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Screening for Obesity and Interventions for Weight Management in Children and Adolescents

A Systematic Evidence Review for the U.S. Preventive Services Task Force

Evidence Synthesis, No. 150

Investigators: , PhD, , MPP, , MPH, , MPH, , PhD, and , MD, MPH.

Author Information and Affiliations
Rockville (MD): Agency for Healthcare Research and Quality (US); .
Report No.: 15-05219-EF-1

Structured Abstract

Background:

Overweight and obesity are common among children and adolescents in the United States, are associated with a number of negative health effects, and increase the likelihood of obesity in adulthood.

Purpose:

To systematically review the benefits and harms of screening for and treatment of obesity and overweight in children and adolescents.

Methods:

We searched MEDLINE, PubMed, PsycINFO, Cochrane Collaboration Registry of Controlled Trials, and the Education Resources Information Center through January 22, 2016 and examined references of relevant reviews. We included English-language studies of benefit or harm of screening for or treatment (behavior-based, orlistat, metformin) of overweight or obesity in children ages 2 to 18 years conducted in or recruited from health care settings. Two investigators independently reviewed titles and abstracts and full-text articles against prespecified inclusion and quality criteria and extracted data from all studies rated as fair or good quality. Weight outcomes were pooled using random effects meta-analyses for lifestyle-based weight loss management programs, stratified by estimated intervention contact hours, and for metformin.

Results:

Among 45 (n=7,099) behavior-based interventions, larger benefits were seen with higher contact hours. Lifestyle-based weight loss programs (including those aiming to minimize weight gain with growth in height) with an estimated 26 or more contact hours consistently demonstrated small average reductions in excess weight in children and adolescents who were overweight or had obesity compared with usual care or other control groups, with no evidence of causing harm. Relative reductions in body mass index (BMI) z-score (zBMI) of 0.20 or more were typical, with intervention groups typically showing absolute reductions of 0.20 or more, maintaining their baseline weight within approximately 5 lb on average. Control groups generally showed small increases or no change in zBMI, which typically equated to gaining 5 to 17 lb on average. The absolute amount of excess weight lost was highly variable within studies, suggesting a wide range of benefit. Interventions offering 52 or more contact hours showed fairly consistent improvements in blood pressure; pooled mean differences in change between groups were −6.4 mm Hg (95% CI, −8.6 to −4.2; k=6; I2=51%) for systolic blood pressure and −4.0 mm Hg (95% CI, −5.6 to −2.5; k=6; I2=17%) for diastolic blood pressure. There were mixed findings for insulin and glucose parameters and no benefit for lipids. Benefits in cardiometabolic outcomes were not observed in trials with fewer than 52 estimated contact hours and were sparely reported. Use of metformin (8 trials, n=616) and orlistat (3 trials, n=779) were associated with BMI reductions of −0.86 kg/m2 (95% CI, −1.44 to −0.29; k=6; I2=0%) for metformin and −0.50 to −0.94 kg/m2 for orlistat, representing very small BMI reductions of about 2 percent from baseline. Medications showed small to no benefit for intermediate cardiometabolic outcomes, including fasting glucose level. Metformin trials were primarily limited to youth with insulin or glucose metabolism abnormalities, most of whom met adult criteria for severe obesity. Nonserious harms were common with medication use, although discontinuation due to adverse effects was usually less than 5 percent. We found no direct evidence on benefits or harms of screening for excess weight in children and adolescents.

Conclusion:

Evidence suggests that lifestyle-based weight loss interventions with 26 or more contact hours are likely to help reduce excess weight in children and adolescents; average effect sizes were relatively small and highly variable. The clinical significance of the small benefit of medication use is unclear.

Contents

Prepared for: Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services1, Contract No. HHSA-290-2012-00015-I, Task Order No. 4. Prepared by: Kaiser Permanente Research Affiliates Evidence-based Practice Center2,

Suggested citation:

O’Connor EA, Evans CV, Burda BU, Walsh ES, Eder M, Lozano P. Screening for Obesity and Interventions for Weight Management in Children and Adolescents: A Systematic Evidence Review for the U.S. Preventive Services Task Force. Evidence Synthesis No. 150. AHRQ Publication No. 15-05219-EF-1. Rockville, MD: Agency for Healthcare Research and Quality; 2017.

This report is based on research conducted by the Kaiser Permanente Research Affiliates Evidence-based Practice Center (EPC) under contract to the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD (Contract No. HHSA-290-2012-00015-I, Task Order No. 4). The findings and conclusions in this document are those of the authors, who are responsible for its contents, and do not necessarily represent the views of AHRQ. Therefore, no statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services.

The information in this report is intended to help health care decisionmakers—patients and clinicians, health system leaders, and policymakers, among others—make well-informed decisions and thereby improve the quality of health care services. This report is not intended to be a substitute for the application of clinical judgment. Anyone who makes decisions concerning the provision of clinical care should consider this report in the same way as any medical reference and in conjunction with all other pertinent information (i.e., in the context of available resources and circumstances presented by individual patients).

This report may be used, in whole or in part, as the basis for development of clinical practice guidelines and other quality enhancement tools, or as a basis for reimbursement and coverage policies. AHRQ or U.S. Department of Health and Human Services endorsement of such derivative products may not be stated or implied.

1

5600 Fishers Lane, Rockville, MD 20857; www​.ahrq.gov

2

Kaiser Permanente Center for Health Research, Portland, OR

Bookshelf ID: NBK476325PMID: 29364619

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