Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Systematic Review
  • Published:

Management for children and adolescents with overweight and obesity: a recommendations mapping

Pediatric Research volume 97, pages 92–98 (2025)Cite this article

Abstract

Background

Childhood obesity is a global public health issue, and the status of clinical practice guidelines (CPGs) as instruction manuals for the management of childhood obesity remains unclear. This study aims to identify and apprise the methodological and reporting quality of CPGs focused on childhood obesity and provide an overview of key recommendations.

Methods

Databases and websites reporting guidelines were searched from January, 2018 to September, 2023. The methodological quality was graded using the AGREE II, and RIGHT was used to assess the reporting completeness.

Results

Among the six included CPGs, two were rated as high quality and considered “Recommended” and three were reported no less than 80%. CPGs included 184 recommendations cover diagnosis, assessment and management of complications, interventions and prevention. The diagnostic criteria for children with obesity over 2 years of age are based on normative BMI percentiles, depending on sex and age. CPGs recommended the delivery of multi-component behavior-changed interventions included controlling diet and increasing physical activity. Pharmacological interventions and bariatric surgery are considered as complementary therapies.

Conclusion

CPGs for childhood obesity should emphasize the impact of psychological factors and consider the provision of interventions from multiple settings, and could consider the role of complementary alternative therapies.

Impact

  • Six guidelines have been published in the past 5 years focusing children obesity.

  • Recommendations covered diagnosis, multiple intervention and prevention.

  • Guidelines should focus on the role of complementary alternative therapies.

  • Guidelines should emphasize the impact of psychological factors.

  • Guidelines should consider the provision of interventions from multiple settings.

Access through your institution
Buy or subscribe

This is a preview of subscription content, access via your institution

Access options

Access through your institution

Buy this article

  • Purchase on SpringerLink
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Fig. 1
Fig. 2: Grading and analysis of methodological quality and reporting completeness of CPGs.
Fig. 3: Recommendation mapping of high-quality clinical practice guidelines.

Similar content being viewed by others

Data availability

All data are provided in the article and the Electronic Supplementary Material.

References

  1. Pan, X. F., Wang, L. & Pan, A. Epidemiology and determinants of obesity in China. Lancet Diabetes Endocrinol. 9, 373–392 (2021).

    Article  PubMed  Google Scholar 

  2. Hu, K. & Staiano, A. E. Trends in obesity prevalence among children and adolescents aged 2 to 19 years in the US from 2011 to 2020. JAMA Pediatr. 176, 1037–1039 (2022).

    Article  PubMed  PubMed Central  Google Scholar 

  3. Osei Bonsu, E. & Addo, I. Y. Prevalence and correlates of overweight and obesity among under-five children in Egypt. Front. Public Health 10, 1067522 (2022).

    Article  PubMed  PubMed Central  Google Scholar 

  4. World Health Organization. WHO European Regional Obesity Report 2022 (World Health Organization, 2022).

  5. Buoncristiano, M. et al. Childhood overweight and obesity in Europe: changes from 2007 to 2017. Obes. Rev. 22, e13226 (2021).

    Article  PubMed  Google Scholar 

  6. Lister, N. B. et al. Child and adolescent obesity. Nat. Rev. Dis. Prim. 9, 24 (2023).

    Article  PubMed  Google Scholar 

  7. NCD Risk Factor Collaboration (NCD-RisC). Worldwide trends in body-mass index, underweight, overweight, and obesity from 1975 to 2016: a pooled analysis of 2416 population-based measurement studies in 128·9 million children, adolescents, and adults. Lancet 390, 2627–2642 (2017).

    Article  PubMed Central  Google Scholar 

  8. World Health Organization. Obesity. https://www.who.int/health-topics/obesity#tab=tab_1 (2019).

  9. Mei, Z. et al. Validity of body mass index compared with other body-composition screening indexes for the assessment of body fatness in children and adolescents. Am. J. Clin. Nutr. 75, 978–985 (2002).

    Article  CAS  PubMed  Google Scholar 

  10. World Health Organization. Consideration of the Evidence on Childhood Obesity for the Commission on Ending Childhood Obesity: Report of the Ad hoc Working Group on Science and Evidence for Ending Childhood Obesity (World Health Organization, 2016).

  11. Institute of Medicine (US) Committee on Standards for Developing Trustworthy Clinical Practice Guidelines. et al. Clinical Practice Guidelines We Can Trust (National Academies Press, 2011).

  12. Gooey, M. et al. Clinical practice guidelines for the prevention of childhood obesity: a systematic review of quality and content. Obes. Rev. 23, e13492 (2022).

    Article  PubMed  PubMed Central  Google Scholar 

  13. Tully, L. et al. Guidelines for treating child and adolescent obesity: a systematic review. Front. Nutr. 9, 902865 (2022).

    Article  PubMed  PubMed Central  Google Scholar 

  14. Tian, C. et al. Barriers and strategies of clinical practice guideline implementation in China: aggregated analysis of 16 cross-sectional surveys. J. Public Health 1–14 (2023). Online ahead of print.

  15. Mathew, A. & Clase, C. M. Conflicts of interest and the trustworthiness of clinical practice guidelines. Clin. J. Am. Soc. Nephrol. 17, 771–773 (2022).

    Article  PubMed  PubMed Central  Google Scholar 

  16. Chen, Y., Wang, C., Shang, H., Yang, K. & Norris, S. L. Clinical practice guidelines in China. BMJ 360, j5158 (2018).

    Article  PubMed  PubMed Central  Google Scholar 

  17. Shekelle, P. G. et al. Validity of the Agency for Healthcare Research and Quality clinical practice guidelines: how quickly do guidelines become outdated? JAMA 286, 1461–1467 (2001).

    Article  CAS  PubMed  Google Scholar 

  18. Shojania, K. G. et al. How quickly do systematic reviews go out of date? A survival analysis. Ann. Intern. Med. 147, 224–233 (2007).

    Article  PubMed  Google Scholar 

  19. Miake-Lye, I. M., Hempel, S., Shanman, R. & Shekelle, P. G. What is an evidence map? A systematic review of published evidence maps and their definitions, methods, and products. Syst. Rev. 5, 28 (2016).

    Article  PubMed  PubMed Central  Google Scholar 

  20. Hajizadeh, A. et al. Recommendation mapping of the World Health Organization’s guidelines on tuberculosis: a new approach to digitizing and presenting recommendations. J. Clin. Epidemiol. 134, 138–149 (2021).

    Article  PubMed  PubMed Central  Google Scholar 

  21. Page, M. J. et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 372, n71 (2021).

    Article  PubMed  PubMed Central  Google Scholar 

  22. Johnston, A., Kelly, S. E., Hsieh, S. C., Skidmore, B. & Wells, G. A. Systematic reviews of clinical practice guidelines: a methodological guide. J. Clin. Epidemiol. 108, 64–76 (2019).

    Article  PubMed  Google Scholar 

  23. Ouzzani, M., Hammady, H., Fedorowicz, Z. & Elmagarmid, A. Rayyan—a web and mobile app for systematic reviews. Syst. Rev. 5, 210 (2016).

    Article  PubMed  PubMed Central  Google Scholar 

  24. Brouwers, M. C. et al. AGREE II: advancing guideline development, reporting and evaluation in health care. CMAJ 182, E839–E842 (2010).

    Article  PubMed  PubMed Central  Google Scholar 

  25. Brouwers, M. et al. Appraisal of Guidelines for Research & Evaluation II. https://www.agreetrust.org/wp‐content/uploads/2017/12/AGREE‐II‐Users‐Manual‐and‐23‐item‐Instrument‐2009‐Update‐2017.pdf (2017).

  26. Chen, Y. et al. A reporting tool for practice guidelines in health care: the RIGHT statement. Ann. Intern. Med. 166, 128–132 (2017).

    Article  PubMed  Google Scholar 

  27. Kramer, M. S. & Feinstein, A. R. Clinical biostatistics. LIV. The biostatistics of concordance. Clin. Pharmacol. Ther. 29, 111–123 (1981).

    Article  CAS  PubMed  Google Scholar 

  28. Ríos, E. et al. Evaluation of the quality of clinical practice guidelines for the management of esophageal or gastric variceal bleeding. Eur. J. Gastroenterol. Hepatol. 26, 422–431 (2014).

    Article  PubMed  Google Scholar 

  29. Santesso, N., Wiercioch, W., Barbara, A. M., Dietl, H. & Schünemann, H. J. Focus groups and interviews with the public led to the development of a template for a GRADE Plain Language Recommendation (PLR). J. Clin. Epidemiol. 141, 18–25 (2022).

    Article  PubMed  Google Scholar 

  30. American Psychological Association. Clinical Practice Guideline for Multicomponent Behavioral Treatment of Obesity and Overweight in Children and Adolescents (American Psychological Association, 2018).

  31. Henry, B. W., Ziegler, J., Parrott, J. S. & Handu, D. Pediatric weight management evidence-based practice guidelines: components and contexts of interventions. J. Acad. Nutr. Diet. 118, 1301–1311.e23 (2018).

    Article  PubMed  Google Scholar 

  32. Hampl, S. E. et al. Clinical practice guideline for the evaluation and treatment of children and adolescents with obesity. Pediatrics 151, e2022060640 (2023).

    Article  PubMed  Google Scholar 

  33. Valerio, G. et al. Diagnosis, treatment and prevention of pediatric obesity: consensus position statement of the Italian Society for Pediatric Endocrinology and Diabetology and the Italian Society of Pediatrics. Ital. J. Pediatr. 44, 88 (2018).

    Article  PubMed  PubMed Central  Google Scholar 

  34. Yi, D. Y. et al. Clinical practice guideline for the diagnosis and treatment of pediatric obesity: recommendations from the Committee on Pediatric Obesity of the Korean Society of Pediatric Gastroenterology Hepatology and Nutrition. Korean J. Pediatr. 62, 3–21 (2019).

    Article  CAS  PubMed  Google Scholar 

  35. National Institute for Health and Care Excellence. Obesity: Identification, Assessment and Management (National Institute for Health and Care Excellence (NICE), 2023).

  36. Ojeda-Rodríguez, A. et al. Improved diet quality and nutrient adequacy in children and adolescents with abdominal obesity after a lifestyle intervention. Nutrients 10, 1500 (2018).

    Article  PubMed  PubMed Central  Google Scholar 

  37. Puder, J. J. & Munsch, S. Psychological correlates of childhood obesity. Int. J. Obes. 34, S37–S43 (2010).

    Article  Google Scholar 

  38. Smith, J. D., Fu, E. & Kobayashi, M. A. Prevention and management of childhood obesity and its psychological and health comorbidities. Annu. Rev. Clin. Psychol. 16, 351–378 (2020).

    Article  PubMed  PubMed Central  Google Scholar 

  39. Anderson, S. E., Sacker, A., Whitaker, R. C. & Kelly, Y. Self-regulation and household routines at age three and obesity at age eleven: longitudinal analysis of the UK Millennium Cohort Study. Int. J. Obes. 41, 1459–1466 (2017).

    Article  CAS  Google Scholar 

  40. Schlam, T. R., Wilson, N. L., Shoda, Y., Mischel, W. & Ayduk, O. Preschoolers’ delay of gratification predicts their body mass 30 years later. J. Pediatr. 162, 90–93 (2013).

    Article  PubMed  Google Scholar 

  41. Styne, D. M. et al. Pediatric obesity-assessment, treatment, and prevention: an Endocrine Society Clinical Practice Guideline. J. Clin. Endocrinol. Metab. 102, 709–757 (2017).

    Article  PubMed  PubMed Central  Google Scholar 

  42. Harrison, K. et al. Toward a developmental conceptualization of contributors to overweight and obesity in childhood: the Six-Cs model. Child. Dev. Perspect. 5, 50–58 (2011).

    Article  Google Scholar 

  43. Reinehr, T. Lifestyle intervention in childhood obesity: changes and challenges. Nat. Rev. Endocrinol. 9, 607–614 (2013).

    Article  PubMed  Google Scholar 

  44. Grant-Guimaraes, J., Feinstein, R., Laber, E. & Kosoy, J. Childhood overweight and obesity. Gastroenterol. Clin. North. Am. 45, 715–728 (2016).

    Article  PubMed  Google Scholar 

  45. Barnett, S. J. et al. Long-term follow-up and the role of surgery in adolescents with morbid obesity. Surg. Obes. Relat. Dis. 1, 394–398 (2005).

    Article  PubMed  Google Scholar 

  46. Melstrom, L. G. et al. Adenocarcinoma of the gastroesophageal junction after bariatric surgery. Am. J. Surg. 196, 135–138 (2008).

    Article  PubMed  Google Scholar 

  47. Sui, Y. et al. A systematic review on use of Chinese medicine and acupuncture for treatment of obesity. Obes. Rev. 13, 409–430 (2012).

    Article  CAS  PubMed  Google Scholar 

  48. Guo, T. et al. Acupoint catgut embedding for obesity: systematic review and meta-analysis. Evid. Based Complement. Altern. Med. 2015, 401914 (2015).

    Article  Google Scholar 

  49. Guyatt, G. H. et al. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ 336, 924–926 (2008).

    Article  PubMed  PubMed Central  Google Scholar 

  50. Sarkies, M. N., Jones, L. K., Gidding, S. S. & Watts, G. F. Improving clinical practice guidelines with implementation science. Nat. Rev. Cardiol. 19, 3–4 (2022).

    Article  PubMed  Google Scholar 

  51. Tian, C. et al. The effects of exercise on insomnia disorders: an umbrella review and network meta-analysis. Sleep Med. 115, 66–75 (2024).

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Evidence-Based Social Sciences Research Centre, Lanzhou University, Lanzhou, China

    Chen Tian, Meng Xu, Honghao Lai, Yao Lu & Long Ge

  2. Department of Health Policy and Management, School of Public Health, Lanzhou University, Lanzhou, China

    Chen Tian, Meng Xu, Honghao Lai, Yao Lu, Bo Tong, Yiyun Wang & Long Ge

  3. Key Laboratory of Evidence Based Medicine of Gansu Province, Lanzhou, China

    Chen Tian, Meng Xu & Long Ge

  4. Evidence-Based Nursing Research Center, School of Nursing, Lanzhou University, Lanzhou, China

    Mingyao Sun

  5. First Clinical School of Medicine, Lanzhou University, Lanzhou, China

    Yong Wang

  6. Department of Pediatric, Gansu Provincial Maternity and Child Care Hospital, Lanzhou, China

    Feiyang Na

  7. Department of Endocrinology, Gansu Provincial Hospital, Lanzhou, China

    Jing Wang

  8. Department of Endocrinology, First Hospital of Lanzhou University, Lanzhou, China

    Qiong Li

Authors
  1. Chen Tian
    View author publications

    Search author on:PubMed Google Scholar

  2. Meng Xu
    View author publications

    Search author on:PubMed Google Scholar

  3. Honghao Lai
    View author publications

    Search author on:PubMed Google Scholar

  4. Mingyao Sun
    View author publications

    Search author on:PubMed Google Scholar

  5. Yao Lu
    View author publications

    Search author on:PubMed Google Scholar

  6. Yong Wang
    View author publications

    Search author on:PubMed Google Scholar

  7. Bo Tong
    View author publications

    Search author on:PubMed Google Scholar

  8. Yiyun Wang
    View author publications

    Search author on:PubMed Google Scholar

  9. Feiyang Na
    View author publications

    Search author on:PubMed Google Scholar

  10. Jing Wang
    View author publications

    Search author on:PubMed Google Scholar

  11. Qiong Li
    View author publications

    Search author on:PubMed Google Scholar

  12. Long Ge
    View author publications

    Search author on:PubMed Google Scholar

Contributions

C.T. and M.X. was responsible for development of the search strategy and did the systematic searches. Y.Y.W. and B.T. screened titles and abstracts. C.T., H.H.L., Y.L. and M.Y.S. screened full text. C.T. and M.X. extracted data. C.T., H.H.L., M.Y.S. and Y.W. did the AGREE II and RIGHT assessment. L.G. provided methodological support. F.Y.N. and J.W. provided clinical guidance. C.T. wrote the manuscript, and Q.L. and L.G. revised the manuscript. All authors contributed to the article and approved the submitted version.

Corresponding authors

Correspondence to Qiong Li or Long Ge.

Ethics declarations

Ethical approval information, institution(s) and number(s)

Not applicable.

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Tian, C., Xu, M., Lai, H. et al. Management for children and adolescents with overweight and obesity: a recommendations mapping. Pediatr Res 97, 92–98 (2025). https://doi.org/10.1038/s41390-024-03357-3

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue date:

  • DOI: https://doi.org/10.1038/s41390-024-03357-3

Search

Advanced search

Quick links