Children with obesity should receive intensive counselling to promote healthy diet and exercise habits from the age of six, a panel of US experts has recommended, saying research has shown the effectiveness of this.
The government-backed US Preventive Services Task Force (USPSTF) had recommended in 2017 that screening for obesity should start at the age of six, and the agency says intensive behavioural interventions – defined as at least 26 hours of counselling with one or more health professionals – for achieving a healthy weight and improving the quality of life for children and adolescents, have proved to be highly effective.
Reuters reports that the new USPSTF advice, which is in draft form, does not address the use of medications like Novo Nordisk’s Wegovy, which is approved for children aged 12 and older, or surgery.
The task force said it had reviewed evidence on weight loss medications but found that more research is needed to fully understand the long-term health outcomes of these.
The behavioural interventions would comprise “a package” that includes physical activity, support for behaviour change, and education about healthy eating, said task force member Dr Katrina Donahue of the University of North Carolina School of Medicine.
The panel’s review of data from 58 randomised controlled trials involving more than 10 000 children found that these interventions work, “as long as the child receives a total of at least 26 hours of contact with professionals”, Donahue said.
The USPSTF assigned a “grade B” to the evidence favouring the intensive interventions, meaning there is high certainty they would have at least a moderate benefit. Children in the trials lost an average of 2kg to 3kg, with reductions maintained for at least one year.
Obesity in children and adolescents until the age of 19 is defined as having a body mass index higher than 95% of youngsters of the same age and gender.
Nearly one in five US children and teens fall into this category, according to the US Centres for Disease Control and Prevention (CDC).
Guidelines from the American Academy of Paediatrics (AAP) also advise lifestyle support, including 26 or more hours of “face-to-face, family-based, multi-component treatment over a three- to 12-month period”.
But the AAP has advised paediatricians to offer weight-loss drugs for children 12 and older with obesity, and referral for evaluation for metabolic and bariatric surgery for adolescents 13 and older with severe obesity.
Dr Sarah Hampl of Children’s Mercy Kansas City and the University of Missouri-Kansas City School of Medicine, a spokesperson for the AAP who was not involved in the USPSTF guideline, said many factors contribute to childhood obesity, including socio-ecological, environmental and genetic influences, and treatment should include identifying and addressing as many of these risk factors as possible.
The USPSTF draft recommendation will be available for public comment until 16 January.
USPSTF article – High BMI in children: interventions (Open access)
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