With obesity still rising among certain groups of kids, a government panel is renewing its advice that all children and adolescents 6 to 18 years old be screened for obesity.
Screening is just the first step. Kids who are obese should then be referred to treatment programs that use a variety of approaches to change their behavior and help them slim down.
The recommendations come from the U.S. Preventive Services Task Force, a group of experts appointed by the Department of Health and Human Services’ Agency for Healthcare Research and Quality. The task force’s advice influences health care providers and the coverage offered by health insurers.
The recommendations, published in the Journal of the American Medical Association, earned a “B” grade from the task force. That means the experts determined with “moderate certainty” that the overall benefit of obesity screening and treatment referral is “moderate.”
Here are more details about the recommendations:
Q. Is screening really necessary? I mean, can’t you tell if children are obese just by looking at them?
A. Not necessarily. As extra pounds become the new normal, fewer parents are able to recognize when their child’s weight is too high.
Besides, the medical definition of childhood obesity is pretty specific. You start by measuring a child’s height and weight and using that to calculate his or her body mass index. That’s weight (measured in kilograms) divided by height (measured in meters) squared. There are online calculators to help you, including: www.nhlbi.nih.gov/health/educational/lose_wt/BMI/bmicalc.htm
To determine if a child meets the criteria for obesity, you compare his or her BMI to the BMIs of other kids who are the same age. Doctors use growth charts from 2000 as a baseline for these comparisons. If a child’s BMI is high enough to land him or her in the top 5 percent, he or she is considered obese. Today, about 17 percent of Americans 2 to 19 years old are in this category, according to the Centers for Disease Control and Prevention.
Q. What’s wrong with having a high BMI?
A. Children with obesity are at greater risk for a variety of health conditions. These include asthma, high blood pressure, insulin resistance, high cholesterol, orthopedic problems and obstructive sleep apnea.
The task force also noted that obese children are more likely to experience “mental health and psychological issues,” as well as being teased or targeted by bullies.
Q. What if it’s just baby fat? Won’t kids just grow out of it?
A. Not necessarily. Tracking studies show that about 64 percent of pre-teens who are obese grow up to become obese adults. By the time kids become teenagers, the odds are even more stacked against them — nearly 80 percent of obese teens go on to become obese adults.
Adults who are obese (defined as having a body mass index of 30 or higher) are more likely to develop serious chronic diseases, including Type 2 diabetes and heart disease and certain types of cancer.
Q. OK, let’s say my pediatrician tells me my kid is obese. Now what?
A. The task force advises doctors to help their patients find a “comprehensive, intensive behavioral intervention.” That’s a fancy way of describing a weight-loss counseling program.
Q. What am I looking for?
A. In clinical trials, the programs that were most effective shared several features:
They included at least 26 “contact hours” with patients, spread out over a period of months. The ones with the best results had 52 contact hours, enough for one hour per week for an entire year.
They involved not just the child but his or her parents and siblings.
They included instruction on healthful eating, including steps such as how to read nutrition information on food labels.
They showed kids how to exercise safely and supervised some of their workouts.
They taught kids the value of reducing their access to junk food, limiting their screen time and steering clear of other triggers that could undermine their progress.
They helped kids learn how to set goals for themselves, monitor their progress and reward themselves when appropriate.
Q. Where can I find that?
A. Programs like these can involve not just doctors but dietitians, psychologists, exercise physiologists and other kinds of specialists. The task force acknowledged that some families would have “limited access” to programs, but it didn’t dwell on this problem.
Others did. In an editorial published in JAMA Internal Medicine, Drs. Jason Block and Emily Oken of Harvard Medical School pointed out that in “most areas of the United States,” programs like this simply aren’t available. Among children’s hospitals, for instance, only 60 percent have something that meets the task force’s criteria, and only 25 percent have a program that lasts a full year.
Even if a kid is fortunate enough to live near one of these hospitals, his or her family might not be able to afford to use it, Block and Oken added.
Three other doctors from Johns Hopkins University School of Medicine were even more critical. In a JAMA editorial, Drs. Rachel Thornton, Raquel Hernandez and Tina Cheng wrote that the task force’s recommendations could wind up diverting resources from more practical public health measures that could do more to reduce childhood obesity.
Q. Like what?
A. Thornton, Hernandez and Cheng touted efforts to keep junk foods out of schools and prevent companies from marketing sugary drinks to kids.
Block and Oken mentioned some other policies that have been shown to improve kids’ eating habits, such as taxes on sugar-sweetened beverages or changes in the rules governing the Special Supplemental Nutrition Program for Women, Infants and Children.
“Greater focus on policies that support healthful behaviors across all settings will be essential not only in ensuring the sustained success of treatment for established obesity, but also in preventing its onset,” the Harvard pair wrote.
Q. Can’t a doctor just prescribe some kind of medicine?
A. The task force considered two medications that are sometimes used to help kids lose weight, orlistat and metformin. Clinical trials have found that both drugs helped children lose about five to seven pounds. But that wasn’t enough to reduce their BMIs by even one point. However, the drugs did cause side effects, such as vomiting, cramping and “uncontrolled passage of stool,” according to the panel’s report.
Overall, the experts concluded that the clinical benefit of these drugs was “uncertain.”
Q. Didn’t I hear that the childhood obesity epidemic had stabilized?
A. That’s true for American kids overall — it’s been around 17 percent for about the past decade, according to data from the CDC’s National Health and Nutrition Examination Surveys. At the turn of the century, that figure was about 14 percent; in the 1970s, it was under 6 percent.
But some groups of kids are still getting fatter. For instance, obesity rates are still rising among African-American girls and Latino boys. Also, the proportion of kids who are severely obese continues to grow.