19 January 2010

Federal Panel Urges Obesity Screening for Kids Ages 6 and Up

Children who are obese should be referred to treatment, USPSTF panel says


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MONDAY, Jan. 18 (HealthDay News) -- A federal panel of health experts has issued new recommendations encouraging U.S. doctors to screen children aged 6 and older for obesity, and to offer them a referral to intensive weight management programs when necessary.

The recommendations from the U.S. Preventive Services Task Force (USPSTF) update those issued in 2005. At that time, the group said there was insufficient evidence to recommend routine obesity screening in children.

However, "since 2005, a series of randomized clinical trials have demonstrated that there is effective therapy, so we felt compelled to change the recommendations," said the UPSTF panel chair Dr. Ned Calonge, chief medical officer of the Colorado Department of Public Health in Denver.

"This is an encouraging message. There's hope for successful treatment, and we hope that parents will ask their pediatrician if their child needs intervention," said Calonge.

He said it's better to address the problem as early as possible in childhood instead of waiting until your child is grown.

"Once you become an overweight adult, it's more difficult to change your behavior," Colange said. "We do believe that childhood behaviors can be changed, and investing in changing these behaviors in kids is an investment that can pay off lifelong."

The new recommendations will be published in the February issue of Pediatrics, and are available online on Jan. 18 on the Pediatrics Web site.

Although recent statistics suggest that the rate of childhood obesity may be leveling off, one out of every six U.S. children is still obese, according data from the U.S. National Center for Health Statistics released last Wednesday.

The new recommendations now urge doctors to screen all children between 6 and 18 years of age for obesity. Screening should be done using height and weight measurements used to calculate body mass index (BMI), and findings should be compared to other children of the same sex and age. Kids whose BMI is over the 95th percentile for their gender and age are considered obese.

For children or teens who meet the definition of obesity, the task force recommends that doctors refer children and teens to intensive weight-management programs. Such programs should include more than 25 hours of contact with the child or teen over the first six months, and include three components:

  • Counseling for weight loss
  • A physical activity program or counseling on physical activity
  • Behavioral management counseling, such as teaching goal-setting and self-monitoring behaviors

In an editorial in the same issue of the journal, Dr. Sandra Hassink, a member of the American Academy of Pediatrics' board of directors, wrote that the current USPSTF report is "significant because it provides evidence that obesity treatment can be effective and beyond the immediate intervention." However, she also wrote that the recommendation fell short because it should have included younger children, from age 2 and up.

Another concern is that there may not be enough weight-management treatment programs available for all the children who meet the task force's threshold for obesity.

"The recommendation is that any program for children should be at least 25 hours over six months, and it's not easy to find programs that are 25 hours in duration," explained Dr. Goutham Rao, clinical director of the Weight Management and Wellness Center at Children's Hospital of Pittsburgh.

"Very intense programs like this are usually very expensive and private-pay, and they may take in few kids," he said.

Calonge said that at least for now, there may be a shortage of programs. But, he said, as more children are referred, and more insurers start reimbursing for the treatment, more programs should become available. He pointed out that when mammograms were first recommended, few centers were available to address this need, but that hospitals and private companies quickly filled the gap.

Rao agreed that more programs will likely become available, and said that new ways to help children change their behaviors may be developed. At his own center, they've recently developed on online weight-loss program where children keep daily food logs and have email contact with a dietician.

And, despite the potential shortage of treatment programs, Rao said, these recommendations "are a major step in the right direction. The longer you wait to address obesity, the more habits are entrenched. The younger children are, the easier it is to make changes."

More information

Get advice on keeping your children at a healthy weight from the U.S. Centers for Disease Control and Prevention.


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