Obesity Screening for Kids Should Start Earlier

When looking at a child it’s not always obvious if that child is obese. As eating habits and lifestyle changes take root, extra weight is becoming the new normal and parents might not detect when their child’s weight hits the wrong side of the scale. In the US, obesity is fairly common among children and adolescents. Obesity is associated with a number of negative health effects in children such as asthma, high blood pressure, sleep apnea, insulin resistance and orthopedic issues along with corresponding psychological and mental health issues due to bullying or other instances of body shaming.

A 2010 recommendation by the US Preventive Services Task Force, a group of medical experts, was reaffirmed on 2017 that advised all children and adolescents in the age group 6-18 years old be screened for obesity. The USPSTF advice is a major influence for healthcare providers and insurers who provide health coverage. The new advisory was published in the Journal of the American Medical Association, where the task force graded with moderate certainty about the overall benefit of early obesity screening and treatment referral.

According to the official definition, based on the official growth charts kids who have a body mass index in the 95th percentile for their age and gender are considered obese. Today, the US has 17% kids who fit in this percentile, and another 32% who are overweight i.e. between the 95th and 85th percentile.

The task force reviewed 20 clinical trials where behavioral and pharmacological interventions for obesity in children were tested and found that comprehensive, moderate to high-intensity programs were quite effective in improving their BMI. The programs included three components for comprehensive effects,

  1. Weight loss or healthy diet counseling,
  2. Physical activity counseling, and
  3. Techniques for behavioral management, like self-monitoring and goal setting, etc.

These lifestyle based interventions for weight loss, accompanying activities, and behavioral skill-set counseling with 26hrs or more of contact with the child and their family, spread over six months is likely to help reduce excess weight and address the issue of obesity effectively.

The USPSTF reviewed the evidence of these interventions for effectiveness and their primary care and referral feasibility. It also examined the evidence for the possibility and extent of potential harm on children and adolescents. Therefore, the task force only recommended behavioral interventions for weight loss, as the small benefit from medication is unclear and had presented several side-effects. Bariatric surgery was not considered by the panel as they noted that any patient who is a candidate for this treatment would be overweight enough for identification without screening. The recommended programs measured statistically insignificant yet small improvements on the psychological side with self-esteem, mental health, and quality of life.

Reducing childhood obesity has a larger goal of reducing the number of these children who grow-up to become obese adults. Most teens who are obese, almost 80% according to tracking studies, are on their way to becoming obese adults.

However, several editorials published in the same JAMA Internal Medicine have criticized the blanket recommendation by the government panel without acknowledging the obvious shortcomings. Jason Block and Emily Oken from Harvard Medical School and the Harvard Pilgrim Health Care Institute respectively pointed out, ‘Most children with obesity do not have access to the intensive multicomponent behavioral treatments recommended by the USPSTF… [And] absent or inadequate insurance coverage is a major barrier to care.’

A program like the one advocated involves not only doctors but also, dietitians, nutritionists, exercise physiologist, psychologists, etc. among other specialists. The task force did not dwell on the problems leading to the availability of all these catalysts both geographically as well as their financial viability, as insurance coverage for these is spotty at best along with a major obstacle of reimbursement.

Rachel Thornton along with her colleagues from Johns Hopkins School of Medicine agrees that intensive interventions as recommended by the USPSTF are ‘impractical’ for many families. They argued that ‘At best, implementing the USPSTF recommendation will have modest effects on obesity prevalence in the United States,’ and are in fact liable to divert funds from other important population based approaches to preventing obesity among children and adolescents.

Though all efforts for curbing the menace of childhood obesity are laudable, the truth rings in this statement by Dr Thornton, ‘The approach to chilhood obesity must go beyond the clinician’s office.’

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