provide resources specifically for the Registered Dietitian.

This guideline is not intended:
  • For treating overweight or obesity among children under five years of age
  • For prevention of child and adolescent overweight or obesity
  • As a replacement for interventions typically within the scope of practice of an athletic trainer or behavioral or psychological professional, for which adequate training in physical activity interventions or behavioral therapy is necessary.
Note: Interventions for adult weight management may be related to treatment of childhood overweight (especially when treating overweight or obesity in parents), however, the research and treatment approaches are sufficiently different for these two populations that separate interventions are appropriate. See Adult Weight Management evidence-Based Nutrition Practice Guideline. 

Guideline Category

Counseling, Management, Treatment

Clinical Specialty

Family Practice, Nutrition, Pediatrics

Intended Users

Registered Dietitians, Physicians, Students

Guideline Objective(s)

Overall Objective

To provide evidence-based recommendations for pediatric weight management that reduce adiposity, prevent further weight gain, and maintain improvements in adiposity over a prolonged period.

Specific Objectives
  • To define evidence-based recommendations for registered dietitians (RDs) that are carried out in collaboration with other health care providers.
  • To guide practice decisions that integrate medical, nutritional, and behavioral elements
  • To promote consistency of practice among RDs
  • To promote self-management strategies that empower the patient and family to take responsibility for day-to-day management, and to provide the RD with data to make recommendations to adjust Medical Nutrition Therapy or recommend other therapies to achieve target clinical outcomes
  • To enhance the quality of life for the patients and their families by utilizing customized strategies based on the individual’s preferences, lifestyle, and goals
  • To develop content for intervention that can be tested for impact on clinical outcomes
  • To define the highest quality of care within cost constraints of the current health care environment and family situation.

Target Population

Child (6 to 12 years), Adolescent (13 to 18 years), Male, Female

Target Population Description

 Children (6-12 years), Adolescents (13-18 years) with pediatric obesity (childhood obesity is defined as BMI>=95th percentile by child age).

Interventions and Practices Considered

This guideline is based on ADA's Nutrition Care Process and Model, which involves the following steps:

  • Assessment
  • Diagnosis
  • Intervention
  • Monitoring and Evaluation.

This guideline addresses topics that correspond to the following areas of the Nutrition Care Process. Please refer to the Algorithms in this guideline for a more detailed view of the recommendations and their application within the Nutrition Care Process.

Specific Medical Procedures

Different medical tests and methodological procedures are used in the studies analyzed. Since medical tests and methodological procedures change and develop over time, the work group does not recommend any particular assessment, intervention or monitoring method unless otherwise specified.

Outline of the Nutrition Care Process

I. Referral to a Registered Dietitian

II. Nutrition Care Process

A. Nutrition Assessment

Below you will find the nutrition assessment terms related to pediatric weight management care from International Dietetics & Nutrition Terminology Reference Manual: Standardized Language for the Nutrition Care Process, Second Edition. To view a complete list of all nutrition assessment terms, click here.

1. Biochemical data, medical tests and procedures, including relevant laboratory data

2. Anthropometric measurements including: Height, weight, BMI and waist circumference

3. Physical exam findings

4.  Food and nutrition history, including:

  • Measurement or estimation of energy needs
  • Comprehensive diet history, including current dietary intake and receptivity to change
  • Family history and involvement
  • Physical activity patterns Psychosocial and economic issues impacting nutrition therapy

5.  Client history, including

  • Medical history
  • Comorbid conditions and need for additional modifications in nutrition care plan.

B. Nutrition Diagnosis

Below you will find the nutrition diagnoses related to pediatric weight management care from International Dietetics & Nutrition Terminology Reference Manual: Standardized Language for the Nutrition Care Process, Second Edition. To view a complete list of all nutrition diagnoses, click here.

C. Intervention (Planning and Implementation)

Below you will find the nutrition interventions related to pediatric weight management care from International Dietetics & Nutrition Terminology Reference Manual: Standardized Language for the Nutrition Care Process, Second Edition. To view a complete list of all nutrition interventions, click here.

Individualized nutrition prescription

  • Goals and intervention strategies:
  • Dietary interventions
  • Physical activity interventions
  • Behavioral interventions
  • Pharmacotherapy or surgery, when indicated.

D. Monitoring and Evaluation

Below you will find the nutrition monitoring and evaluation terms related to pediatric weight management care from International Dietetics & Nutrition Terminology Reference Manual: Standardized Language for the Nutrition Care Process, Second Edition. To view a complete list of all nutrition monitoring and evaluation terms, click here.

Nomenclature

The terms "patient" and "client" are used interchangeably throughout this guideline to describe an individual receiving care.

“Child” is defined as individuals ages 6-12

“Adolescent” is defined as individuals ages 13-18

“Youth” is defined as combined Children and Adolescent populations

"Adiposity" is defined as the degree of fatness (including obesity, but also including body composition)

"Multicomponent" is defined as a combination of different modes of treatment which may include dietary therapy, physical activity, nutritional counseling and behavior therapy. Depending on the expertise and training of the health care team members, different treatment components may be delivered by one or more persons.

"Intervention" refers to a strategy for therapy within a particular program component or mode of treatment.