Children with obesity should receive intensive counseling from the age of 6 to promote healthy eating and exercise habits. This emerges from a draft recommendation published by a panel of US experts on Wednesday.
The government-backed US Preventive Services Task Force (USPSTF) had recommended in 2017 that obesity screening begin at age 6.
Since then, research has shown that intensive behavioral interventions – defined as at least 26 hours of consultation with one or more health professionals – are effective in achieving a healthy weight and improving the quality of life of children and adolescents, the panel said. No time frame was specified in the recommendation.
The new USPSTF recommendation does not cover the use of medications such as Novo Nordisk’s Wegovy, which is approved for children ages 12 and older, or surgery.
The task force said it reviewed the evidence on weight-loss medications but found that more research is needed to fully understand the long-term health effects of medications.
The behavioral interventions would include a “package” that includes physical activity, behavior change support and healthy eating education, Dr. Katrina Donahue of the University of North Carolina School of Medicine, a member of the task force.
Because local resources vary, the response will be different in each city,” Donahue acknowledged.
But the panel’s review of data from 58 randomized controlled trials involving more than 10,000 children found that these interventions work “as long as the child has at least 26 total hours of contact with professionals,” Donahue said.
The USPSTF gave the evidence for the intensive interventions a grade of B, meaning there is a high likelihood that the interventions will have at least a moderate benefit. The children who took part in the studies lost an average of 4 to 6.5 pounds (2 to 3 kilograms), with weight loss lasting for at least a year.
Obesity in children and adolescents up to age 19 is defined as a body mass index – a ratio of weight to height – that is higher than that of 95% of children and adolescents of the same age and gender.
According to the US Centers for Disease Control and Prevention, nearly one in five children and adolescents in the US fall into this category.
The American Academy of Pediatrics (AAP) guidelines also recommend lifestyle support, including 26 or more hours of “personal, family-based, multicomponent treatment over a period of 3 to 12 months.”
However, the AAP has recommended that pediatricians offer weight-loss medications to children age 12 and older with obesity and to refer adolescents age 13 and older with severe obesity for evaluation for metabolic and bariatric surgery.
Dr. Sarah Hampl of Children’s Mercy Kansas City and the University of Missouri-Kansas City School of Medicine, an AAP spokeswoman who was not involved in the USPSTF policy, pointed out that many factors contribute to childhood obesity, including socioenvironmental, environmental and genetic influences, and that treatment should include identification and treatment of as many of these risk factors as possible.
A minimum of 26 hours of intensive health behavior and lifestyle treatment has been shown to improve children’s weight-related and other health outcomes,” she said.
“Any child with obesity should be carefully examined and reassessed over time. There is a spectrum of conditions in children with obesity, with some adolescents requiring more advanced treatment in addition to intensive health behavior and lifestyle treatment.
The USPSTF draft recommendation is open for public comment until January 16. (Reporting by Nancy Lapid; Editing by Michele Gershberg and Marguerita Choy)