Healthcare providers should refer children age 6 or older with obesity to comprehensive, intensive behavioral interventions, according to a draft recommendation released by the U.S. Preventive Services Task Force (USPSTF) on Dec. 12.
Obesity in children and adolescents is defined as having a body mass index (BMI) that is higher than 95% of children and adolescents of the same age and gender.
In the draft recommendation, the USPSTF notes that behavioral interventions include multiple components, including offering counseling sessions that target both the parent and child; offering group sessions in addition to individual or single-family sessions; offering information about healthy eating, safe exercise, and reading food labels; and implementing techniques that encourage changes in behavior, such as diet and activity monitoring and goal setting.
Comprehensive, intensive behavioral interventions with at least 26 hours of contact are supported by evidence as effective interventions for children and adolescents with obesity, according to the draft recommendation. A prior recommendation from USPSTF in 2017 called for screening for obesity in children to begin at age 6. When finalized, the draft recommendation will replace the 2017 recommendation, shifting away from screening for obesity and toward behavioral interventions for this population. The USPSTF notes that because assessing BMI is now part of routine clinical practice, it was not a focus of the updated evidence review and recommendation.
The USPSTF also reviewed evidence on the use of weight loss medications in children and adolescents. In the rationale for the draft recommendation, the USPSTF states that it found inadequate evidence on the benefits of weight-loss medications, but it did find adequate evidence regarding harms from medication interventions based on the number of studies reporting gastrointestinal symptoms. The USPSTF noted that more research is needed on the long-term health outcomes and benefits of both behavioral and pharmacotherapy interventions.
The draft recommendation’s stance on weight-loss drugs differs from a recommendation released earlier this year by the American Academy of Pediatrics (AAP), which suggests that pediatricians offer such medications to children age 12 and older with obesity. We blogged about the recommendation earlier this year. The AAP guidelines also recommended weight-reduction surgery in certain circumstances, but the USPSTF does not address surgical interventions in the draft recommendation, noting that such interventions are outside of the scope of the primary care setting.
In Arkansas, childhood obesity rates have continued to climb, according to annual data collected and analyzed by ACHI. Analyses of BMI data for the 2021-22 school year indicate that approximately 26% of Arkansas children who attend public schools are classified as obese and 17% are classified as overweight, while 55% of children are classified as having a healthy weight and 2% are classified as underweight. Other research conducted by ACHI revealed concerning BMI growth patterns among certain children who were tracked over time, finding that among children who began kindergarten with obesity, BMIs increase at a higher rate through the eighth grade compared to their peers.
The USPSTF’s draft recommendation is open for public comment through Jan. 16, 2024.