Children and adolescents older than age 6 years should be screened for obesity, according to a draft recommendation statement released by the U.S. Preventive Services Task Force (USPSTF).
The USPSTF gave a B grade to the recommendation, and note that clinicians should refer children to intensive behavioral interventions to improve weight status.
Screening and intensive behavioral interventions for obesity in children and adolescents older than 6 years of age could lead to improvements in weight status and related cardiometabolic factors after 6 to 12 months. In addition, pharmacotherapy interventions such as orlistat and metformin showed small amounts of weight loss, but the clinical significance of this benefit is still uncertain.
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The task force notes several risk factors for obesity, including parental obesity, poor nutrition, low levels of physical activity, inadequate sleep, sedentary behaviors, and low family income. Risk factors for obesity in younger children include maternal diabetes, maternal smoking, gestational weight gain, and rapid infant growth.
The recommended screening test for obesity is a BMI measurement, which should be plotted on a growth chart such as the ones developed by the CDC. Obesity is defined as an age-specific and sex-specific BMI in the 95th percentile. There is no evidence regarding screening intervals for obesity in children in adolescents, but height and weight are measured during health maintenance visits and can be used to calculate BMI.
The USPSTF found that BMI is an adequate screening measure for obesity, and the task force found no direct evidence that assessed the harms of screening for obesity in this patient population.
Intensive behavioral interventions with at least 26 contact hours or more for a period of weeks or months were shown to improve weight loss. These interventions frequently included sessions that targeted the parent and child, offered individual or family sessions, provided information about healthy eating, and included supervised physical activity sessions. Interventions with a total of 52 contact hours also demonstrated greater loss and improvements in cardiometabolic measures.
The task force added that adherence to interventions can affect efficacy. Among the trials included in the task force’s recommendation, 68% to 95% of participants completed all of the sessions, but lower adherence to the sessions could decrease the benefit of the interventions.
“Prospective data suggest that cardiovascular risk factors in adults without obesity are similar between those who had obesity as children and those who did not,” the authors note. “This suggests that adverse cardiovascular effects in childhood may be reversible with weight loss. This is of particular importance since obesity in childhood and adolescence may continue into adulthood and lead to poor health outcomes.”
The USPSTF will accept comments from the public regarding this recommendation until November 28, 2016.
