Clinicians should screen children and adolescents for obesity, and promote comprehensive behavioral interventions to improve their weight status, according to the U.S. Preventive Services Task Force (USPSTF).
There is adequate evidence (B grade) that body mass index (BMI) screening and lifestyle-based weight loss interventions for children and adolescents, ages 6 to 18 years, can effectively lead to improvements in weight status and certain related cardiometabolic factors after 6 to 12 months, according to a task force draft statement.
The statement follows a 2010 recommendation to screen all children ages 6 and older for obesity. Task force member Alex R. Kemper, MD, MPH, of Duke University in Durham, N.C., told MedPage Todaythat "childhood obesity has more than doubled in children and quadrupled in adolescents in the past 30 years" and the new draft recommendation is an effort to address the growing issue.
"Both recommendations are largely consistent, reaffirming the importance of screening children and adolescents for obesity and offering or recommending behavioral health interventions, if needed. While the B grade remains unchanged, there was a slight adjustment in adding the word 'adolescents' to further clarify the population included in the recommendation," he told MedPage Today.
The updated recommendation also falls in line with obesity screening guidance from other health organizations such as the American Academy of Family Physicians, the National Academies Health and Medicine Division, and the National Association of Pediatric Nurse Practitioners.
The task force chose BMI measurement as the recommended screening measure due to its feasibility, acceptable accuracy in identifying young individuals with excess weight, and evidence linking it to cardiovascular risk factors.
They suggested that all children ages 6 to 18 should be screened for obesity, but noted that children with obese parents, poor nutrition, low levels of physical activity, inadequate sleep, sedentary behaviors, and low family income may be at an increased risk, therefore requiring screening.
"Parents do not always recognize when their children are overweight," stated Kemper said in a press release. "Looking at BMI as part of usual health care provides an opportunity to identify children who have obesity and refer them to a comprehensive program, leading to improved health outcomes."
Task force members examined 45 trials (n=7,099) of behavioral interventions for obesity -- 42 trials (n=6,956) used multicomponent interventions targeting lifestyle change -- and found that the net benefit of intensive behavioral interventions was moderate.
Seven trials with 52 contact hours or more demonstrated benefits of treatment, with a pooled standardized mean difference in change of -1.10 (95% CI -1.30 to -0.89), and nine trials with 26 to 51 contact hours showed smaller effects, with a pooled standardized mean difference in change of -0.34 (95% CI -0.52 to -0.16).
Cardiometabolic outcomes were consistently reported in studies with 52 contact hours or more and pooled reductions in systolic -6.4 mm Hg (95% CI, -8.6 to -4.2) and diastolic blood pressure -4.0 mm Hg (95% CI, -5.6 to -2.5) were statistically significant.
Of the findings, task force co-chair David C. Grossman, MD, MPH, of Group Health in Seattle, explained that "behavioral interventions can help children improve their health, manage their weight, and prevent future obesity-related health problems."
However, lower adherence in clinical practice could decrease the overall benefit of these interventions.
Kemper told MedPage Today that effective comprehensive, behavioral interventions are "those that last at least 26 hours, and may include sessions that target both the parent and child."
Interventions should offer information on healthy eating and safe exercise, discuss the use of stimulus control, such as limiting access to tempting foods and restricting television and computer time, and include supervised physical activity.
The recommendation also looked at pharmacotherapy interventions such as orlistat and metformin. The drugs yielded small amounts of weight loss, but the magnitude of this benefit is of uncertain clinical significance due to inadequate evidence regarding the effectiveness of metformin and orlistat, they noted.
The USPSTF is supported by the Agency for Healthcare Research and Quality.
- Reviewed by Robert Jasmer, MD Associate Clinical Professor of Medicine, University of California, San Francisco and Dorothy Caputo, MA, BSN, RN, Nurse Planner