The U.S. Preventive Services Task Force recommends that clinicians screen for obesity in children and adolescents aged at least 6 years and offer or refer them to comprehensive, intensive behavioral interventions to promote improvements in weight status, according to a report recently published in JAMA.
The task force gave such practices a B grade statement.
“Lifestyle-based weight-loss interventions with 26 or more hours of intervention contact are likely to help reduce excess weight in children and adolescents,” Elizabeth A. O’Connor, PhD, from Kaiser Permanente Research Center for Health Research, and colleagues wrote. “The clinical significance of the small benefit of medication use is unclear.”
The USPSTF cited data from the CDC that indicated about 17% of children and adolescents aged 2 to 19 years in the United States have obesity, and nearly 32% of children and adolescents have obesity or are overweight.
According to a press release, this recommendation is “largely consistent” with the 2016 draft recommendation USPSTF issued on this subject, but now contains the word adolescents to further clarify the population to which the recommendation applies.
In 2007, an AMA committee recommended that clinicians’ assessments include BMI calculation as behavioral and medical risk factors for obesity. The AAP agreed with those recommendations and recommended plotting BMI on a growth chart on a yearly basis for all patients aged at least 2 years, researchers stated.
In separate recommendations, the USPSTF also indicated it concluded separately that there is insufficient evidence to assess the balance of benefits and harms of screening for primary hypertension in asymptomatic children and adolescents to prevent subsequent CVD in childhood or adulthood, and insufficient evidence to assess the balance of benefits and harms of screening for lipid disorders in children and adolescents. Both of these recommendations received an I grade.
In an editorial related to the 26 hours of behavioral intervention the USPSTF recommended to treat childhood obesity, Rachel L.J. Thornton, MD, PhD, of the department of pediatrics at Johns Hopkins School of Medicine, and colleagues wrote that the USPSTF’s statements are unrealistic.
“Such intensive intervention is impractical for many families and is not included within many reimbursement frameworks. In addition, pediatric clinicians face the persistent challenges of treating obesity, including lack of time, lack of resources, and inadequate referral networks... By focusing on clinic-based interventions, the USPSTF recommendation reinforces a false dichotomy between individual-level, clinic-based obesity treatment interventions and population-level, policy-based prevention interventions,” they wrote. “At best, implementing the USPSTF recommendation will have modest effects on obesity prevalence in the United States. At worst, implementation could divert resources from population-health approaches to prevention and push practitioners to refer obese children and adolescents to intensive weight management programs that are ill-equipped to meet the demand and rarely exist within local communities.” – by Janel Miller
The researchers report no relevant financial disclosures.
O’Connor EA, et al. JAMA. 2017:doi:10.1001/jama.2017.0332.
Thornton RL, et al. JAMA. 2017;doi:10.1001/jama.2017.3434.
US Preventive Services Task Force. JAMA. 2017;doi:10.1001/jama.2017.6803.