Guidelines for treating child and adolescent obesity: A systematic review

Abstract

Obesity is a chronic disease that compromises the physical and mental health of an increasing proportion of children globally. In high-income countries, prevalence of paediatric obesity is increasing faster in those from marginalised populations such as low-income households, suggesting the disease as one that is largely systemic. Appropriate treatment should be prioritised in these settings to prevent the development of complications and co-morbidities and manage those that already exist. An array of clinical practice guidelines are available for managing overweight and obesity in children and adolescents, but no systematic review has yet compared their quality or synthesised their recommendations. We aimed to narratively review clinical practice guidelines published in English for treating child and adolescent obesity, to identify the highest quality guidelines, and assess similarities, conflicts, and gaps in recommendations. We systematically searched academic databases and grey literature for guidelines published. We used the AGREE II tool to assess the quality, and identified nine high quality guidelines for inclusion in a narrative review of recommendations. Guidelines predominantly recommended the delivery of multi-component behaviour-change interventions aimed at improving nutrition and physical activity. Treatment outcomes were generally focussed on weight, with less emphasis on managing complications or improving quality-of-life. There was no evidence-based consensus on the best mode of delivery, setting, or treatment format. The guidelines rarely included recommendations for addressing the practical or social barriers to behaviour change, such as cooking skills or supervised physical activity. There is insufficient evidence to evaluate pharmaceutical and surgical interventions in children, and these were generally not recommended. It should be noted that this review addressed documents published in English only, and therefore the included guidelines were applicable predominantly to high-resource settings.

Validation of a Useful Tool for Screening for Overweight and Obesity in Pre-Adolescents

“…Their incidence and prevalence have increased worldwide [3]. The drastic rise in the prevalence of childhood overweight and obesity in recent years is due to significant changes in lifestyle and eating habits in childhood, as well as the promotion of an obesogenic environment that promotes and further encourages the incidence of obesity [4].…”

Clinical practice guidelines for the management of overweight and obesity published internationally: A scoping review

“…Clinical practice guidelines are "statements that include recommendations intended to optimize patient care that are informed by a systematic review of evidence and an assessment of the benefits and harms of alternative care options." 4 Several reviews of guidelines for the clinical management of overweight and obesity in children and adolescents 5,6 and adults 7 have been conducted. Two common areas of focus within these reviews are (a) diagnostic criteria for overweight and obesity, and (b) treatment options for these conditions.…”

“…For children and adolescents, all guidelines included in one review recommended using body mass index (BMI) percentiles or standardized BMI scores based on various reference groups for determining whether children and adolescents have overweight or obesity. 5,6 A multidisciplinary response for the clinical management of people with overweight and obesity was typically recommended. For children and adolescents, multicomponent lifestyle interventions comprising diet, physical activity, and behavioral modification have been recommended as first-line treatments.…”

“…For children and adolescents, multicomponent lifestyle interventions comprising diet, physical activity, and behavioral modification have been recommended as first-line treatments. 5,6 Reviewers identified that, due to limited evidence, pharmaceutical and surgical options are generally not recommended for these populations. 6 For adults, guidelines recommended that multidisciplinary teams manage overweight and obesity as a chronic disease.…”

“…5,6 Reviewers identified that, due to limited evidence, pharmaceutical and surgical options are generally not recommended for these populations. 6 For adults, guidelines recommended that multidisciplinary teams manage overweight and obesity as a chronic disease. 7 Within these guidelines, multicomponent lifestyle interventions-comprising diet, physical activity, and strategies to support behavior change for at least 6 to 12 months-have been recommended.…”