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Defeat Diabetes
150 153rd Ave,
Suite 300

Madeira Beach, FL 33708

Obesity Screening Recommended for Children Ages 6 to 18 Years

Posted: Sunday, January 31, 2010

The US Preventive Services Task Force (USPSTF) recommends that clinicians screen children ages 6 to 18 years for obesity and refer them as appropriate to programs to improve their weight status, according to evidence-based guidelines.

Chair Ned Calonge, MD, MPH, from the Colorado Department of Public Health and Environment in Denver, and colleagues from the USPSTF write, "Since the 1970's, childhood and adolescent obesity has increased three- to sixfold.... Approximately 12% to 18% of 2- to 19-year-old children and adolescents are obese (defined as having an age- and gender-specific BMI [body mass index] at >95th percentile).... Previously, the USPSTF found adequate evidence that BMI was an acceptable measure for identifying children and adolescents with excess weight."

The USPSTF evaluated evidence for the efficacy of pediatric weight management interventions that are feasible in primary care or referable from primary care. The task force also considered the evidence for the magnitude of potential harms of treatment in children and adolescents.

This evidence led the USPSTF to issue a grade B recommendation that clinicians screen children 6 years and older for obesity and provide obese children with intensive counseling and behavioral interventions designed to improve weight status, or that they refer them for such counseling and interventions.

During health maintenance visits, height and weight are routinely measured, allowing calculation of BMI. Based on a review of 20 clinical trials of behavioral and pharmacologic interventions for obesity, the task force concluded that evidence was adequate that comprehensive, moderate- to high-intensity interventions effectively improve BMI in children.

"Over the past several years, research into weight management in obese children and adolescents has improved in quality and quantity," write Evelyn P. Whitlock, MD, MPH, from the Center for Health Research, Kaiser Permanente in Portland, Oregon, and colleagues. "Despite important gaps, available research supports at least short-term benefits of comprehensive medium- to high-intensity behavioral interventions in obese children and adolescents."

Moderate- to high-intensity programs are defined as those in which there are more than 25 hours of contact with the child and/or family during a 6-month period. Low-intensity interventions were not associated with significant improvement in weight status.

Three components needed for effective, comprehensive programs are counseling regarding healthy diet and/or weight loss; counseling regarding physical activity recommendations or a physical activity program; and behavioral management techniques including setting goals and self monitoring.

Families seeking treatment for obese children should therefore consider comprehensive programs targeting weight control through healthy food choices, physical exercise, and building behavioral skills.

The task force also concluded that evidence is adequate that the harms of behavioral interventions are no greater than small, and that there is moderate certainty that the net benefit is moderate for screening for obesity in children at least 6 years old and for offering or referring children to moderate- to high-intensity interventions to improve weight status.

Although interventions that combined pharmacotherapy (sibutramine or orlistat) with behavioral interventions were associated with modest short-term improvement in weight status in children at least 12 years old, there were no long-term data on maintenance of improvement after medications were discontinued. The magnitude of the harms of these medications in children could not be estimated with certainty, but known adverse effects include elevated heart rate and blood pressure and adverse gastrointestinal tract effects.

"Recognition that screening is the first step to individual evaluation and counseling for obesity prevention and treatment should be standard in practice now," Dr. Hassink writes. "Working with families to screen for high-risk nutrition and activity behaviors that contribute to obesity in early childhood must be part of that task. With that said, the current USPSTF report is significant because it provides evidence that obesity treatment can be effective and extend beyond the immediate intervention and that pediatricians in the context of a medical home model that supports multidisciplinary care, with the appropriate supports of training and reimbursement, can provide effective obesity prevention and treatment for the families and children in their care."

Source: Diabetes In Control: Pediatrics, online January 18, 2010.

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