USPSTF draft statement recommends children with obesity begin behavioral interventions at age 6

In a draft statement published to its website on December 12, 2023, the United States Preventive Services Task Force (USPSTF) intends to recommend children and adolescents with a high body mass index (BMI) (≥95th percentile for age and sex) receive intensive behavioral interventions starting at 6 years of age.¹

According to the in-progress statement, children and adolescents are categorized as overweight if their respective BMI is between the 85th and 95th percentile and as having obesity when BMI is at or above the 95th percentile.

The statement, which when final will update the 2017 USPSTF statement on screening for obesity in children and adolescents beginning at age 6 years, states that nearly 20% of children and adolescents in the United States aged 2 to 19 years have a BMI at or above the 95th percentile.

This data, based on the Centers for Disease Control and Prevention (CDC) growth charts from 2000, is pulled from US-specific, population-based norms for children aged 2 years and up.

The recommendation states that intensive behavioral interventions with at least 26 contact hours or more for up to 1 year that include supervised physical activity sessions result in weight loss in children and adolescents.

The interventions, likely to be delivered via multidisciplinary teams, include parent and child sessions or group sessions discussing healthy eating information, safe exercising, reading food labels, and incorporating behavior change techniques.

The USPSTF is encouraging clinicians to promote behavioral interventions as the primary weight loss intervention, citing a lack of evidence on the potential harms of long-term medication use.

In draft statement preparation to update its 2017 recommendation, the Task Force reviewed evidence on both behavioral counseling and pharmacotherapy interventions for weight loss or management.

The USPSTF noted that this evidence can be provided in or referred from a primary care setting, and that surgical interventions fall outside of this setting.

A review of 58 randomized control trials (RCTs) was conducted, with 50 of the 58 trials being for behavioral interventions, while 8 reviewed pharmacotherapy interventions including semaglutide, liraglutide, orlistat, and phentermine and topiramate.

According to the data, only semaglutide (Wegovy; Novo Nordisk) was associated with a greater improvement in weight-related quality of life. In most trials, pharmacotherapy was associated with larger mean BMI reduction compared to placebo.

Eight trials (n = 1345) examined adverse effects of pharmacotherapy, which found that gastrointestinal side effects such as gallstones, flatus with discharge, and fecal incontinence were common in patients that received semaglutide, liraglutide, and orlistat.

Serious adverse effects were rare in each pharmacotherapy trial, however, the Task Forces noted that no evidence on adverse effects were available beyond 1 month after medication discontinuation, and no longer than 17 months for any medication.

Of the 50 behavioral intervention trials, 18 (n = 2539) examined the harms of behavioral interventions. No trials, with outcomes reported 6 to 12 months after baseline assessments, found an increased risk of any adverse event. Decreases in self-esteem, body satisfaction, or disordered eating were also not found.

The USPSTF’s draft recommendation of comprehensive, intensive behavioral interventions differs from the American Academy of Pediatrics (AAP) 2023 guideline,that includes comprehensive treatment of high BMI with pharmacotherapy for children younger than 13 years and consideration of bariatric surgery for adolescents, in addition to improved nutrition, physical activity, and behavioral therapy.

The AAP guidance, released in January 2023, stated that primary care physicians should oversee ongoing medical monitoring, intensive and long-term care strategies, and treatment for obese children and adolescents.²

The Task Force concluded with “moderate certainty that offering or referring children and adolescents age[d] 6 years or older with a high BMI to comprehensive, intensive behavioral interventions has a moderate net benefit.”

References:

1. High body mass index in children and adolescents: interventions. United States Preventive Services Task Force. December 12, 2023. Accessed December 13, 2023. https://www.uspreventiveservicestaskforce.org/uspstf/draft-recommendation/high-body-mass-index-children-adolescents-interventions
2. Krewson C. AAP releases guideline on evaluating and treating pediatric obesity. Contemporary Pediatrics. January 10, 2023. Accessed December 13, 2023. https://www.contemporarypediatrics.com/view/aap-releases-guideline-on-evaluating-and-treating-pediatric-obesity