Pediatric Weight Management

PWM: Introduction (2015)

Guideline Overview 

Guideline Title 

Pediatric Weight Management (2015) Evidence-Based Nutrition Practice Guideline

Guideline Narrative Overview 

The focus of this guideline is on the treatment of pediatric overweight and obesity in a multicomponent,  multidisciplinary context.

Unlike adults, who are defined as overweight or obese depending on the absolute value of their body mass index (BMI) (kg/m2), BMI percentiles are used for children and adolescents. BMI percentile indicates the position of a child’s BMI relative to children of the same sex and age (US Centers for Disease Control Growth Charts). Throughout this guideline the terms “overweight” will be used to classify children whose BMI is between the 85th and 94th percentile and  “obese” and “obesity” will be used as a general designation for children whose BMI is greater than or equal to the 95th percentile.

The table below illustrates the terminology for weight classification reproduced from Table 1 of the Expert Committee Recommendations, 2007.

TABLE 1. Terminology for BMI Categories
 
BMI Category Former Terminology Recommended Terminology
<5th percentile Underweight Underweight
5th to 84th percentile Healthy weight Healthy weight
85th to 94th percentile At risk of overweightab Overweightc
95th percentile Overweightab or obesitya Obesitycd
 
a Expert committee recommendations, 1998.
b CDC recommendations, 2002.
c International Obesity Task Force, 2000.
d Institute of Medicine, 2005.
 
Reference: Sarah E. Barlow and the Expert Committee. Expert Committee Recommendations Regarding the Prevention, Assessment, and Treatment of Child and Adolescent Overweight and Obesity: Summary Report. Pediatrics 2007;120; S164-S192. (P. S168).

Multicomponent Pediatric Weight Management Treatment

Obesity is a complex multifactoral chronic disease that develops from an interaction between genetics and the environment. The development of obesity involves the integration of family, behavioral, cultural, physiological, metabolic and genetic factors. Treatment of obesity should be based on a multicomponent weight management program.

Medical Nutrition Therapy and Pediatric Weight Management 

Scientific evidence supports the importance of the registered dietitian nutritionist (RDN) as a member of the interprofessional team caring for overweight or obese children. The RDN provides medical nutrition therapy (MNT) as part of multicomponent pediatric weight management,  including nutrition, physical activity and behavioral counseling which are important components of the nutrition care process.

The RDN plays an integral role on the interprofessional care team by determining the optimal nutrition prescription and developing the nutrition care plan for pediatric clients in all phases of care and includes family participation and support, as appropriate. Based on the child's clinical status, plan for treatment, and comorbidities, the RDN monitors and evaluates the effectiveness of the nutrition care plan in promoting nutritional health and quality of life. The RDN adjusts the nutrition care plan as necessary to achieve desired outcomes.

Guideline Development 

This guideline outlines the most current information on pediatric overweight and obesity.

The recommendations in this guideline were based upon a systematic review of the literature and the work performed by the Academy of Nutrition and Dietetics Expert Work Group on Pediatric Weight Management and the Nutrition Evidence Library (NEL) Dietary Guidelines Advisory Committee (DGAC) 2015. Because of the extreme heterogeneity between multicomponent pediatric weight management intervention studies, classic meta-analysis was not possible. Studies were separated into arms and arms were categorized into types based on 30 different intervention characteristics using multiple correspondence analysis. Weighted means for each time point were estimated for separate arm types and compared. Qualitative Comparative Analysis procedures were used to evaluate context dependence.

To view the guideline development and review process, see Methodology. A summary of the evidence analysis is below:

Topics include: 
  • PWM: Assessment of Fast Food Meal Frequency in Children and Teens
  • PWM: Multicomponent Pediatric Weight Management Interventions
  • PWM: Family Participation in Multicomponent Pediatric Weight Management Interventions
  • PWM: Length of Treatment in Multicomponent Pediatric Weight Management Interventions
  • PWM: Treatment Setting in Multicomponent Pediatric Weight Management Interventions
  • PWM: Sessions (Group and Individual) in Multicomponent Pediatric Weight Management Interventions
  • PWM: Fast Food Meal Frequency in Children and Teens
The number of supporting documents in the PWM project for these topics is below:

•    Recommendations: 9
•    Conclusion Statements: 5 
•    Evidence Summaries: 2
•    Article Worksheets: 73

Additional conclusion statements, evidence summaries and article worksheets supporting the recommendations are located in the Nutrition Evidence Library (NEL) DGAC 2015.

Contributors 

To see the list of expert work group members, analysts and other contributors and disclosures for this project, expand the Project Team - Pediatric Weight Management (2012-2015) on Pediatric Weight Management project page.

Revision

Academy guidelines are revisited every five years. An expert workgroup will be convened by the Evidence-based Practice Committee to determine the need for new and revised recommendations based on the available science. The process includes:   
  • Literature searches to identify new research published since the previous searches were completed. Updated inclusion/exclusion criteria and search terms may be warranted.
  • Review to determine if the update will include modification to all, some or no recommendations compared to the earlier version(s) of the guideline, or development of new recommendations.
  • Creation of a table comparing the new guideline and the older version of the guideline. The document will indicate which recommendations remained unchanged; updated; new; or not reviewed.
Using the Academy's EAL Methodology, an unbiased and transparent systematic review will be completed and the updated guidelines published on the EAL.
 

Future Research Needs

Additional research is needed in the pediatric weight management population. High levels of complexity in multicomponent pediatric weight management interventions render simple bivariate analyses of effects meaningless or misleading. Procedures for analyzing the effectiveness of these interventions need to use methods of analysis suitable for multicomponent interventions and contextually dependent outcomes.