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Effectiveness of Weight Management Interventions in Children: A Targeted Systematic Review for the USPSTF Evelyn P. Whitlock, Elizabeth A. O'Connor, Selvi B. Williams, Tracy L. Beil and Kevin W. Lutz Pediatrics 2010;125;e396-e418; originally published online Jan 18, 2010; DOI: 10.1542/peds.2009-1955

The online version of this article, along with updated information and services, is located onthe World Wide Web at: http://www.pediatrics.org/cgi/content/full/125/2/e396

PEDIATRICS is the official journal of the American Academy of Pediatrics. A monthly publication, it has been published continuously since 1948. PEDIATRICS is owned, published, and trademarked by the American Academy of Pediatrics, 141 Northwest Point Boulevard, Elk Grove Village, Illinois, 60007. Copyright © 2010 bythe American Academy of Pediatrics. All rights reserved. Print ISSN: 0031-4005. Online ISSN: 1098-4275.

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Effectiveness of Weight Management Interventions in Children: A Targeted Systematic Review for the USPSTF abstract
CONTEXT: Targeted systematic review to support the updated US Preventive Services Task Force (USPSTF) recommendationon 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, referencelists 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. Investigatorsabstracted 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/m2 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/m2 for orlistat) or moderate (2.6 kg/m2 for sibutramine) BMI reduction in obese adolescents on active medication; however, no studiesfollowed 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 12 years. CONCLUSIONS: Over the past several years, research into weight management in obese children and adolescents has improvedin 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. Pediatrics 2010;125:e396–e418
AUTHORS: Evelyn P. Whitlock, MD, MPH, Elizabeth A. O’Connor, PhD, Selvi B. Williams, MD, MPH, Tracy L. Beil, MS, and Kevin W. Lutz, MFA
Center for HealthResearch, Kaiser Permanente, Portland, Oregon; and Oregon Evidence-Based Practice Center, Portland, Oregon KEY WORDS obesity, primary care, treatment, children, adolescents ABBREVIATIONS USPSTF—US Preventive Services Task Force FDA—Food and Drug Administration KQ— key question NICE—National Institute for Health and Clinical Excellence AHRQ—Agency for Healthcare Quality and Research SDS—standard...