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Treatment of Pediatric Obesity: An Umbrella Systematic Review
Tamim Rajjo1,2, Khaled Mohammed1,3, Mouaz Alsawas1,3
1Evidence-Based Practice Center, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery.
Insights
Several childhood obesity interventions effectively improve health outcomes. Comprehensive, multicomponent approaches yield the best results for pediatric weight management and related health markers.
Area of Science:
- Pediatric Endocrinology
- Public Health Nutrition
- Evidence-Based Medicine
Background:
- Childhood obesity is a growing public health concern with significant health implications.
- Numerous interventions exist to manage excess body weight in children.
- Evaluating the evidence quality and effectiveness of these interventions is crucial.
Purpose of the Study:
- To appraise the quality of evidence for pediatric obesity interventions.
- To assess the effectiveness of interventions on various obesity-related outcomes.
- To identify the most effective strategies for childhood weight management.
Main Methods:
- Systematic search for systematic reviews of randomized controlled trials (RCTs) in pediatric obesity interventions.
- Inclusion criteria: interventions lasting ≥6 months.
- Quality assessment using the GRADE approach (Grading of Recommendation, Assessment, Development, and Evaluation).
Main Results:
- Physical activity, dietary, educational, pharmacological, and surgical interventions showed varied effects on anthropometric and metabolic outcomes.
- Pharmacological interventions had mixed results, with some improving BMI but increasing blood pressure.
- Surgical interventions and comprehensive multicomponent interventions demonstrated significant BMI reduction.
- Combined interventions (diet, physical activity, behavioral therapy, education) effectively reduced BMI, blood pressure, and triglycerides.
Conclusions:
- Multiple childhood obesity interventions are effective for improving metabolic and anthropometric measures.
- Comprehensive, multicomponent interventions appear to offer the most significant overall benefits.
- Evidence quality varies across interventions, highlighting the need for robust research.
Objective:
Multiple interventions are available to reduce excess body weight in children. We appraised the quality of evidence supporting each intervention and assessed the effectiveness on different obesity-related outcomes.
Methods:
We conducted a systematic search for systematic reviews of randomized controlled trials evaluating pediatric obesity interventions applied for ≥6 months. We assessed the quality of evidence for each intervention using GRADE (Grading of Recommendation, Assessment, Development, and Evaluation) approach.
Results:
From 16 systematic reviews, we identified 133 eligible randomized controlled trials. Physical activity interventions reduced systolic blood pressure and fasting glucose (low to moderate quality of evidence). Dietary interventions with low-carbohydrate diets had a similar effect to low-fat diets in terms of body mass index (BMI) reduction (moderate quality of evidence). Educational interventions reduced waist circumference, BMI, and diastolic blood pressure (low quality of evidence). Pharmacological interventions reduced BMI (metformin, sibutramine, orlistat) and waist circumference (sibutramine, orlistat) and increased high-density lipoprotein cholesterol (sibutramine) but also raised systolic and diastolic blood pressure (sibutramine). Surgical interventions (laparoscopic adjustable gastric banding, Roux-en-Y gastric bypass, sleeve gastrectomy) resulted in the largest BMI reduction (moderate quality of evidence). Combined interventions consisting of dietary modification, physical activity, behavioral therapy, and education significantly reduced systolic and diastolic blood pressure, BMI, and triglycerides. Combined parent-child interventions and parent-only interventions had similar effects on BMI (low quality of evidence).
Conclusions:
Several childhood obesity interventions are effective in improving metabolic and anthropometric measures. A comprehensive multicomponent intervention, however, appears to have the best overall outcomes.