title: Treatment of Pediatric Obesity: An Umbrella Systematic Review.
abstract: Multiple interventions are available to reduce excess body weight in children. We appraised the quality of evidence supporting each intervention and assessed the effectiveness on different obesity-related outcomes.
  
  
  
  We conducted a systematic search for systematic reviews of randomized controlled trials evaluating pediatric obesity interventions applied for ≥6 months. We assessed the quality of evidence for each intervention using GRADE (Grading of Recommendation, Assessment, Development, and Evaluation) approach.
  
  
  
  From 16 systematic reviews, we identified 133 eligible randomized controlled trials. Physical activity interventions reduced systolic blood pressure and fasting glucose (low to moderate quality of evidence). Dietary interventions with low-carbohydrate diets had a similar effect to low-fat diets in terms of body mass index (BMI) reduction (moderate quality of evidence). Educational interventions reduced waist circumference, BMI, and diastolic blood pressure (low quality of evidence). Pharmacological interventions reduced BMI (metformin, sibutramine, orlistat) and waist circumference (sibutramine, orlistat) and increased high-density lipoprotein cholesterol (sibutramine) but also raised systolic and diastolic blood pressure (sibutramine). Surgical interventions (laparoscopic adjustable gastric banding, Roux-en-Y gastric bypass, sleeve gastrectomy) resulted in the largest BMI reduction (moderate quality of evidence). Combined interventions consisting of dietary modification, physical activity, behavioral therapy, and education significantly reduced systolic and diastolic blood pressure, BMI, and triglycerides. Combined parent-child interventions and parent-only interventions had similar effects on BMI (low quality of evidence).
  
  
  
  Several childhood obesity interventions are effective in improving metabolic and anthropometric measures. A comprehensive multicomponent intervention, however, appears to have the best overall outcomes.
authors.affiliation: Evidence-Based Practice Center, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery.|Department of Family Medicine.
authors.forename: Tamim
authors.initials: T
authors.lastname: Rajjo
authors.affiliation: Evidence-Based Practice Center, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery.|Division of Preventive, Occupational and Aerospace Medicine, and.
authors.forename: Khaled
authors.initials: K
authors.lastname: Mohammed
authors.affiliation: Evidence-Based Practice Center, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery.|Division of Preventive, Occupational and Aerospace Medicine, and.
authors.forename: Mouaz
authors.initials: M
authors.lastname: Alsawas
authors.affiliation: Evidence-Based Practice Center, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery.
authors.forename: Ahmed T
authors.initials: AT
authors.lastname: Ahmed
authors.affiliation: Evidence-Based Practice Center, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery.|Division of Preventive, Occupational and Aerospace Medicine, and.
authors.forename: Wigdan
authors.initials: W
authors.lastname: Farah
authors.affiliation: Evidence-Based Practice Center, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery.|Division of Preventive, Occupational and Aerospace Medicine, and.
authors.forename: Noor
authors.initials: N
authors.lastname: Asi
authors.affiliation: Evidence-Based Practice Center, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery.|Division of Preventive, Occupational and Aerospace Medicine, and.
authors.forename: Jehad
authors.initials: J
authors.lastname: Almasri
authors.affiliation: Library Public Services, Mayo Clinic, Rochester, Minnesota 55905.
authors.forename: Larry J
authors.initials: LJ
authors.lastname: Prokop
authors.affiliation: Evidence-Based Practice Center, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery.|Division of Preventive, Occupational and Aerospace Medicine, and.
authors.forename: Mohammad Hassan
authors.initials: MH
authors.lastname: Murad
mesh_terms: D000293:Adolescent; D019440:Anti-Obesity Agents / Q000627:therapeutic use*; D001067:Appetite Depressants / Q000627:therapeutic use*; D050110:Bariatric Surgery; D001521:Behavior Therapy; D001786:Blood Glucose / Q000378:metabolism; D001794:Blood Pressure; D015992:Body Mass Index; D002648:Child; D008076:Cholesterol, HDL / Q000378:metabolism; D003503:Cyclobutanes / Q000627:therapeutic use; D004035:Diet Therapy; D050528:Diet, Carbohydrate-Restricted; D018752:Diet, Fat-Restricted; D015444:Exercise; D005081:Exercise Therapy; D005743:Gastrectomy; D015390:Gastric Bypass; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007783:Lactones / Q000627:therapeutic use; D008687:Metformin / Q000627:therapeutic use; D000077403:Orlistat; D010353:Patient Education as Topic; D063766:Pediatric Obesity / Q000378:metabolism / Q000628:therapy*; D016896:Treatment Outcome; D014280:Triglycerides / Q000378:metabolism; D055105:Waist Circumference
chemical_list: D019440:Anti-Obesity Agents; D001067:Appetite Depressants; D001786:Blood Glucose; D008076:Cholesterol, HDL; D003503:Cyclobutanes; D007004:Hypoglycemic Agents; D007783:Lactones; D014280:Triglycerides; D008687:Metformin; D000077403:Orlistat; C058254:sibutramine