Better results for pediatric weight programs led by health care pros vs. laypeople
Click Here to Manage Email Alerts
Children with overweight or obesity had a short-term decrease in weight and BMI with professional-led interventions vs. standard care, but weight loss was not sustained long term, according to a study published in JAMA Network Open.
Interventions led by non-health care professionals were not associated with weight loss.
“Intensive behavioral lifestyle therapy is considered the cornerstone for treatment of obesity in this age group,” Jonathan McGavock, PhD, associate professor in the department of pediatrics and child health at the University of Manitoba and an investigator at the Children’s Hospital Research Institute of Manitoba in Canada, and colleagues wrote. “While efficacious, these approaches are costly and often impractical in real-world settings. Less intensive interventions delivered in community settings are less costly but often yield less significant weight loss.”
McGavock and colleagues conducted a systematic review and meta-analysis of 78 randomized clinical trials of weight-loss interventions done over a period of at least 12 weeks with children with overweight or obesity (n = 5,780; mean age, 1-12 years in 58 trials, 13-18 years in 25 trials; no mean age reported in 3 trials). The trials came from several data sources published between January 1996 and June 2019.
The randomized clinical trials were classified into three comparisons: professional-led vs. standard, layperson-led vs. standard and professional-led vs. layperson-led. Professional-led behavioral interventions were led by health care professionals such as dietitians, nurses, kinesiologists and physicians. Layperson-led interventions included the involvement of nonprofessionals from the child’s community, family, school or neighborhood. Standard of care interventions were classified as those who received recommendations for behavior change but did not have additional support.
Using random-effects network meta-analysis, researchers found that professional-led behavioral interventions were associated with decreases in weight (standardized mean difference [SMD] = –1.6 kg; P < .001), BMI (SMD = –0.3 kg/m2; P < .001), body fat percentage (SMD = –1.7%; P < .001) and waist circumference (SMD = –1.3 cm; P < .001) when compared with standard care.
Layperson-led interventions were not associated with a loss in weight or BMI or reductions in body fat or waist circumference compared with standard care.
No differences were observed in trials comparing professional-led with layperson-led interventions in weight or BMI.
“There is some evidence that layperson- or peer-led approaches support positive behavioral change and improved health outcomes among adults living with obesity or obesity-related comorbidities,” researchers wrote. “Layperson- or community-led interventions have proved to be associated with low-resource areas or settings in which culturally tailored approaches are preferred by community members. The meta-analysis conducted here found that layperson-led behavioral trials were not associated with statistically significant reductions in body weight among children and adolescents living with obesity.”
Trials with prolonged follow-up did not show a long-term weight reduction in either professional-led or layperson-led care following the end of the intervention when compared with standard care. Professional- and layperson-led interventions were ranked equally for their association with absolute and relative weight loss during long-term follow-up.
Based on the findings, the researchers considered professional-led interventions the best approach for short-term absolute and relative weight loss, with layperson-led intervention ranked second.
Collapse
Read more about
Click Here to Manage Email Alerts