USPSTF Recommends Intensive Behavioral Interventions for Children, Teens with High BMI

The US Preventive Services Task Force (USPSTF) in a final statement recommends that children and adolescents aged 6 years and older with elevated body mass index (BMI) be provided with or referred for intensive, comprehensive behavioral interventions.¹ The accompanying evidence review found that interventions of 26 contact hours or more were associated with improvements in weight status and quality of life in the young and vulnerable population.²

The new guidance updates the 2017 USPSTF statement that advised primary care clinicians to screen youth for obesity but did not detail interventions. The recommendation statement was published June 18, 2024, in JAMA.¹

Approximately 20% (19.7%) of US children and adolescents have a BMI at or greater than the 95th percentile for their age and sex. Moreover, the prevalence of elevated BMI increases with age and is higher among children of minority racial and ethnic populations and youth from lower socioeconomic backgrounds, according to the statement.¹ The rate of BMI increase in children and adolescents nearly doubled in the first 9 months of the COVID-19 pandemic.³

The task force recommends that to achieve the weight loss benefits of intensive behavioral interventions requires at least 26 hours of contact with a health care professional over 1 year and acknowledges the effort will require commitment from the child as well as the family.¹ The evidence review found the most effective interventions included several components, including sessions alone with the child or adolescent and family sessions targeting both parents and child (separately, together, or both).¹ Group sessions were also found useful. Education sessions focused on healthy food choices and habits and reading food labels, counseling sessions on techniques that target behavior change (eg, goal setting, problem solving) and supervised exercise sessions were all associated with modest weight loss. There was additional evidence that the types of interventions the task force recommends are often provided by multidisciplinary teams that may include pediatricians, exercise physiologists, dieticians, and behavioral health experts.¹

The recommendation, a B grade, is based on data from a systematic review of evidence of the benefits and harms of weight management interventions commissioned by the USPSTF and led by Elizabeth O’Connor, PhD, a behavioral health psychologist at Kaiser Permanente.² O’Connor and colleagues analyzed 58 randomized controlled trials (N = 10 143) on behavioral health interventions (50) and pharmacotherapy (8). The researchers found that across 28 of the studies the interventions resulted in modest reductions in BMI and weight-related outcomes after 6 to 12 months of treatment (mean difference, 0.7 kg/m²; 95% CI, –1 to –0.3). Interventions with higher contact hours and that included physical activity sessions yielded greater effects.²

The review of evidence on antiobesity medications included data on liraglutide, phentermine/topiramate and semaglutide; O’Connor and colleagues found the latter associated with the greatest effect on weight loss (mean difference, 6 kg/m²; 95% CI,7.3 to 4.6).²

However, more research is needed to fully understand the value and impact of such medications in the young population, “including the possible harms of long-term medication use,” the USPSTF said in a press release.⁴

According to the National Institutes of Health, approximately 15% to 30% of adults with obesity had obesity during childhood or adolescence. The cardiovascular risk factors that arise as a result of early life obesity typically persist into adulthood.⁴ In fact, the change in the nature of adipose tissue in adolescents with obesity can be a “reasonable mediator” of excess adult morbidity and mortality. Among the health conditions in youth caused by obesity are hypertension, hyperlipidemia, type 2 diabetes, and gallbladder disease. Anxiety and depression are more prevalent in these children as are social problems and low self-esteem associated with bullying and social stigma.⁴

Good, but not enough

Authors of an editorial accompanying the statement in JAMA said that the recommendations fall short of what is required to stem the persistent rise in youth obesity.³ A spectrum of public policy and financial investments is needed with specific targets to expand resources for physical activity, reduce poverty, address weight stigma and discrimination, and support ongoing research that will guide population-based interventions. Thomas N. Robinson, MD, MPH, Irving Schulman, MD Endowed Professor in child health at Stanford University, and Sarah C Armstrong, MD, professor in the department of family medicine and community health at Duke University School of Medicine, wrote, “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.”³

References

1. US Preventive Services Task Force. Interventions for high body mass index in children and adolescents. US Preventive Services Task Force Recommendation Statement. JAMA. Published online June 18, 2024. doi:10.1001/jama.2024.11146
2. O’Connor E, Evans CV, Henninger M, Redmond N, Senger CA. Interventions for weight management in children and adolescents: updated evidence report and systematic review for the US Preventive Services Task Force. JAMA. Published online June 18, 2024. doi:10.1001/jama.2024.6739
3. Robinson TN, Armstrong SC. Treatment interventions for child and adolescent obesity: from evidence to recommendations to action. JAMA. Published online June 18, 2024. doi:10.1001/jama.2024.11980 https://jamanetwork.com/journals/jama/article-abstract/2820247
4. Task Force issues final recommendation statement on interventions for high body mass index in children and adolescents. News release. United States Preventive Services Task Force. June 18, 2024. Accessed June 21, 2024. https://www.uspreventiveservicestaskforce.org/uspstf/sites/default/files/file/supporting_documents/high-bmi-children-adolescents-final-rec-bulletin.pdf
5. Balusundaram P, Krishna S. Obesity effects on child health. StatPearls. National Institutes of Health. Updated April 10, 2023. Accessed June 21, 2024. https://www.ncbi.nlm.nih.gov/books/NBK570613/