Managing obesity in children: a clinical practice guideline.
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Ball Geoff D C, Merdad Roah, Birken Catherine S, Cohen Tamara R, Goodman Brenndon, Hadjiyannakis Stasia, Hamilton Jill, Henderson Mélanie, Lammey John, Morrison Katherine M, Moore Sarah A, Mushquash Aislin R, Patton Ian, Pearce Nicole, Ramjist Joshua K, Lebel Tracy Rhyason, Timmons Brian W, Buchholz Annick, Cantwell Jennifer, Cooper Jennifer, Erdstein Julius, Fitzpatrick-Lewis Donna, Hatanaka Dawn, Lindsay Patrice, Sajwani Tasneem, Sebastianski Meghan, Sherifali Diana, Pierre Julie St, Ali Muhammad Usman, Wijesundera Jessica, Alberga Angela S, Ausman Christine, Baluyot Trisha C, Burke Emily, Dadgostar Kara, Delacruz Bronwyn, Dettmer Elizabeth, Dymarski Maegan, Esmaeilinezhad Zahra, Hale Ilona, Harnois-Leblanc Soren, Ho Josephine, Gehring Nicole D, Kucera Marsha, Langer Jacob C, McPherson Amy C, Naji Leen, Oei Krista, O'Malley Grace, Rigsby Angelica M, Wahi Gita, Zenlea Ian S, Johnston Bradley C
Аннотация
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.