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Tables
- Table 1:
Overview of literature reviews that will address research questions to inform the guideline
Question Review type Study designs included Comparison Follow-up duration (after baseline) Potential outcomes* Potential subgroups and sensitivity analysis* 1. What are values, preferences, perceptions, attitudes and beliefs of children and adolescents with obesity and their caregivers regarding the benefits and harms (in the context of important health-related outcomes) of obesity management strategies? Systematic review Any NA NA Perceptions, experiences, attitudes, beliefs and expectations
Children, adolescents and parents
Sex, gender
Ethnicity, culture, SES
Typical v. atypical growth and development (physical or cognitive delay or disability)
2. What tools, processes and procedures are recommended by expert groups for the clinical assessment of children and adolescents with obesity? What are the gaps in the existing guidelines? Scoping review, with stakeholder consultation Any NA NA Edmonton Obesity Staging System for Pediatrics, (23) including the 4 Ms (metabolic health, mental health, mechanical health and social milieu)
Children, adolescents, and parents
Sex, gender
Ethnicity, culture, SES
Typical v. atypical growth and maturation (physical or cognitive delay or disability)
Communication and terminology
Weight bias and stigma
Screening, enrolment and follow-up
3. Among children and adolescents with obesity, what is the effect of psychological and behavioural change interventions (see Appendix 1 for definition) on health outcomes deemed important to stakeholders, including families, clinicians and researchers? Systematic review and meta-analysis Randomized controlled trials Any nonactive (e.g., wait-list control) or active (e.g., standard care) alternative management strategies Immediate post and longest follow-up (closest to 12 mo) Anthropometry (e.g., body weight, BMI, WC)
Cardiometabolic risk factors (e.g., blood pressure, insulin resistance, HDL-C)
Outcomes reported by patients or proxies (caregivers) (e.g., anxiety, depression, health-related quality of life)
Adverse events
Age
Weight status
Sex, gender
Risk of bias
If we identify studies that reported data at ≥ 16 mo, we will assess the 12-mo estimate with and without these data
4. Among children and adolescents with obesity, what is the effect of pharmacotherapeutic interventions on health outcomes deemed important to stakeholders, including families, clinicians and researchers? Systematic review and meta-analysis Randomized controlled trials Any nonactive (e.g., wait list control) or active (e.g., standard care) alternative management strategies Immediate post and longest follow-up (closest to 12 mo) Anthropometry (e.g., body weight, BMI, WC)
Cardiometabolic risk factors (e.g., blood pressure, insulin resistance, HDL-C)
Outcomes reported by patients or proxies (caregivers) (e.g., anxiety, depression, health-related quality of life)
Adverse events
Age
Weight status
Sex, gender
Risk of bias
If we identify studies that reported data at ≥ 16 mo, we will assess the 12-mo estimate with and without these data
5. Among children and adolescents with obesity, what is the effect of bariatric surgery interventions on health outcomes deemed important to stakeholders, including families, clinicians and researchers? Systematic review and meta-analysis Randomized controlled trials, prospective or retrospective cohort studies and other observational studies Any nonactive (e.g., wait list control) or active (e.g., standard care) alternative management strategies For the weight outcomes up to 12 mo; 18-mo and longest follow-up; for other outcomes up to 18 mo Anthropometry (e.g., body weight, BMI, WC)
Cardiometabolic risk factors (e.g., blood pressure, insulin resistance, HDL-C)
Outcomes reported by patients or proxies (caregivers) (e.g., anxiety, depression, health-related quality of life)
Adverse events
Age
Weight status
Sex, gender
Risk of bias
If we identify studies that reported data at ≥ 16 mo, we will assess the 12-mo estimate with and without these data
Note: BMI = body mass index, HDL-C = high-density lipoprotein cholesterol, NA = not applicable, SES = socioeconomic status, WC = waist circumference.
↵* Potential outcomes and subgroups will be determined on the basis of data derived from surveys with stakeholders (parents, clinicians and researchers).
Implications Strong recommendation Weak recommendation For patients Most people in this situation would want the recommended course of action and only a small proportion would not. Most people in this situation would want the suggested course of action, but many would not. For clinicians Most people should receive the recommended course of action. Adherence to this recommendation according to the guideline could be used as a quality criterion or performance indicator. Formal decision aids are not likely to be needed to help people make decisions consistent with their values and preferences. Clinicians should recognize that different choices will be appropriate for different patients and that they must help each patient arrive at a management decision consistent with her or his values and preferences. Decision aids may be useful to help people to make decisions consistent with their values and preferences. Clinicians should expect to spend more time with patients when working toward a decision. For policy-makers The recommendation can be used to develop policy (e.g., taxation of products high in sugar or salt). Policy-making will require substantial debates and involvement of many stakeholders. Policies are also more likely to vary between regions. Performance indicators would have to focus on the fact that adequate deliberation about the management options has taken place.
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