USPSTF Recommends Screening for Obesity in Children, Adolescents

The US Preventive Services Task Force (USPSTF) has updated its recommendation on screening for obesity in children and adolescents to suggest regular screenings in those aged 6 and older, who can then be referred to weight management interventions. However, an accompanying editorial suggests that clinical interventions are not enough to counter the epidemic of obesity among America’s youth.

Published in JAMA, the recommendation outlines the benefits and risks of screening for obesity in this population and determines with moderate certainty that there is a net benefit to screening and offering comprehensive behavioral interventions. It confirms that clinicians should use body mass index (BMI) measurement to identify obese children and youths during check-ups.

The USPSTF also observed that “comprehensive, intensive behavioral interventions” that are delivered across a time of 2 months to 1 year for at least 26 hours of contact have been shown to result in weight loss. These interventions, which often include both the child and parents, educate patients on how to make healthy diet choices, boost their levels of physical activity, and monitor progress. They are often delivered by an array of professionals including pediatricians, physical therapists, dietitians, and behavioral specialists.

In explaining the rationale for the screening recommendation, the USPSTF cited the high rates of obesity among children and adolescents and the fact that these rates are rising especially rapidly in some subgroups, like Hispanic boys and African American girls. Obese children and adolescents can face social consequences like bullying, as well as health impacts like asthma and orthopedic issues. If obesity persists as an adult, it increases the risk of diseases like type 2 diabetes.

An editorial published simultaneously in JAMA concurs that obesity is a serious health issue impacting children and adolescents, but questions the helpfulness of the USPSTF’s recommendation. One main concern is that it focuses too much on clinical interventions rather than on broader policy changes targeting a population.

“The approach to childhood obesity must go beyond the clinician’s office,” the authors write. They recommend a comprehensive strategy that considers the social determinants of health, such as the inability to access healthy foods or unsafe neighborhoods that make exercise difficult. Policies that improve nutrition in schools and restrict the marketing of sugary beverages could prove to be more cost-effective than offering behavioral treatment programs that not all children can access.

The editorial also advocates for earlier obesity detection and intervention efforts, despite the USPSTF’s finding that there is insufficient evidence to recommend screening in children younger than 6. Interventions that focus on the primary prevention of obesity and meaningfully improving health at the population level will be “critical for reversing the obesity epidemic,” the editorial authors concluded.