USPSTF reviews weight loss interventions for children and teens

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Weight loss interventions for children and teens are under review by the U.S. Preventive Services Task Force (USPSTF).

A public comment period opened this week to update the 2017 recommendation, “Screening for Obesity in Children and Adolescents.” The review will not address questions about screening for high weight, but will focus exclusively on updated evidence for the benefits and harms of weight management interventions.

The USPSTF draft recommendation is for clinicians to provide or refer children and adolescents aged 6 years or older with high body mass index (BMI) to comprehensive, intensive behavioral interventions.

USPSTF outlined the calculations for BMI, derived by dividing weight in kilograms by the square of height in meters. The parameters for determining “overweight” and “obesity” for youths were calculated from U.S. population data gathered from the 1960s to the 1990s and compiled as growth charts by the U.S. Centers for Disease Control and Prevention (CDC).

“Being comprised only of height and weight, BMI is a crude measure that does not account for different distributions in fat or fat-free mass,” the USPSTF announcement said. “On the other hand, the convenience of BMI measurement makes it suitable for use in a variety of settings and BMI is the accepted clinical standard measure of excess fat in the United States.”

There has been an upward trend of youths with BMI in the 95th percentile or greater, which is considered “obesity” based on the CDC’s growth charts from 2000. Now that includes about 19.7% of youths aged 2 to 19 years, and there are statistically significant differences among youths based on age, race and ethnicity, and socioeconomic status. But it’s difficult to say whether youth BMI have a direct effect on long-term health, “or whether risk is elevated primarily because risk factors often track into adulthood,” according to USPSTF.

Meanwhile, labeling children and teens as overweight or obese can have poor psychosocial outcomes and may lead to higher rates of unhealthy weight-control behaviors. “Weight stigma is pervasive and harmful,” with weight-based teasing and bullying common by peers, parents and teachers.

Data also show Americans generally are “not meeting recommendations for healthy diet and activity behaviors,” with too much screen time, not enough physical activity, and not enough sleep, according to USPSTF.

Reviewing studies on children and teen weight, USPSTF “found adequate evidence that comprehensive, intensive … behavioral interventions in children and adolescents age 6 years or older with a high BMI can lead to improvements in weight status and quality of life,” the recommendation said. It noted behavioral interventions need at least 26 contact hours for moderate net benefits.

As for the latest generation of antiobesity medicines, USPSTF said there is not enough evidence yet on potential benefits of pharmacotherapy. Potential harms are “no greater than moderate” due to studies reporting gastrointestinal symptoms such as fecal incontinence, flatus, and gall stones.

The USPSTF public comment period opened Dec. 12 and will last to Jan. 16, 2024.