USPSTF: Provide or refer youth with high BMI to behavioral interventions
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Key takeaways:
- Behavioral interventions may include education on healthy eating and exercise sessions.
- USPSTF also assessed weight-loss medications but determined that more research on their long-term use and harms is needed.
In a final recommendation statement, the U.S. Preventive Services Task Force said that health care professionals should refer or provide youth aged 6 years and older with high BMI to intensive, comprehensive behavioral interventions.
The recommendation, a B grade, aligns with the task force’s draft recommendation from last year and replaces the USPSTF’s 2017 recommendation to screen for obesity in children and adolescents aged 6 years and older, which similarly recommended comprehensive behavioral interventions.
“Almost one out of every five children and teens in the U.S. has a high BMI,” USPSTF member John M. Ruiz, PhD, said in a press release. “Fortunately, there are a variety of effective intensive behavioral interventions available that can help kids with a high BMI achieve a healthy weight, while improving quality of life.”
According to the National Institute of Diabetes and Digestive and Kidney Diseases, 2017 to 2018 National Health and Nutrition Examination Survey data showed that 16.1%, 19.3% and 6.1% of youth aged 2 to 19 years have overweight, obesity or severe obesity, respectively.
In the final evidence report, Elizabeth A. O’Connor, PhD, a behavioral health psychologist at Kaiser Permanente, and colleagues analyzed 58 randomized controlled trials (n = 10,143) on behavioral health interventions.
They found that in 28 of the trials, interventions resulted in small reductions in BMI and other weight-related outcomes after 6 to 12 months (mean difference = –0.7 kg/m2; 95% CI, –1 to –0.3).
According to the task force, comprehensive behavioral interventions may include:
- counseling on behavioral change techniques like problem solving and goal setting;
- education about healthy eating habits; and
- supervised exercise sessions.
Effective interventions require at least 26 or more hours with a health care professional over 1 year and commitment from both youth and their families, the USPSTF noted.
The researchers also assessed evidence on several anti-obesity medications like liraglutide, phentermine/topiramate and semaglutide, finding that the latter produced the largest effect on weight loss (mean difference = 6 kg/m2; 95% CI,7.3 to 4.6).
However, more research is needed to fully understand the impact of such medications, “including the possible harms of long-term medication use,” the release said.
“We know that there are proven strategies to help kids who have a high BMI achieve a healthy weight,” Wanda Nicholson, MD, MPH, MBA, USPSTF chair, said in the release. “These interventions work best when both kids and parents are engaged, so it is important that health care professionals provide support in identifying which counseling interventions are available, accessible, and a good fit for the family.”
In a related editorial, Thomas N. Robinson, MD, MPH, an Irving Schulman, MD Endowed Professor in child health at Stanford University, and Sarah C. Armstrong, MD, a professor in the department of family medicine and community health at Duke University School of Medicine, wrote that the recommended interventions will not be enough to curb rising obesity in youth.
They pointed out that public policies and investments aimed at physical activity resources, reducing poverty, weight stigma and discrimination and producing further research to guide population-based strategies are all warranted.
“A synergistic combination of effective clinical care, as recommended by the USPSTF, and public policy interventions is critically needed to turn the tide on childhood obesity,” Robinson and Armstrong wrote.
References:
- O’Connor E, et al. JAMA. 2024;doi:10.1001/jama.2024.6739.
- Overweight & obesity statistics. https://www.niddk.nih.gov/health-information/health-statistics/overweight-obesity. Accessed June 14, 2024.
- Robinson T, Armstrong S. JAMA. 2024;doi:10.1001/jama.2024.11980.
- Task Force issues final recommendation statement on interventions for high body mass index in children and adolescents. https://www.uspreventiveservicestaskforce.org/uspstf/sites/default/files/file/supporting_documents/high-bmi-children-adolescents-final-rec-bulletin.pdf. Published June 18, 2024. Accessed June 14, 2024.
- USPSTF. JAMA. 2024;doi:10.1001/jama.2024.11146.
Perspective
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The U.S. Preventive Services Task Force recommendation for treatment of children and adolescents with obesity is a critical step in tackling a growing health crisis. An important first step to improving this vulnerable population’s health is the recommendation of greater than 26 weeks of supervised physician, dietitian and exercise therapist supervision. Involving the entire family in the process is important because others within the household are often in similar situations.
In order to combat this growing disease, long-term health care treatment and behavioral follow up is required, since obesity is a lifelong disease that requires more than 26 weeks of treatment. In addition to improving emotional and physical well-being, diet and exercise programs that lead to successful results are beneficial for those who are suffering.
Obesity is a major problem in this country, and reversing it will take time and effort, including supervised behavioral changes and a change in eating habits and exercise. We are beginning to rebuild how we will combat obesity in America with this recommendation, which is the beginning of a lifelong process.
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