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Obesity screening

USPSTF recommends screening for obesity in children

USPSTF reviewed the evidence on screening for obesity in children and adolescents and the benefits and harms of weight management interventions

The US Preventive Services Task Force (USPSTF) is recommending that clinicians screen for obesity in children and adolescents aged six years and older and offer or refer them to comprehensive, intensive behavioural interventions to promote improvements in weight. This level B recommendation, is published in JAMA, and indicates that there is high certainty that the net benefit is moderate, or there is moderate certainty that the net benefit is moderate to substantial.

Approximately 17 percent of children and adolescents ages 2 to 19 years in the US are obese, based on year 2000 Centers for Disease Control and Prevention growth charts, and almost 32 percent are overweight. Obesity in children and adolescents is associated with mental health and psychological issues, asthma, obstructive sleep apnoea, orthopaedic problems, and adverse cardiovascular and metabolic outcomes such as high blood pressure, abnormal lipid levels, and insulin resistance.

Children and adolescents also may experience teasing and bullying based on their weight. Obesity in childhood and adolescence may continue into adulthood and lead to adverse cardiovascular outcomes or other obesity-related issues, such as type 2 diabetes.

To update its 2010 recommendation, the USPSTF reviewed the evidence on screening for obesity in children and adolescents and the benefits and harms of weight management interventions.

In 2005, the USPSTF found that age- and sex-adjusted BMI percentile is the accepted measure for detecting overweight or obesity in children and adolescents because it is feasible for use in primary care, a reliable measure, and associated with adult obesity.

The USPSTF found adequate evidence that screening and intensive behavioural interventions for obesity in children and adolescents six years and older can lead to improvements in weight status. The magnitude of this benefit is moderate. Studies on pharmacotherapy interventions (i.e., metformin and orlistat) showed small amounts of weight loss. The magnitude of this benefit is of uncertain clinical significance, because the evidence regarding the effectiveness of metformin and orlistat is inadequate.

The USPSTF found adequate evidence to bound the harms of screening and comprehensive, intensive behavioural interventions for obesity in children and adolescents as small to none, based on the likely minimal harms of using BMI as a screening tool, the absence of reported harms in the evidence on behavioural interventions, and the non-invasive nature of the interventions. Evidence on the harms associated with metformin is inadequate. Adequate evidence shows that orlistat has moderate harms.

Comprehensive, intensive behavioural interventions (26 or more contact hours) in children and adolescents six years and older who have obesity can result in improvements in weight status for up to 12 months; there is inadequate evidence regarding the effectiveness of less intensive interventions. The harms of behavioural interventions can be bounded as small to none, and the harms of screening are minimal. Therefore, the USPSTF concluded with moderate certainty that screening for obesity in children and adolescents 6 years and older is of moderate net benefit.

To access this paper, please click here

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