USPSTF Recommends Screening For Obesity in Children and Adolescents
Intensive Lifestyle-Based Interventions Produce Weight Loss
The U.S. Preventive Services Task Force (USPSTF) recommends that clinicians screen for obesity in children and adolescents ages six years and older and offer or refer them to comprehensive, intensive behavioral interventions, according to an evidence report published in the Journal of the American Medical Association. The recommendation garnered a B rating, indicating there is high certainty that the net benefit is moderate, or there is moderate certainty that the net benefit is moderate to substantial. Intensive lifestyle-based weight loss interventions with 26 or more contact hours was found to help reduce excess weight this population, without excess harm.
Data from the National Health and Nutrition Examination Survey indicate that an estimated 17 percent of U.S. children and adolescents suffered from obesity between 2011 – 2014, a disease associated with problematic cardiometabolic measures such as high blood pressure, dyslipidemia, insulin resistance, asthma, obstructive sleep apnea and other comorbidities.
Across 42 lifestyle-based intervention trials, those with an estimated 26 hours or more of contact consistently demonstrated mean reductions in excess weight when compared with usual care or control groups. Groups receiving lifestyle-based interventions with the largest number of contact hours showed greater improvements in blood pressure than control groups and some improvement in insulin and glucose measures, but typically no improvements in levels of fasting plasma glucose or lipids. Overall, authors Elizabeth A. O'Connor, PhD, et al., found that intervention groups experienced reductions in body mass index (BMI) and maintained their baseline weight within a mean of five pounds, while control groups showed small increases in weight or no change in BMI.
The use of metformin or orlistat was associated with very small reductions in excess weight, amounting to less than one BMI unit between groups. Medications showed small or no benefit for cardiometabolic outcomes, including fasting glucose level. Non-serious harms were common with medication use, although discontinuation due to adverse effects capped out at less than five percent. The evidence base for the use of both medications was limited due to the small number of relevant trials.
The results of the USPSTF review are consistent with a recent review commissioned by the Canadian Task Force on Preventive Health Care, which included a different but overlapping body of evidence, including trials with no connection to a health care setting. That review also found that behavioral weight management interventions were associated with a small but robust reduction in BMI, small improvements in blood pressure and improvements in quality of life. Other reviews have reported similarly favorable results from lifestyle-based weight management interventions, particularly comprehensive programs involving parents and at least a moderate level of intervention intensity.
In an editorial opinion, Rachel L. J. Thornton, MD, PhD, et al., emphasize that strategies for obesity prevention and weight management must incorporate support for physicians' efforts to implement standardized care approaches and advocate for healthy community environments, compelling insurers and employers to "ensure coverage of, access to, and incentives for routine obesity prevention, screening, diagnosis and treatment."
Thornton and colleagues reinforce the importance of acknowledging and addressing the role that socioeconomic and environmental disparities have in the prevalence and severity of childhood obesity and the related comorbidities, encouraging implementation of weight-management interventions begin as early as possible to counteract these disparities.
"The USPSTF recommendation should provide an impetus to redouble efforts to invest in practice, community, policy and multilevel intervention research focused on achieving primary prevention and sustained improvements in health and health trajectories for children and adolescents and their families. Such a focus is critical for reversing the obesity epidemic," write Thornton et al.
Keywords: Body Mass Index, Body Weight, Comorbidity, Life Style, Parents, Pediatric Obesity, Preventive Health Services, Primary Prevention, Weight Loss, United States Food and Drug Administration
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