USPSTF: Refer Kids 6+ with High BMI to Intensive Behavioral Interventions

Researchers from the US Preventive Services Task Force (USPSTF) addressed the high prevalence of obesity among children and adolescents in the US, especially among certain ethnic groups and those from lower-income families, in a recent statement that was published in JAMA. The 2017 USPSTF statement on screening for obesity in adolescents and children six years of age or older is updated by this recommendation. Experts now advise practitioners to assign patients with a high body mass index (BMI) who are six years of age or older to complete, rigorous behavioral therapies, or to give the treatment themselves.

Context
According to Centers for Disease Control (CDC) growth charts from 2000, about 20% of US adolescents and children between the ages of 2 and 19 have a BMI that is either at or greater than the 95th percentile for their sex and age.

The aforementioned prevalence increases with age and is especially noticeable in children who identify as Native American or Alaska Native, non-Hispanic Black, Hispanic/Latino, and originate from lower-income households.

The evidence supporting behavioral counseling and medication-assisted weight management strategies that primary care settings can refer patients to or offer was examined by the USPSTF. Interventions for weight loss that involved surgery were excluded.

Behavioral therapies were investigated in fifty randomized clinical trials (RCTs) involving 8,798 participants. The results demonstrated significant improvements in quality of life, cardiometabolic risk factors, and BMI reductions. Pharmacotherapy was evaluated in eight trials; semaglutide and phentermine/topiramate demonstrated considerable BMI reductions, but they also came with notable adverse effects.

The advantages of behavioral treatments
The USPSTF concluded, with a moderate degree of certainty, that comprehensive and intensive behavioral therapies offer a modest net benefit for adolescents and children with high BMIs who are six years of age or older based on the review’s findings. Either these interventions should be given, or patients should be directed to the proper medical specialists.

Behavioral therapies improved quality of life, decreased cardiometabolic risk factors, and significantly lowered BMI. Interventions with a high level of contact (>26 hours) worked especially well.

In particular, behavioral therapies that included physical exercise under supervision and involved at least 26 contact hours over the course of a year produced outcomes including notable reductions in weight and improvements in cardiometabolic risk variables.

Multidisciplinary teams are frequently involved in these programs, which include safe exercise and nutrition education, supervised physical activity sessions, and behavior modification strategies like goal-setting, problem-solving, and activity and food monitoring.

Research has demonstrated that these therapies enhance quality of life and cardiometabolic outcomes while lowering BMI and weight. High-intensity interventions, for instance, have been linked to improvements in blood pressure, fasting plasma glucose levels, and a 1.4-point drop in BMI.

There are obstacles in the way of families using these strategies. The USPSTF recognizes that there is stigma associated with having a high body mass index (BMI), however it did not find any proof that the behavioral therapies that are advised worsen stigma or cause associated harms, or that they enhance self-esteem or quality of life.

Interventions involving pharmacotherapy
There is insufficient data to support pharmacotherapy in kids and teenagers. When compared to a placebo, medications such as liraglutide, semaglutide, orlistat, and phentermine/topiramate have demonstrated greater weight loss.

For instance, after 16 months, semaglutide had a BMI reduction that was 6.0 points higher. However, long-term maintenance of weight loss post-medication is not well-documented, and gastrointestinal side effects are common. For this reason, the USPSTF recommends prioritizing behavioral interventions over pharmacotherapy.

Resources for families and clinicians
The recommendation made reference to a number of resources that the Department of Health and Human Services, the CDC, and the Community Preventive Services Task Force have made accessible to assist physicians and families.

The USPSTF also cites relevant guidelines for screening children and adolescents for high blood pressure, lipid diseases, and diabetes.

In conclusion
According to USPSTF recommendations, practitioners should refer or offer intensive and comprehensive behavioral therapies to adolescents and children with high BMIs who are six years of age or older. These multi-component therapies with a minimum of 26 contact hours are beneficial in decreasing cardiometabolic risk factors and lowering body mass index (BMI).

Despite its promise in helping people lose weight, pharmacotherapy should not be the main strategy due to its lack of proof and possible side effects.

While medications were linked to mild side effects, mostly gastrointestinal problems, they also demonstrated greater BMI decreases. There is little data supporting the long-term advantages and disadvantages of medication.

Conversely, behavioral interventions did not result in a rise in unfavorable outcomes, such as eating disorders or low self-esteem. Pharmacotherapy shown modest damage due to gastrointestinal problems, although being beneficial for weight loss.

A multimodal strategy that includes behavioral counseling, community support, and institutional improvements to reduce health disparities is needed to address childhood obesity.

In order to determine which behavioral and pharmacological interventions are most beneficial for children under six, as well as to investigate the long-term consequences of each, further study is required.

For more information: Interventions for High Body Mass Index in Children and Adolescents: US Preventive Services Task Force Recommendation Statement, JAMA, doi:10.1001/jama.2024.11146