US panel recommends children with obesity start counseling from age 6

[December 13, 2023]  By Nancy Lapid

(Reuters) -Children with obesity should receive intensive counseling to promote healthy diet and exercise habits starting at age 6, according to a draft recommendation issued by a panel of U.S. experts on Wednesday.

The government-backed U.S. Preventive Services Task Force (USPSTF) had recommended in 2017 that screening for obesity start at age 6.

Research since then has shown the effectiveness of intensive behavioral interventions - defined as at least 26 hours of counseling with one or more health professionals - for achieving a healthy weight and improving the quality of life for children and adolescents, the panel said. The recommendation did not specify a timeframe.

The new USPSTF advice does not address the use of medications such as Novo Nordisk's Wegovy, which is approved for children age 12 and above, or surgery.

The Task Force said it reviewed evidence on weight loss medications but found that more research is needed to fully understand the long-term health outcomes for medications.

The behavioral interventions would comprise "a package" that includes physical activity, support for behavior change, and education about healthy eating, said task force member Dr. Katrina Donahue of the University of North Carolina School of Medicine.

Because local resources vary, the interventions will "look different in different cities," Donahue acknowledged.

But the panel's review of data from 58 randomized 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 favoring the intensive interventions, meaning there is high certainty the interventions would have at least a moderate benefit. Children in the trials lost an average of 4 to 6.5 pounds (2 to 3 kilograms), with reductions maintained for at least one year.

Obesity in children and adolescents through age 19 is defined as having a body mass index – a ratio of weight to height – higher than 95% of youngsters of the same age and gender.

Nearly one in five U.S. children and teens fall into this category, according to the U.S. Centers for Disease Control and Prevention.

Guidelines from the American Academy of Pediatrics (AAP) also support lifestyle support including 26 or more hours of "face-to-face, family-based, multicomponent treatment over a 3- to 12-month period."

But the AAP has advised pediatricians to offer weight-loss drugs for children age 12 and up with obesity and referral for evaluation for metabolic and bariatric surgery for adolescents age 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, noted that many factors contribute to childhood obesity, including socioecological, environmental, and genetic influences, and treatment should include identifying and addressing as many of these risk factors as possible.

“A minimum of 26 hours of intensive health behavior and lifestyle treatment has been shown to improve children’s weight-related and other health outcomes," she said.

"Each child with obesity should be carefully evaluated and reevaluated over time. There is a spectrum of disease for children with obesity, with some youth needing more advanced treatments in addition to intensive health behavior and lifestyle treatment.”

The USPSTF draft recommendation will be available for public comment through Jan. 16.

(Reporting by Nancy Lapid; editing by Michele Gershberg and Marguerita Choy)

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