Interventions for high body mass index in children and adolescents : an evidence update for the U.S. Preventive Services Task Force / Elizabeth O'Connor [and five others].

Format:

Book

Author/Creator:

O'Connor, Elizabeth, author.

Language:

English

Subjects (All):

Obesity--Social aspects.

Obesity.

Physical Description:

1 online resource (viii, 364 pages) : illustrations

Other Title:

Interventions for high body mass index in children and adolescents

Place of Publication:

Rockville, MD : Agency for Healthcare Research and Quality, 2024.

Summary:

OBJECTIVE: To examine the benefits and harms of weight management interventions in healthcare settings among children and adolescents with high body mass index (BMI). DATA SOURCES: MEDLINE via Ovid, PsycINFO via Ovid, and the Cochrane Central Registry of Controlled Trials through January 12, 2023; ongoing surveillance through August 2, 2023. STUDY SELECTION: English-language studies of benefit or harm of weight management interventions (behavioral, liraglutide, semaglutide, orlistat, phentermine/topiramate) among children ages 2 to 18 years with high BMI (e.g., ≥85th or ≥95th percentile for age and sex) conducted in or recruited from healthcare settings. DATA ANALYSIS: Outcomes with sufficient evidence for meta-analysis were pooled using random-effects models, stratified by estimated intervention contact hours. RESULTS: Fifty-eight randomized, controlled trials (RCTs) were included (N=10,143): 50 trials of behavioral interventions (N=8,798), three of liraglutide (N=296), two of orlistat (N=579), two of phentermine/topiramate (N=269), and one of semaglutide (N=201). Behavioral weight management interventions were associated with small reductions in BMI and other weight-related outcomes after 6 to 12 months (mean difference in change between groups [MD], −0.7 kg/m2 [95% CI, −1.0 to −0.3]; 28 RCTs [n=4,494]; I2=86.8%). Larger effects were seen in interventions with higher contact hours and that offered physical activity sessions. Reporting was sparse for other outcomes, and very few found statistically significant improvements in health outcomes (quality of life, depression, social adjustment), cardiometabolic, or behavioral outcomes. Pooled analyses showed that trials offering 26 or more hours of intervention contact, which typically included physical activity sessions, found improvements in blood pressure (e.g., MD in systolic blood pressure, −3.6 mm Hg [95% CI, −5.7 to −1.5]; 8 RCTs [n=773]; I2=47.3%) and fasting plasma glucose (MD, −1.9 mg/dL [95% CI, −2.7 to −1.2]; 4 RCTs [n=367]; I2=0%) after 6 to 12 months. Semaglutide and phentermine/topiramate had the largest effects on BMI, (e.g., MD, −6.0 kg/m2 [95% CI, −7.3 to −4.6]; 1 RCT [n=201] for semaglutide; MD, −5.4 kg/m2 [95% CI, −6.4 to −4.3]; 1 RCT [n=227] for 15 mg/92 mg phentermine/topiramate). Effects on BMI were smaller after 12 to 13 months for liraglutide (MD, −1.6 kg/m2 [95% CI, −2.5 to −0.7]; 1 RCT [n=251]) and orlistat (e.g., MD, −0.9 kg/m2 [95% CI not reported]; p<0.001; n=539). Weight outcomes were either not reported after medication discontinuation or showed immediate weight increase after discontinuation. Semaglutide was associated with improved quality of life (MD, 5.3 [95% CI, 0.2 to 8.3] on a 100-point scale), but none of the other pharmacotherapy studies found between-group differences in quality of life or depression incidence after 6 to 13 months. Semaglutide and phentermine/topiramate improved one or more lipid measures, but there was little to no improvement in other cardiometabolic outcomes with pharmacotherapy. Gastrointestinal side effects were common among patients taking liraglutide, semaglutide, and orlistat, and the most common side effects reported with phentermine/topiramate were musculoskeletal and psychiatric, when taken at doses of 15 mg/92 mg. Discontinuation due to adverse effects occurred in 10.4 percent of participants taking liraglutide, ranged from 0.9 to 15.4 percent with 15 mg/92 mg of phentermine/topiramate, but was relatively rare with semaglutide, orlistat, and 7.5 mg/46 mg of phentermine/topiramate (less than 5% in all groups). Serious adverse effects were rare for all medications and did not differ between groups in any study. No evidence was available on adverse effects beyond 1 month after medication discontinuation, and no longer than 17 months for any medication. LIMITATIONS: Data on behavioral interventions were extremely limited beyond 12 to 13 months. Very limited evidence showed weight rebounding after medication was discontinued, and there was no evidence on harms of medications beyond 17 months. CONCLUSIONS: In the short term, weight management interventions led to lower weight in children and adolescents with effects that ranged in size from modest (for behavioral interventions, orlistat, and liraglutide) to substantial (for semaglutide and phentermine/topiramate), with no evidence of serious harm and small to no impact on health, behavioral, or intermediate cardiometabolic outcomes. Evidence is lacking about how weight management interventions affect weight beyond 1 year and after medication discontinuation, the longer-term impacts on psychosocial outcomes, and adverse events associated with pharmacotherapy.

Contents:

Acknowledgments

Chapter 1. Introduction

Purpose

Terminology and Measures

Prevalence

Association of Weight Loss and BMI With Health Outcomes

Harms Associated With Diagnosing Children as Being Overweight or Having Obesity and the Harms of Weight Stigma and Weight Bias

Etiology and Risk Factors

Prevalence of Potentially Weight-Related Behaviors in Children and Adolescents

Recommended Interventions

Previous USPSTF Recommendation

Chapter 2. Methods

Scope and Purpose

Key Questions and Analytic Framework

Data Sources and Searches

Study Selection

Quality Assessment and Data Abstraction

Data Synthesis and Analysis

Grading the Strength of the Body of Evidence

Contextual Questions

Expert Review and Public Comment

USPSTF and AHRQ Involvement

Chapter 3. Results

Overview of Included Studies

Description of Included Studies

KQ1. Do Primary Care-Relevant Behavioral, Pharmacotherapy, or Combined Weight Management Interventions for Children and Adolescents With Higher BMI Improve Health Outcomes?

KQ2. Do Primary Care-Relevant Behavioral, Pharmacotherapy, or Combined Weight Management Interventions for Children and Adolescents With Higher BMI Affect Weight Outcomes or Cardiometabolic Outcomes?

KQ3. Do Primary Care-Relevant Behavioral, Pharmacotherapy, or Combined Weight Management Interventions for Children and Adolescents With Higher BMI Improve Behavioral Outcomes?

KQ4. Are There Harms Associated With Weight Management Interventions for Children and Adolescents?

Contextual Findings

Chapter 4. Discussion

Summary of Evidence

Long-Term Weight Maintenance

Potential Harms of Weight Management Interventions

Evidence on Health Benefits of Weight Loss

Approaches for Improving the Health of Children and Adolescents With High Weight

Applicability of the Included Studies to the U.S. Population

Methodologic Differences Between the Previous and Current Reviews

Limitations of Our Review

Future Research Needs

Conclusion

References

Appendixes

Appendix A. Detailed Methods

Appendix B. Included Studies

Appendix C. Excluded Studies

Appendix D. Evidence Tables

Appendix E. Additional Figures

Appendix F. Ongoing Studies.

Notes:

Description based on publisher supplied metadata and other sources.