Primary care providers should start screening kids for obesity when they're two to five years old, instead of waiting until they're older, investigators advise.
Children aged two to five "responded better to a clinical obesity program than older kids", said Dr Carl A. Sather, with a greater decline in body mass index (BMI) z-scores compared to older children and teens.
In 2010, the US Preventive Services Task Force (USPSTF) advised that obesity screening start at age six. But Sather says that in the preschool set, metabolic abnormalities due to obesity are just as serious as in their older peers.
The USPSTF guidelines say kids with an age- and gender-specific BMI at or above the 95th percentile who don't respond to six months of primary care treatment should be referred to more intensive programs, with dietary, physical activity, and behavioural counselling components.
Sather and Dr Sandeep K. Gupta, both from the Indiana University School of Medicine in Indianapolis, US, and their colleagues studied 462 children enrolled in just such a programme - including 44 who were two to five years old.
For the first three months of the programme, the children (and their parents, for the youngest participants) received intensive counselling from a dietician, a physical therapist, a child psychologist, and a paediatrician or nurse practitioner. The second three months involved monthly group meetings. The meetings were held every other month for the second half of the year.
Baseline mean BMI z-scores were 3.46 in the preschoolers and 2.55 among older subjects. Younger and older kids had similar rates of dyslipidemia (HDL-cholesterol level < 40 mg/dL) - 56% and 59%, respectively - and transaminitis (an elevated ratio of aspartate aminotransferase to alanine aminotransferase), 7% vs. 7.5%, respectively.
BMI z-scores fell significantly more in the younger group at three months (-0.23 vs. -0.05, p < 0.001) and at six months (-0.64 vs. -0.10, p < 0.001).
Subject retention was low, however: about 43% at three months and less than 14% at six months. Thus, comparisons at three months involved 19 of the younger kids and 182 of the older ones; at 6 months there were 5 in the young group and 58 in the older group.
"Although our numbers are small, the data is convincing, and we believe it would be appropriate to screen all children for obesity, starting at 2," Sather concluded. "We hope our findings will prompt more research into BMI screening for a healthier paediatric population." - (Reuters Health, April 2011)
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