Pediatric Weight Management

PWM: Benefits and Risks/Harms of Implementation (2015)

Benefits and Risks/Harms of Implementing the Recommendations

Benefits and Risks/Harms of Implementing the Recommendations

Safety issues should be considered for each form of treatment recommended. A description of the general benefits and risks associated with implementation of this guideline must be addressed.
 

This guideline was developed for overweight or obese children and adolescents (ages 6-18 years, unless otherwise stated) treated in an outpatient setting. Therefore, clinical judgment is crucial in the application of these guidelines for individuals in other age groups and settings.

When using these treatment recommendations:

  • Review the patient’s age, development,  socioeconomic status,  cultural issues and other health conditions.    
  • Consider a referral to social services to assist patients with financial arrangements if economic issues are a concern.
  • Use clinical judgment when evaluating patients with co-morbid conditions. Such conditions may include: diabetes, psychiatric disorders, and metabolic diseases. 
Factors to consider when exploring treatment options include:
  • Adequate staffing with expertise in the major component areas of pediatric weight management and adequate space for counseling and physical activity are required. 
  • Intervention format and training and educational materials should be developmentally appropriate, health literate, as well as culturally relevant for both the child and parent/care giver
  • The following may impact success of counseling:
    • Awareness and sensitivity to parental style in limit setting and creating healthy boundaries and ability to support child’s weight loss efforts 
    • Family dynamics (e.g., parent-child relationship; parenting techniques, parental attitude towards food and weight, etc.) 
    • Family unit differences and circumstances at home (i.e., single parent; lives part of the time with other parent) 
    • Parent and/or family commitment to program participation (during sessions and at home) 
    • Parent and/or family unable or unwilling to actively participate (i.e., no child care for younger children at home; disinterest)
  • Absenteeism and attrition may affect success rate. Participation may be limited by the location of counseling (distance from home or workplace), the duration lenght and frequency of sessions.
  • Costs to Organization/Program and Patient/Family
    • Substantial infrastructure is required to implement a multicomponent pediatric weight management program. The costs and resources required depend upon a number of factors, including the level of professional and support staffing,  the setting,  individual or group sessions,  size of groups,  frequency of visits, and duration of intervention
    • Reimbursement for nutrition, physical activity and behavioral components may vary and participant absenteeism and attrition may affect reimbursement and program sustainability.
    • Limitations in or lack of health insurance coverage for pediatric weight management could limit program access and participation
    • The duration or length of sessions may require addition costs to parents, such as costs related to child care or lost wages to attend sessions.
  • The RDN should be aware of and refer to community resources and programs to support pediatric weight management.
For more specific detail concerning the risks/harms, conditions of application and costs, see individual recommendations.

Potential Benefits

A priority aim and benefit of implementing the recommendations in this guideline is to improve the number of children and adolescents who are able to meet their treatment goal, whether by reducing body weight, preventing further weight gain, improving body composition, or maintaining weight loss.
 

Risk/Harm Considerations

Potential risks/harms to consider when exploring treatment options include:

  • Group pediatric weight management sessions conducted in school settings may lead to stigmatization of some children and teens (Barlow, 2007) 
  • The harm of delivering multicomponent pediatric weight management interventions is small. Pediatric weight management interventions for overweight and obese youths may mildly increase injury risk with exercise. However, no evidence of other adverse effects resulting from pediatric weight management programs on growth, eating disorder pathology, or mental health was found. Caution is suggested, since these findings were tentative due to incomplete reporting. More robust harms assessment and reporting was recommended to confirm this (USPSTF, Barton 2010; Whitlock et al, 2010). An update of the US Preventive Services Task Force (USPSTF) recommendation on screening for obesity in children and adolescents underway at the time of this publication. 
References:

Barlow SE; Expert Committee. Expert committee recommendations regarding the prevention, assessment, and treatment of child and adolescent overweight and obesity: summary report. Pediatrics. 2007 Dec; 120 Suppl 4: S164-S192. PMID: 18055651.

US Preventive Services Task Force, Barton M. Screening for obesity in children and adolescents: US Preventive Services Task Force recommendation statement.
Pediatrics. 2010 Feb;125 (2): 361-367. doi: 10.1542/peds.2009-2037. Epub 2010 Jan 18. PMID: 20083515

Whitlock EP, O'Connor EA, Williams SB, Beil TL, Lutz KW. Effectiveness of weight management interventions in children: a targeted systematic review for the USPSTF. Pediatrics. 2010 Feb;125 (2): e396-e418. doi: 10.1542/peds.2009-1955. Epub 2010 Jan 18. Review. PMID: 20083531.