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USPSTF revising guidelines on youth obesity screening and intervention
Children and adolescents 6 years of age or older who underwent screening for obesity and were recommended for lifestyle-based weight loss interventions displayed a reduction of excess weight, according to draft evidence released by the U.S. Preventive Services Task Force.
The evidence is part of a new draft recommendation that promotes comprehensive, intensive behavioral interventions to help improve the weight status of children and adolescents who are overweight or obese, according to a U.S. Preventive Services Task Force (USPSTF) statement. The task force seeks to update its 2010 B-grade recommendation which concluded, with moderate certainty, that children aged 6 years or older endured a moderate net benefit if they were screened for obesity and were referred to moderate- or high-intensity interventions. The update, also a B-grade recommendation, focuses on the benefits of vulnerable children and adolescents who engage in 26 hours or more of weight loss intervention.
“[There was] adequate evidence that screening and intensive behavioral interventions for obesity in children and adolescents age 6 years and older can effectively lead to improvements in weight status and certain related cardiometabolic factors after 6 [months] to 12 months,” the USPSTF stated in the draft recommendation. “The magnitude of this benefit is moderate.”
The draft recommendation is based on a systematic review conducted by the Kaiser Permanente Research Affiliates Evidence-based Practice Center (EPC). The members of the USPSTF, along with the Agency for Healthcare Research and Quality (AHRQ), developed an analytic framework and five key questions that were adapted from the 2010 review. Investigators performed a literature search through Jan. 22, 2016 of 9,491 abstracts and 464 full-text articles. Of these, 59 studies met inclusion criteria and were analyzed.
There was no direct evidence that screening children of 6 years or older for obesity was beneficial or harmful. However, the investigators found 26 or more hours of participation in lifestyle-based weight management interventions posed no harm. Furthermore, 52 hours or more of participation in interventions improved some cardiometabolic measures.
“Less-intensive programs are unlikely to improve weight status, except perhaps for children who are overweight but do not yet have obesity,” the report concluded. “The clinical significance of the small benefits seen with the use of metformin and orlistat is unclear. The degree to which changes in excess weight are maintained in the long term, particularly into adulthood, are unknown.”
The draft recommendation and draft evidence will be available for review and public comment through Nov. 28. – by Alaina Tedesco
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