Effectiveness of primary care interventions for weight management in children and adolescents : an updated, targeted systematic review for the USPSTF / Evelyn P. Whitlock.

Format:

Book

Author/Creator:

Whitlock, Evelyn P., author.

Language:

English

Subjects (All):

Obesity in children--Prevention.

Obesity in children.

Primary health care.

Physical Description:

1 online resource (v, 66 pages)

Place of Publication:

Rockville, MD : Agency for Healthcare Research and Quality, 2010.

Summary:

OBJECTIVES: To examine behavioral and pharmacological weight management interventions for overweight (defined as BMI greater or equal to 85th to 94th percentile of age- and sex-specific norms) and/or obese (BMI greater or equal to 95th percentile) children and adolescents which are feasible to conduct in primary care settings or that may be available for referral from primary care in order to update an identified gap in the previous report on childhood obesity for the United States Preventive Services Task Force (USPSTF). DATA SOURCES: We identified two good quality systematic reviews published after the previous USPSTF review that addressed our research questions. We searched Ovid MEDLINE(r), PsycINFO, Database of Abstracts of Reviews of Effects, the Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, and Education Resources Information Center from 2005 (2003 for pharmacological studies) to June 10, 2008 to identify literature that was published after the search dates of prior relevant systematic reviews; we also examined reference lists of five other good-quality systematic reviews and of included trials, and considered experts' recommendations. From the two good quality systematic reviews and 2786 abstracts, we identified 25 trials in 30 publications that addressed our research questions. REVIEW METHODS: After review by two investigators against pre-determined inclusion/exclusion criteria, we included fair-to-good quality trials to evaluate the effects of treatment on weight and weight-related co-morbidities; we would have included large comparative cohort studies to evaluate longer term followup and harms of treatment if they had been available. Investigators abstracted data into standard evidence tables with abstraction checked by a second investigator. Studies were quality-rated by two investigators using established criteria. RESULTS: Available research primarily enrolled obese (rather than overweight) children and adolescents aged 4 to 18 years and no studies targeted those less than 4 years of age. Comprehensive behavioral interventions involving medium- to high-intensity interventions were the most effective behavioral approach and consistently resulted in small to moderate short-term improvements, with a weighted mean difference in BMI change of 2.4 kg/m2 between groups. More limited evidence suggests that these improvements can be maintained completely (or somewhat) over the 12 months following the end of treatments, and that there are few harms with behavioral interventions. Two medications (sibutramine, orlistat) combined with behavioral interventions resulted in small to moderate short-term weight loss in very obese adolescents (BMI reduction of 2.6 kg/m2 more than behavioral treatment plus placebo for sibutramine, 0.85 kg/m2 for orlistat); however, no studies followed weight changes after medication use ended. Potential side effects were greater than for behavioral interventions and varied in severity. Only one medication (orlistat) is FDA-approved for use in children and adolescents, and it is approved for prescription use in those 12 years and older. CONCLUSIONS: The research evaluating the treatment of obese children and adolescents has improved in terms of quality and quantity in the past several years. While there are still significant gaps in our understanding of obesity and overweight treatment in children and adolescents, current research suggests that behavioral interventions can be effective in managing weight in obese children and adolescents. Combined behavioral-pharmacological interventions may be useful in very obese adolescents, particularly if research confirms that weight loss is maintained.

Contents:

1. Introduction

Scope and Purpose

Background

2. Methods

Methods Synopsis

USPSTF Involvement

3. Results

KQ1. Do weight management programs (behavioral, combined behavioral and pharmacological) lead to BMI, weight, or adiposity stabilization or reduction in children and adolescents who are obese (≥95th BMI percentile) or overweight (84-94th percentile)?

KQ2. Do weight management programs (behavioral, combined behavioral and pharmacological) help children and adolescents who are initially obese or overweight maintain BMI, weight, or adiposity improvements after the completion of an active intervention?

KQ1a & 2a. Do behavioral or combined behavioral and pharmacological weight management programs lead to other positive outcomes (e.g., improved behavioral or physiological measures, decreased childhood morbidity, improved childhood functioning, or reduced adult morbidity and mortality)?

KQ1b & KQ2b. Do specific components of the weight management programs influence the effectiveness of the programs?

KQ1c & KQ2c. Are there population or environmental factors that influence the effectiveness of the weight management programs?

KQ3. What are the adverse effects of weight management programs (behavioral, combined behavioral and pharmacological) attempting to stabilize, reduce, or maintain BMI?

4. Discussion

Summary of Review Findings

Review Limitations

Contextual Issues/Next Steps

Future Research

Conclusions

References

Acronyms

Glossary

Appendix A Detailed Methods

Appendix B

Appendix C.

Notes:

Description based on publisher supplied metadata and other sources.