CLOSED SUBMISSION
The World Health Organization (WHO) is seeking experts to serve as members of the Guideline Development Group (GDG) that will contribute to the development of a WHO guideline on the integrated management of children and adolescents with obesity using a primary health care approach.
This Call for experts provides information about the WHO guideline that will be developed, the role of GDG at WHO, the profiles of experts currently being sought, and the application and selection processes.
Background
The global prevalence of obesity for children 5 to 19 years old for both sexes was 6.8% in 2016 compared to 2.9% in 2000 (1,2). The International Classification of Diseases 11 (ICD-11) defines obesity as “a chronic complex disease defined by excessive adiposity that can impair health. It is in most cases a multifactorial disease due to obesogenic environments, psycho-social factors and genetic variants. In a subgroup of patients, single major etiological factors can be identified (medications, diseases, immobilization, iatrogenic procedures, monogenic disease/genetic syndrome). Body mass index (BMI) is a surrogate marker of adiposity calculated as weight (kg)/height² (m²). The BMI categories for defining overweight vary by age and gender in infants, children and adolescents. (3)”. In addition to the ill health and disability caused directly by excess weight gain, obesity is linked to a range of disease and short to long-term health outcomes (4). These include asthma, cancer, cardiovascular disease, dementia, depression, diabetes mellitus, dysfunction in fertility and impotence, kidney disease, liver disease, osteoarthritis, pancreatitis, birth complications and sleep apnoea (5). Many children living with obesity go on to do so as adolescents and adults (6).
In order to respond to current global epidemiology and to complement existing prevention-focused guidelines, normative guidance from WHO is needed focusing on a people-centred integrated management and care of children and adolescents who already have obesity, using a primary health care approach. A primary health care approach includes three components: 1) meeting people’s health needs throughout their lives; 2) addressing the broader determinants of health through multisectoral policy and action; and 3) empowering individuals, families and communities to take charge of their own health (7). The integrated management of childhood illnesses (IMCI) includes three strategies: 1) improving case management skills of health-care staff, 2) improving overall health systems, and 3) improving family and community health practices (8). In healthcare facilities, the IMCI entails the identification of illness in outpatient settings, adopting a people-centred, integrated care perspective instead of focusing on a specific diagnosis, working with caretakers, and expediting the referral of severely ill children to the appropriate facility or specialist in the health system or network of service providers to address the relevant health needs. ( 9). People-centred care is an approach to care that consciously adopts the perspectives of individuals, carers, families and communities as participants in and beneficiaries of trusted health systems that respond to their needs and preferences in humane and holistic ways. People-centred care also requires that people have the education and support they need to make decisions and participate in their own care.
Objectives and desired impact of the WHO guideline
The main objective of the guideline is to provide locally-adaptable, clear, science-informed global clinical and public health recommendations on the integrated management and care of children and adolescents with obesity, using a primary health care approach and grounded in gender, equity and human rights approaches to leave no one behind. The specific aims are:
- Provide recommendations on individuals, family, community and home-based interventions; diet, physical activity and behavioural interventions; pharmacological interventions and surgery options, for the management of children and adolescents with obesity.
- Outline science-informed support strategies for children and adolescents with obesity and their caretakers and the home environment to support wellbeing, healthier weight achievement and maintenance.
- Provide guidance on monitoring of clinical follow-up, including treatment compliance to health and wellbeing outcomes, such as dietary habits and healthier behaviours and lifestyles.
There will be a focus on primary healthcare-based interventions, including but not limited to diet, physical activity and behavioural interventions, diagnosis and referrals for pharmacological interventions and/or surgery. Recommendations will consider the perspective of the individual, the community, the multiple sectors involved and the health systems. Outcomes are clinical (e.g., fat composition changes, weight loss/maintenance, comorbidities), related to anthropometry (e.g., BMI, waist circumference, percent body fat) and biochemistry and physical (e.g., fasting glucose, HBA1C). Outcomes should also include health-related quality of life, participants’ view of the intervention, self- or guardian-reported intervention change, among others. These will be informed by a review on perceptions and views of children and adolescents with obesity as well as on the health care professionals, family members and community actors.
Role of the Guideline Development Groups in WHO
As part of the WHO guideline development process, the Guideline Development (10), the Guideline Development Group will support WHO in:
- Providing input into the scope of the guideline and in the development of key questions in PICO (Population, Intervention or Exposure, Comparison, Outcome) format;
- Choosing and ranking priority outcomes;
- Examining the Grading of Recommendations Assessment, Development and Evaluation (GRADE) evidence profiles or other assessments of the quality of the evidence used to inform the recommendations and provide input;
- Formulating recommendations, including direction and strength;
- Reviewing the preliminary version of the recommendations in the guideline document before submission for WHO executive clearance process for publication and further dissemination.
The GDG will meet to reach a consensus on the direction and strength of each of the draft recommendations, explicitly taking into consideration factors of human rights and sociocultural adaptability, societal implications, equality and non-discrimination, economic considerations, feasibility and health system considerations, certainty (or quality) of the evidence and balance of benefit and harms (11, 12). They will also consider issues on guideline implementation, monitoring and evaluation, and knowledge gaps (11, 12).
There will be at least two plenary meetings for the GDG: one at the beginning of the guideline and one later on in the guideline development process for approving recommendations. There will be one additional meeting for specific working sub-groups. The tentative dates for the meetings are detailed below:
- Plenary (all members of the GDG): Wednesday 24 March and Thursday 25 March 2021
- Infants and children under 5 years of age (working group): Wednesday 19 May and Thursday 20 May 2021
- Children 5 - 9 years of age (working group): Wednesday 7 July and Thursday 8 July 2021
- Adolescents 10 - 19 years of age (working group): Wednesday 29 September and Thursday 30 September 2021
- Plenary (all members of the GDG): Wednesday 1 December and Thursday 2 December 2021
It is likely that the selected GDG members will serve on the relevant group for a period of one year. The working language of the meetings will be English.
Eligibility criteria for potential Guideline Development Group members
The GDG will be multidisciplinary, with members who have a range of technical knowledge, skills and experience. WHO welcomes expressions of interest from:
1. Relevant technical experts in the management of obesity in children and adolescents, particularly in the fields of:
- physical activity and fitness
- anthropometry and body composition
- endocrinology
- clinical dietetics
- nutrition in general
- sports medicine and fitness
- maternal and child nutrition
- mental health, including behavioural sciences
- behavioural sciences
- energy and nutrient metabolism
- paediatrics
- adolescent health
- philosophy of science
- social sciences
2. End-users who will adopt, adapt and implement the guideline, including:
- decision-makers and public health policymakers in ministries of health and other national, regional and local levels
- health professionals, including providers at the primary care setting
- nutrition experts
- health programme managers
- healthcare system managers
3. Representatives of agencies involved in the planning and management of obesity and other health and wellbeing action, including:
- non-government organizations
- professional societies
4. Representatives of groups most affected by this guideline, including:
- parents’ groups and carers of children and adolescents with obesity
- consumer groups
5. Experts in assessing evidence and developing guidelines informed by evidence, particularly related to the field of the management of obesity in children and adolescents, such as:
- methodologist and epidemiologists
6. Other technical experts, such as:
- health economist, bioethicists,
- experts on ethics, equity, human rights and gender in public health
GDG members should have no significant conflict of interest that would impair their neutrality, independence or objectivity in the guideline development process. To this end, applicants are required to complete the WHO Declaration of Interest for WHO Experts and the shortlisting by WHO of any individual for selection as a member of a GDG is dependent on WHO determining that there is no conflict of interest or that those conflicts that were identified can be appropriately managed (i.e., in addition to WHO’s evaluation of such individual’s experience, expertise and motivation and other criteria).
Submitting your application
To register your interest in being considered for above-mentioned Guideline Development Group, please submit your application by Friday 12 February 2021.
- by email, to nutrition@who.int with the subject “GDG Childhood Obesity”.
You will need to submit the following documents:
- A cover letter, indicating your motivation to apply.
- Your curriculum vitae (including education background, relevant work experience, and relevant peer-reviewed publications).
- A completed Declaration of Interest form for WHO Experts, which can be downloaded here.
- A Confidentiality Undertaking form, which can be downloaded here (optional at this time).
After you have submitted your interest, your application will be reviewed by WHO. Due to an expected high volume of interest, only shortlisted individuals will be informed.
Important information about the selection processes
Each curriculum vitae will be reviewed to assess whether the applicant meets the qualifications and has relevant expertise in the subject matter areas listed above. Declaration of Interest forms will be reviewed. Any potential or perceived conflicts of interest disclosed in the Declaration of Interests form will be considered in the selection process. Representatives of commercial organizations may not serve as experts.
The selection of members of the GDGs will be based on the following criteria: technical expertise, experience in international and country policy work, communication skills, and ability to work constructively with people from different cultural backgrounds and orientations. The selection of GDG members will also take account of the need for diverse perspectives from different regions, especially from low and middle-income countries, and for gender diversity.
WHO will publish the names and a short biography of the shortlisted individuals on the WHO internet ahead of the first meeting of the GDG.
All GDG members will serve in their individual expert capacity and shall not represent any governments, any commercial industries or entities, any research, academic or civil society organizations, or any other bodies, entities, institutions or organizations. It is expected that GDG meetings will take place electronically. If required, travel and accommodation expenses of GDG members to participate in GDG meetings will be covered by WHO in accordance with its applicable policies, rules and procedures. No honoraria will be provided to any GDG members for their services or otherwise.
References
- Global Health Observatory. Geneva: World Health Organization.
- 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. 2017; 390: 2627–42. doi: 10.1016/S0140-6736(17)32129-3.
- International classification of diseases for mortality and morbidity statistics (11th Revision). Geneva: World Health Organization; 2018 (accessed 23 October 2020).
- Taking action on childhood obesity report. Geneva: World Health Organization; 2018 (accessed 28 October 2020).
- Obesity and overweight, Fact Sheet. Geneva: World Health Organization.
- Report of the Commission on Ending Childhood Obesity. Geneva: World Health Organization.
- Technical series on primary health care: Quality in primary health care. Geneva: World Health Organization; 2018.
- Tulloch J. Integrated approach to child health in developing countries. Lancet. 1999;354, pp.SII16-SII20. doi: 10.1016/s0140-6736(99)90252-0.
- Operational framework for primary health care: Transforming vision into action. Geneva: World Health Organization; New York: United Nations Children’s Fund; 2020,
- WHO Handbook for guideline development, 2nd edition. Geneva: World Health Organization.
- Rehfuess EA, Stratil JM, Scheel IB, et al. The WHO-INTEGRATE evidence to decision framework version 1.0: integrating WHO norms and values and a complexity Perspective. BMJ Global Health. 2019;4:e000844. doi: 10.1136/bmjgh-2018-000844.
- Alonso-Coello P, Schünemann HJ, Moberg J, et al. GRADE Working Group. GRADE Evidence to Decision (EtD) frameworks: a systematic and transparent approach to making well informed healthcare choices. 1: Introduction. BMJ. 2016;353:i2016 doi: 10.1136/bmj.i2016.