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Managing obesity in children: a clinical practice guideline
Geoff D C Ball1, Roah Merdad2, Catherine S Birken2
1Department of Pediatrics, Faculty of Medicine & Dentistry, College of Health Sciences (Ball, Wijesundera), University of Alberta, Edmonton, Alta.; Department of Community Medicine, Faculty of Medicine (Merdad), King Abdulaziz University, Jeddah, Saudi Arabia; The Hospital for Sick Children and Department of Pediatrics (Birken), University of Toronto, Toronto, Ont.; Faculty of Land and Food Systems, Food, Nutrition and Health (Cohen), University of British Columbia, Vancouver, BC; Youth representative (Goodman), Toronto, Ont.; Department of Pediatrics, Faculty of Medicine (Hadjiyannakis), Children's Hospital of Eastern Ontario Research Institute, University of Ottawa, Ottawa, Ont.; Division of Endocrinology, Hospital for Sick Children, Department of Paediatrics, University of Toronto (Hamilton), Toronto, Ont.; Department of Pediatrics, Université de Montréal and Centre de Recherche CHU Sainte-Justine and School of Public Health, Department of Social and Preventive Medicine, Université de Montréal (Henderson), Montréal, Que.; Family representative (Lammey), Ottawa, Ont.; Department of Pediatrics, Centre for Metabolism, Obesity and Diabetes Research (Morrison), McMaster University, Hamilton, Ont.; Dalhousie University (Moore), Halifax, NS; Department of Psychology (Mushquash), Lakehead University, Thunder Bay, Ont.; Obesity Canada (Patton, Pearce), Edmonton, Alta.; Division of General & Thoracic Surgery, The Hospital for Sick Children and Department of Surgery, Temerty School of Medicine, University of Toronto (Ramjist), Toronto, Ont.; Family representative (Lebel), Edmonton, Alta.; McMaster University (Timmons), Hamilton, Ont.; Children's Hospital for Eastern Ontario (Buchholz), Ottawa, Ont.; Family representative (Cantwell, Cooper), Toronto, Ont.; McGill University (Erdstein), Montréal, Que.; School of Nursing, Faculty of Health Sciences (Fitzpatrick-Lewis, Sherifali), McMaster University, Hamilton, Ont.; University of Alberta (Hatanaka), Edmonton, Alta.; Heart and Stroke Foundation (Lindsay), Toronto, Ont.; Edmonton Weight Management Centre & Family Clinic (Sajwani), Edmonton, Alta.; Cochrane Collaboration (Sebastianski), Edmonton, Alta.; Department of Pediatrics (St. Pierre), McGill University, Montréal, Que.; Department of Health Research, Evidence and Impact, Faculty of Health Sciences (Ali), McMaster University, Hamilton, Ont.; Department of Health, Kinesiology, and Applied Physiology (Alberga, Baluyot), Concordia University, Montréal, Que.; School of Health and Human Performance, Faculty of Health (Ausman), Dalhousie University, Halifax, NS; University of Calgary (Delacruz, Kucera), Calgary, Alta.; School of Health and Human Performance (Burke), Dalhousie University, Halifax, NS; Lakehead University (Dadgostar), Thunder Bay, Ont.; The Hospital for Sick Children (Dettmer, Langer, Oei), Toronto, Ont.; Department of Psychology (Dymarski), Carleton University, Ottawa, Ont.; Department of Nutrition, College of Agriculture and Life Sciences (Esmaeilinezhad, Johnston, Rigsby), Texas A&M University, College Station, Tex.; University of British Columbia (Hale), Kimberley, BC; Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute (Harnois-Leblanc), Boston, Mass.; Centre de recherche Azrieli, CHU Sainte-Justine (Harnois-Leblanc), Montréal, Que.; Division of Endocrinology, Department of Pediatrics, Cumming School of Medicine (Ho), University of Calgary, Calgary, Alta.; School of Public Health, College of Health Sciences (Gehring), University of Alberta, Edmonton, Alta.; Holland Bloorview Rehabilitation Hospital (McPherson), Toronto, Ont.; Department of Family Medicine (Naji), McMaster University, Hamilton, Ont.; School of Physiotherapy (O'Malley), Royal College of Surgeons in Ireland, University of Medicine and Health Sciences, Dublin, Ireland; Department of Pediatrics (Wahi), McMaster University, McMaster Children's Hospital, Hamilton, Ont.; Institute for Better Health (Zenlea), Trillium Health Partners, Mississauga, Ont. gdball@ualberta.ca bjohnston@dal.ca.
Background:
Obesity is a complex, chronic, stigmatized disease whereby abnormal or excess body fat may impair health or increase the risk of medical complications, and can reduce quality of life and shorten lifespan in children and families. We developed this guideline to provide evidence-based recommendations on options for managing pediatric obesity that support shared decision-making among children living with obesity, their families, and their health care providers.
Methods:
We followed the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. We used the Guidelines International Network principles to manage competing interests. Caregivers, health care providers, and people living with obesity participated throughout the guideline development process, which optimized relevance. We surveyed end users (caregivers, health care providers) to prioritize health outcomes, completed 3 scoping reviews (2 on minimal important difference estimates; 1 on clinical assessment), performed 1 systematic review to characterize families' values and preferences, and conducted 3 systematic reviews and meta-analyses to examine the benefits and harms of behavioural and psychological, pharmacologic, and surgical interventions for managing obesity in children. Guideline panellists developed recommendations focused on an individualized approach to care by using the GRADE evidence-to-decision framework, incorporating values and preferences of children living with obesity and their caregivers.
Recommendations:
Our guideline includes 10 recommendations and 9 good practice statements for managing obesity in children. Managing pediatric obesity should be guided by a comprehensive child and family assessment based on our good practice statements. Behavioural and psychological interventions, particularly multicomponent interventions (strong recommendation, very low to moderate certainty), should form the foundation of care, with tailored therapy and support using shared decision-making based on the potential benefits, harms, certainty of evidence, and values and preferences of children and families. Pharmacologic and surgical interventions should be considered (conditional recommendation, low to moderate certainty) as therapeutic options based on availability, feasibility, and acceptability, and guided by shared decision-making between health care providers and families.
Interpretation:
This guideline will support children, families, and health care providers to have informed discussions about the balance of benefits and harms for available obesity management interventions to support value- and preference-sensitive decision-making.
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