New Guidelines for Obesity Screening in Children and Adolescents

The US Preventive Services Task Force (USPSTF) has released new recommendations regarding screening children and adolescents aged 6 to 18 years for obesity.

The recommendations include referring those within the 95th percentile of their body mass index (BMI) to intensive lifestyle-based weight loss interventions with 26 or more hours of contact with patients.
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The recommendations are based on the results of a recent evidence report and systematic review conducted for the USPSTF.

In the report and review, the researchers assessed a total of 59 weight loss trials, obtaining data from various databases, publications, and government websites until January 22, 2016, and continuing surveillance through December 5, 2016.

Out of 59 total trials, 45 trials evaluated lifestyle-based interventions compared with a control group receiving usual care, and 11 assessed the benefits of metformin or orlistat use in patients with overweight or obesity compared with placebo.

The researchers assessed patients’ BMI, BMI z scores, cardiometabolic outcomes, quality of life, harms, and other health outcomes.

Although the researchers found no direct evidence on the benefits or harms of screening children and adolescents for overweight or obesity, the results supported growing evidence for the benefit of interventions involving 26 or more contact hours. Groups receiving these intensive interventions consistently showed mean reductions in excess weight, compared with control groups after 6 to 12 months.

In general, intervention groups experienced reduced BMI z scores by 0.20 or more and maintained their baseline weight within a mean of about 5 lbs. However, control groups showed small increases or no change in BMI z score and typically gained an average of 5 to 17 lbs. Only 3 of 26 interventions with fewer contact hours demonstrated weight loss.

Additionally, metformin and orlistat use were related to greater reductions in BMI compared with placebo, but had little to no benefit for cardiometabolic outcomes. Non-serious harms were common in groups receiving medications, and less than 5% of patients discontinued treatment.

“Lifestyle-based weight loss interventions with 26 or more hours of intervention contact are likely to help reduce excess weight in children and adolescents,” the researchers concluded. “The clinical significance of the small benefit of medication use is unclear.”

—Christina Vogt

Reference:

O’Connor EA, Evans CV, Burda BU, Walsh ES, Eder M, Lozano P. Screening for obesity and intervention for weight management in children and adolescents. JAMA. 2017;317(23):2427-2444. doi:10.1001/jama.2017.0332.