Identifying and Dealing with Obesity in Children and Adolescents

According to the year 2000 Centers for Disease Control and Prevention growth charts, among children and adolescents in the age group of 2 to 19 years in the US, about 17% of them are obese, and approximately 32% of them were obese or overweight.

The current study was carried out with the aim of updating the 2010 US Preventive Services Task Force (USPSTF) recommendation on screening 6 years and older children for obesity. The study also evaluated the benefits and harms of weight management interventions in them.

Issues posed by obesity in children and adolescents

Obese children and adolescents experience morbidity like psychological and mental health issues, polycystic ovarian syndrome, orthopedic problems, asthma, hepatic steatosis, obstructive sleep apnea,early maturation, and poor cardiovascular and metabolic results (like insulin resistance, abnormal lipid levels, and high blood pressure).

Obese children and adolescents may also be subjected to bullying and teasing due to their excessive body weight. Further, these children and adolescents may experience a continued obesity in their adulthood which may lead to poor cardiovascular outcomes, and type 2 diabetes.

Racial/ethnic difference in obesity prevelance

The overall rate of obesity in children and adolescents which had steadily increased for 3 decades, stabilized over the last decade, in certain populations, obesity rates are continuing to increase. Some of these populations include the minority sections like Hispanic boys and African American girls. These ethnic/racial difference in the prevalence of obesity are probably an outcome of both non-genetic (like consumption of fast food and sugar-sweetened beverages, the presence of a TV in the bedroom, and socioeconomic status) and genetic factors.

Obesity screening tool

For detecting obesity or overweight in children and adolescents, the USPSTF used the sex- and age-adjusted BMI.

Findings

Obese children and adolescents showed improvements in their weight status when comprehensive, intensive (≥26 contact hours for up to 12 months) behavioral interventions were applied. These interventions included providing sessions for child and parent (together, separately or both);supervised physical activity sessions; individual sessions (both group and family; information on exercising, healthy eating, and reading food labels; and encouragement for using stimulus control (like limiting TV time, limiting the availability of unhealthy foods), self-monitoring, goal setting, problem solving; and contingent rewards. Multidisciplinary teams often delivered these interventions. These teams included physical therapists or exercise physiologists, pediatricians,social workers or psychologists or other behavioral specialists, anddiet assistants or dietitians. The effectiveness of less intensive interventions had inadequate evidence.

Further, adherence to interventions affected the effectiveness of the outcomes. Lower adherence reduced the overall benefit imparted by these interventions. In the current study 68 to 95 percent of participants attended all the sessions.

Advantages of Early Detection and Intervention or Treatment

The study found that screening out obese children and adolescents, and providing them with intensive behavioral interventions can help improvement in their body weight status. The degree of this improvement is moderate. Pharmacotherapy interventions using orlistat and metformin resulted in a little weight loss. However, the degree of this benefit is of uncertain clinical significance as there is inadequate evidence about the effectiveness of these drugs.

Disadvantages of Early Detection and Intervention or Treatment

The study found a little or no harm owing to screening obese children and adolescents, and treating them with intensive behavioral interventions. There was no harm associated with using BMI as the screening tool for obesity, and with applying noninvasive interventions. The harms caused by metformin treatment had inadequate evidence. But there was adequate evidence showing the moderate harms caused by orlistat including cramping or abdominal pain, fecal incontinence, flatus with discharge, and oily or fatty stools.

Conclusions and Recommendation

The USPSTF suggests clinicians to screen children and adolescents who are 6 years and older for obesity, and refer them to or offer comprehensive, intensive behavioral interventions to foster improvements in their body weight status.

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