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Primary care interventions aimed at obesity not effective, new strategies needed

Obesity counseling and guidance in primary care has little effect on BMI, and new practice guidelines and novel approaches are needed to address this, according to data published in Pediatrics.

“Concerns about the rising prevalence of pediatric obesity, as well as the associated comorbidities and long-term medical consequences, have led to well-publicized public health initiatives to reduce obesity in youth,” Leslie A. Sim, PhD, of the departments of psychiatry and psychology at the Mayo Clinic, in Rochester, Minnesota, and colleagues wrote. “In this effort, primary care practitioners have been charged with the task of identifying and intervening when at-risk young patients present for a routine appointment.”

To determine the effect of short-term, primary care interventions for pediatric weight loss on BMI, the researchers reviewed 12 published articles, documenting either randomly controlled trials or quasi-experimental studies. Studies included in the review compared the effect of office-based primary care weight management interventions to any control intervention on percent BMI or BMI z scores in children aged 2 to 18 years.

The researchers used Medline, CENTRAL, Embase, PsychInfo and CINAHL to search for studies published from January 1976 to March 2016. In addition, a pair of reviewers independently screened sources, drew data on participant, intervention and study characteristics, z-BMI and percent BMI, harms and study quality using the Cochrane and Newcastle-Ottawa risk of bias tools.

According to the researchers, compared with usual care or control treatment, short-term strategies that were deemed feasible in primary care were associated with a significant yet small reduction in BMI z score (–0.04; 95% CI, –0.08 to –0.01; P = .02). In addition, interventions had a nonsignificant effect on body satisfaction.

“This review suggests that primary care interventions that incorporate a systemic approach to addressing pediatric overweight and obesity (eg, patient-centered communication, patient education, regular visits and phone calls) have only a marginal effect on reducing pediatric overweight and obesity in the short term,” Sim and colleagues wrote. “… It appears that a paradigm shift might be indicated, in which novel programs are designed and tested, potentially taking into account the evidence about elements of effective behavioral weight loss programs in other settings and about more meaningful markers of health compared with BMI.”

In a related editorial, Sarah C. Armstrong, MD, and Asheley Cockrell Skinner, PhD, both of Duke University, in Durham, North Carolina, argue that the researchers’ findings call on clinicians, researchers and policymakers to reassess their interventions. However, they cautioned against completely disregarding BMI as a screening measure.

“BMI screening with primary care counseling is considered ‘clinically insignificant’ because it results in only a small reduction in a child’s BMI,” Armstrong and Skinner wrote. “However, just as changes in smoking behavior lead to reduced morbidity from chronic obstructive pulmonary disease and lung cancer, so improved diet and activity behaviors lead to improved glucose tolerance, lipid profiles and blood pressure. Primary care nutrition and activity counseling should improve nutrition and activity behaviors. Failing to reduce BMI should not be equated with failing to adopt healthier behaviors.” – by Jason Laday

Disclosure: The researchers report no relevant financial disclosures. Armstrong and Skinner also report no relevant financial disclosures.