USPSTF updated recommendations for intervention strategies in obese children, adolescents

The U.S. Preventive Services Task Force has revised its recommendations for the best treatment and prevention strategies for obese children and adolescents.

In light of new research, the USPSTF now recommends screening for overweight and obesity in children aged 6 to 18 years, and moderate- to high-intensity behavioral programs to promote improvements in weight status.

“The major change in the current recommendation is that the USPSTF has determined that comprehensive moderate- to high-intensity programs that include dietary, physical activity and behavioral counseling components can result in improvement in weight status among obese children aged 6 and older who complete the programs,” the USPSTF wrote in its recommendation statement.

Systematic review

The USPSTF published a report in 2005 about obesity in children and adolescents, but severe deficits in research hindered their ability to make sound recommendations on treatment and prevention for physicians. Since the initial report, new study data have provided information on the efficacy of certain intervention strategies.

Results of a targeted systematic review, also published in Pediatrics, indicated that comprehensive moderate- to high-intensity behavioral interventions have at least short-term benefits for obese children and adolescents.

Researchers at the Center for Health Research at Kaiser Permanente and the Oregon Evidence-Based Practice Center, both in Portland, Oregon, examined the effects of behavioral and pharmacologic weight-management interventions for overweight and obese children and adolescents aged 4 to 18 years. They evaluated published studies, trials and expert recommendations included in databases such as Cochrane and Ovid Medline.

Researchers defined comprehensive moderate- to high-intensity weight-management programs as more than 25 hours of contact with the child or adolescent and their family over a six-month period. Programs included counseling for weight loss, healthy diet, physical activity and behavioral management techniques to help sustain lifestyle changes.

No long-term follow-up data exist for this strategy, but short-term (six to 12 months) maintenance results were encouraging, with 1.9 kg/m2 to 3.3 kg/m2 BMI loss at 12 months.

Researchers also investigated the potential for combination pharmacological agent and behavioral interventions in adolescents aged 12 years and older. Studies showed that sibutramine (Meridia, Abbott) was associated with moderate decrease in BMI for some obese adolescents (2.6 kg/m2). Evidence also indicated similar results in adolescents taking orlistat (0.86 kg/m2; Xenical, Roche; Alli, GlaxoSmithKline). However, no information regarding maintenance after discontinuation of sibutramine or orlistat was available.

Both the behavioral programs and the combined drug and behavioral interventions had low risks for causing harm. Several adolescents experienced adverse events related to the medications, such as elevated heart rate and blood pressure and gastrointestinal problems, and increased the risk of physical injury related to the behavioral programs. However, researchers deemed these effects mild to moderate.

They concluded that the changes to the USPSTF recommendations are significant and reflect the notion that obesity is both treatable and preventable in children and adolescents. – by Melissa Foster

Whitlock EP. Pediatrics. 2010;125e396-e418.

U.S. Preventive Services Task Force. Pediatrics. 2010;125:361-367.