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Effectiveness of weight management interventions in children: a targeted systematic review for the USPSTF
Evelyn P Whitlock1, Elizabeth A O'Connor, Selvi B Williams
1Center for Health Research, Kaiser Permanente, 3800 N Interstate Ave, Portland, OR 97227, USA. evelyn.whitlock@kpchr.org
Insights
Comprehensive behavioral interventions show short-term benefits for childhood obesity management. These weight management strategies are effective and have few harms for children and adolescents.
Area of Science:
- Pediatric Endocrinology
- Public Health
- Behavioral Science
Background:
- Obesity in children and adolescents is a growing public health concern.
- The US Preventive Services Task Force (USPSTF) requires updated evidence for screening recommendations.
Purpose of the Study:
- To evaluate the benefits and harms of behavioral and pharmacologic weight management interventions for overweight and obese youth.
- To inform updated USPSTF guidelines on childhood obesity screening.
Main Methods:
- Systematic review of 15 fair- to good-quality trials involving children and adolescents aged 4-18 years.
- Data sources included major medical and psychological databases, reference lists, and expert recommendations.
- Studies were assessed for quality, and data were abstracted into evidence tables.
Main Results:
- Comprehensive, medium-to-high intensity behavioral interventions demonstrated the most significant effectiveness, with BMI reductions of 1.9-3.3 kg/m² at 12 months.
- Behavioral interventions showed sustained effects post-treatment with minimal harms.
- Pharmacologic interventions combined with behavioral therapy yielded modest BMI reductions, but with greater potential adverse effects and limited long-term data.
Conclusions:
- Research on pediatric weight management has advanced in quality and quantity.
- Current evidence supports the short-term efficacy of intensive behavioral interventions for childhood obesity.
- Gaps in research remain, particularly regarding long-term outcomes and pharmacologic treatments.
Context:
Targeted systematic review to support the updated US Preventive Services Task Force (USPSTF) recommendation on screening for obesity in children and adolescents.
Objectives:
To examine the benefits and harms of behavioral and pharmacologic weight-management interventions for overweight and obese children and adolescents.
Methods:
Our data sources were Ovid Medline, PsycINFO, the Education Resources Information Center, the Database of Abstracts of Reviews of Effects, the Cochrane databases, reference lists of other reviews and trials, and expert recommendations. After 2 investigators reviewed 2786 abstracts and 369 articles against inclusion/exclusion criteria, we included 15 fair- to good-quality trials in which the effects of treatment on weight, weight-related comorbidities, and harms were evaluated. Studies were quality rated by 2 investigators using established criteria. Investigators abstracted data into standard evidence tables.
Results:
In the available research, obese (or overweight) children and adolescents aged 4 to 18 years were enrolled, and no studies targeted those younger than 4 years. Comprehensive behavioral interventions of medium-to-high intensity were the most effective behavioral approach with 1.9 to 3.3 kg/m(2) difference favoring intervention groups at 12 months. More limited evidence suggests that these improvements can be maintained over the 12 months after the end of treatments and that there are few harms with behavioral interventions. Two medications combined with behavioral interventions resulted in small (0.85 kg/m(2) for orlistat) or moderate (2.6 kg/m(2) for sibutramine) BMI reduction in obese adolescents on active medication; however, no studies followed weight changes after medication use ended. Potential adverse effects were greater than for behavioral interventions alone and varied in severity. Only 1 medication (orlistat) has been approved by the US Food and Drug Administration for prescription use in those aged > or =12 years.
Conclusions:
Over the past several years, research into weight management in obese children and adolescents has improved in quality and quantity. Despite important gaps, available research supports at least short-term benefits of comprehensive medium- to high-intensity behavioral interventions in obese children and adolescents.
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