The US Preventive Services Task Force (USPSTF) has updated its 2010 recommendations on obesity screening in children and adolescents aged 6 years and older, emphasizing the importance of both screenings and referrals to comprehensive, intensive behavioral interventions for patients with obesity.1
The recommendation statement was recently published online in the Journal of the American Medical Association (JAMA).
Obesity Screening and Treatments Reassessed
At present, despite the stabilization of child and adolescent obesity rates during the past decade, certain populations, including African-American girls and Hispanic boys, have experienced a rise in obesity.
“These racial/ethnic differences in obesity prevalence are likely a result of both genetic and nongenetic factors,” the USPSTF investigators wrote, noting that socioeconomic status, intake of sugar-sweetened beverages and fast food, and having a television in the bedroom are among the contributing factors.
Since obesity in youth is associated with morbidity and may continue into adulthood, potentially resulting in adverse cardiovascular outcomes or other obesity-related morbidity, the researchers sought to better understand the efficacy of obesity screening in children and adolescents, as well as the benefits and harms of weight management interventions.
The investigators examined 42 trials with multicomponent behavioral interventions, of which 8 were deemed “good quality” and 34 “fair quality.” The total number of participants in the trials was 6956, and half of the trials were conducted in the United States.
According to the findings, comprehensive, intensive behavioral intervention of at least 26 contact hours in children and adolescents with obesity aged 6 years and older can result in improvements in weight status for up to 12 months. Conversely, there was inadequate evidence on the efficacy of less intensive interventions.
The researchers also found that the harms of behavioral interventions were small to none and the harms of screening were minimal. In addition, there was moderate certainty that screening in this population produced a moderate net benefit.
As a result, the USPSTF gave a B grade recommendation to screening for obesity in children and adolescents aged 6 years and older, and offering or referring patients with obesity to comprehensive, intensive behavioral interventions to promote improvements in weight status.
Inadequate Insurance Coverage a “Major Barrier”
In an accompanying editorial2 published in JAMA Internal Medicine, Jason P. Block, MD, MPH, and Emily Oken, MD, MPH, of Harvard Medical School and Harvard Pilgrim Health Care Institute in Boston, Massachusetts, wrote that most children with obesity do not have access to the intensive multicomponent behavioral treatments recommended by the USPSTF.
“Absent or inadequate insurance coverage is a major barrier to care, despite provisions in the Affordable Care Act that require coverage of services with a grade A or B rating by the USPSTF,” they wrote. “Even in the absence of financial barriers, obesity treatment programs are not available in most areas of the United States … Treatment programs tend to be concentrated in urban areas, severely limiting access.”
Drs Block and Oken noted that to move this evidence into action, sustained advocacy, innovative means of improving access such as telehealth programs, and enhanced focus on training healthcare professionals in multiple care roles are essential.
They concluded that the USPSTF recommendations “should lead to universal coverage for comprehensive, intensive behavioral treatment for obesity in children and adolescents. Future efforts, in clinical and community settings and in implementing evidence-based policies, should build on recent progress on obesity prevention.
Disclosures: All members of the USPSTF report receiving travel reimbursement and an honorarium for participating in USPSTF meetings. Drs Block and Oken report no relevant financial disclosures.
- US Preventive Services Task Force. Screening for obesity in children and adolescents: US Preventive Services Task Force recommendation statement [published online June 20, 2017]. JAMA. doi:10.1001/jama.2017.6803
- Block JP, Oken E. Practical considerations for the US Preventive Services Task Force recommendations on obesity in children and adolescents [published online June 20, 2017]. JAMA Intern Med. doi:10.1001/jamainternmed.2017.1978