Leslie A Sim1, Jocelyn Lebow2,3, Zhen Wang4, Afton Koball5, M Hassan Murad4. 1. Departments of Psychiatry and Psychology, and sim.leslie@mayo.edu. 2. Departments of Psychiatry and Psychology, and. 3. Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, Florida; and. 4. Evidence-Based Practice Center and Center for Science of Healthcare Delivery, Mayo Clinic, Rochester, Minnesota. 5. Gundersen Lutheran Health System, Department of Behavioral Health, LaCrosse, Wisconsin.
Abstract
CONTEXT: Although practice guidelines suggest that primary care providers working with children and adolescents incorporate BMI surveillance and counseling into routine practice, the evidence base for this practice is unclear. OBJECTIVE: To determine the effect of brief, primary care interventions for pediatric weight management on BMI. DATA SOURCES: Medline, CENTRAL, Embase, PsycInfo, and CINAHL were searched for relevant publications from January 1976 to March 2016 and cross-referenced with published studies. STUDY SELECTION: Eligible studies were randomized controlled trials and quasi-experimental studies that compared the effect of office-based primary care weight management interventions to any control intervention on percent BMI or BMI z scores in children aged 2 to 18 years. DATA EXTRACTION: Two reviewers independently screened sources, extracted data on participant, intervention, and study characteristics, z-BMI/percent BMI, harms, and study quality using the Cochrane and Newcastle-Ottawa risk of bias tools. RESULTS: A random effects model was used to pool the effect size across eligible 10 randomized controlled trials and 2 quasi-experimental studies. Compared with usual care or control treatment, brief interventions feasible for primary care were associated with a significant but small reduction in BMI z score (-0.04, [95% confidence interval, -0.08 to -0.01]; P = .02) and a nonsignificant effect on body satisfaction (standardized mean difference 0.00, [95% confidence interval, -0.21 to 0.22]; P = .98). LIMITATIONS: Studies had methodological limitations, follow-up was brief, and adverse effects were not commonly measured. CONCLUSIONS: BMI surveillance and counseling has a marginal effect on BMI, highlighting the need for revised practice guidelines and the development of novel approaches for providers to address this problem.
CONTEXT: Although practice guidelines suggest that primary care providers working with children and adolescents incorporate BMI surveillance and counseling into routine practice, the evidence base for this practice is unclear. OBJECTIVE: To determine the effect of brief, primary care interventions for pediatric weight management on BMI. DATA SOURCES: Medline, CENTRAL, Embase, PsycInfo, and CINAHL were searched for relevant publications from January 1976 to March 2016 and cross-referenced with published studies. STUDY SELECTION: Eligible studies were randomized controlled trials and quasi-experimental studies that compared the effect of office-based primary care weight management interventions to any control intervention on percent BMI or BMI z scores in children aged 2 to 18 years. DATA EXTRACTION: Two reviewers independently screened sources, extracted data on participant, intervention, and study characteristics, z-BMI/percent BMI, harms, and study quality using the Cochrane and Newcastle-Ottawa risk of bias tools. RESULTS: A random effects model was used to pool the effect size across eligible 10 randomized controlled trials and 2 quasi-experimental studies. Compared with usual care or control treatment, brief interventions feasible for primary care were associated with a significant but small reduction in BMI z score (-0.04, [95% confidence interval, -0.08 to -0.01]; P = .02) and a nonsignificant effect on body satisfaction (standardized mean difference 0.00, [95% confidence interval, -0.21 to 0.22]; P = .98). LIMITATIONS: Studies had methodological limitations, follow-up was brief, and adverse effects were not commonly measured. CONCLUSIONS: BMI surveillance and counseling has a marginal effect on BMI, highlighting the need for revised practice guidelines and the development of novel approaches for providers to address this problem.
Authors: Mona Sharifi; Calvin Franz; Christine M Horan; Catherine M Giles; Michael W Long; Zachary J Ward; Stephen C Resch; Richard Marshall; Steven L Gortmaker; Elsie M Taveras Journal: Pediatrics Date: 2017-11 Impact factor: 7.124
Authors: Elizabeth Yakes Jimenez; Amanda Harris; Donald Luna; Daniel Velasquez; Jonathan Slovik; Alberta Kong Journal: J Community Health Date: 2017-06
Authors: Nancy E Sherwood; Rona L Levy; Elisabeth M Seburg; A Lauren Crain; Shelby L Langer; Meghan M JaKa; Alicia Kunin-Batson; Robert W Jeffery Journal: Pediatr Obes Date: 2019-03-14 Impact factor: 4.000
Authors: Elsie M Taveras; Richard Marshall; Mona Sharifi; Earlene Avalon; Lauren Fiechtner; Christine Horan; Monica W Gerber; E John Orav; Sarah N Price; Thomas Sequist; Daniel Slater Journal: JAMA Pediatr Date: 2017-08-07 Impact factor: 16.193