KQs 3–5 (interventions): Studies with a primary aim of weight management (including weight loss and weight gain prevention)

KQs 3–5 (interventions): Healthy lifestyle counseling with no weight-related aim

KQs 1, 2 (screening): General primary care or comparable populations

KQs 3–5 (interventions): Either:

• The entire sample has an age- and sex-specific BMI ≥85th percentile or it meets other similar criteria for overweight based on ideal body weight
• The entire sample previously had excess weight and is now engaged in maintenance of weight loss/improved weight trajectory

or

• ≥50% of the sample has an age- and sex-specific BMI ≥85th percentile and ≥80% have risk factors for overweight (e.g., overweight parents; Hispanic, black, or American Indian/Alaska Native ethnicity) or obesity-related medical problems (e.g., diabetes, metabolic syndrome, hypertension, lipid abnormalities, or other cardiovascular-related disorders)

• Studies with an average age younger than 2 or older than 18 years
• Populations limited exclusively to youth who:
  • Have an eating disorder
  • Are pregnant or postpartum
  • Are overweight or obese secondary to a genetic or medical condition, such as polycystic ovarian syndrome, hypothyroidism, Cushing’s syndrome, growth hormone deficiency, insulinoma, hypothalamic disorders (e.g., Froelich syndrome, Bardet-Biedl syndrome, Prader-Willi syndrome), or medication use (e.g., antipsychotics)
  • Are in college

KQs 3–5 (interventions):

• Designed to promote weight reduction or stabilization or maintenance of previous weight reduction or stabilization
• May include the following, alone or in combination:
  • Behaviorally-based interventions
  • Pharmacological (i.e., orlistat, metformin) interventions
  • Health system–level interventions (e.g., stepped care, collaborative care)
• Must be either conducted in a primary care setting, feasible in “usual” primary care, or referable from primary care. Must at least involve the health care system in some way (may be limited to recruitment)

• Primary prevention in children who are normal weight
• Surgical interventions
• Studies that include elements that cannot be implemented in the health care setting (e.g., changes in the physical/built environment, legislation)
• Complementary and alternative medicine approaches (e.g., herbal supplements, acupuncture, Chinese medicine, yoga)
• Studies that provide all or most of participants’ food

KQs 3–5 (interventions): Control groups with no intervention (e.g., wait-list control, usual care), minimal intervention (e.g., pamphlets, single annual session presenting information similar to what intervention groups receive through usual care in a primary care setting), or attention control (e.g., similar format and intensity of intervention on a different content area)

• Personalized prescription for weight loss and exercise based on standardized dietary assessment
• Homework, such as study-provided self-help workbooks
• More than a single annual brief intervention contact (unless content not related to weight loss)

Comparator cannot be focused on healthy lifestyle, as this is too similar to intervention programs for weight loss

• Reduced asthma or sleep apnea
• Decreased morbidity from diabetes mellitus or hypertension
• Improved depression or quality of life (including psychosocial distress and functioning)
• Physical fitness capacity or performance (not behavioral)
• Physical functioning (scores on physical subscales of quality of life measures)
• Disability (global measures of disability, such as activities of daily living)

Adult health outcomes: Obesity

Intermediate outcomes:

• Reduction or appropriate maintenance of weight or adiposity (required outcome). Acceptable measures include weight (kilograms or pounds), age- and sex-normative weight (BMI percentile or z-score for age and sex), relative weight (BMI, percent overweight), total adiposity (dual-energy x-ray absorptiometry, underwater weight, or comparable), other similar measures, or change in any of these measures
• Weight maintenance after an intervention has ended
• Cardiometabolic measures (only when weight-related measures are also reported): insulin resistance/blood glucose/diabetes, blood pressure/hypertension, lipid levels/dyslipidemia, metabolic syndrome, and polycystic ovarian syndrome
• Liver dysfunction/nonalcoholic fatty liver disease

Adverse effects:

• Labeling
• Stigma or increased body image concerns
• Eating disorder
• Suppressed growth
• Exercise-induced injury
• Serious treatment-related harms at any time after initiation of intervention (i.e., death, medical issue requiring hospitalization or urgent medical treatment) or other treatment-related harms reported in trials meeting inclusion criteria for intermediate or health outcomes

KQ 5 (serious harms of pharmacotherapy): No minimum followup; serious harms are events resulting in death, hospitalization, or the need for urgent medical treatment

KQs 3–5 (interventions):

• Other outpatient health care settings
• Phone, mobile, or virtual settings (e.g., online intervention, if there is some connection to a health setting, such as recruitment from a health care setting)
• Community or research settings, if there is some connection to a health setting (e.g. recruitment from a health care setting)

• Community/university research laboratories or other nonmedical centers
• College settings
• Mental health clinics (unless recruitment is through primary care screening)
• Correctional facilities
• School classrooms
• Worksites
• Inpatient/residential facilities
• Emergency departments

KQ 5 (harms of weight loss medications): Large comparative cohort or case-control studies with appropriate comparison group; large case-series; large case-series; large event monitoring studies