Amid concern with unhealthy outcomes for children and teens who have high body mass index (BMI), a U.S. panel has recommended they receive 26 hours or more of behavioral intervention.
The recommendations were published in JAMA, the Journal of the American Medical Association.
The U.S. Preventive Services Task Force issued a final recommendation recently that says children and teens at or above the 95th percentile on weight for their age and sex based on Centers for Disease Control and Prevention growth charts.
The CDC notes that the annual medical cost of obesity is about $1.3 billion and that health costs for children with obesity are $116 higher per child than for children who have a healthy weight. The panel eschews the terms overweight or obese for children and teens.
The CDC said that nearly 15 million children and adolescents in the United States have obesity. CDC has an online calculator to help parents figure out where their child is in the growth charts.
The focus, panel members said, should be on learning about behavioral interventions, including exercise and healthy eating patterns. Additionally, the group highlights the importance of “access to affordable healthy food and beverages,” decreasing “sedentary screen time” and also incorporating digital health interventions.
“Effective, high-intensity behavioral interventions result in greater weight loss than less intense interventions and result in some improvements in cardiometabolic risk factors,” the recommendation says. It notes that many components fit in, including sessions for parents and children — separately or together — group sessions, education on health eating, safe exercise and nutrition, as well as “techniques such as problem solving, monitoring diet and physical activity behaviors, and goal setting.”
Medication and children
As CNN reported, “Recent studies have shown that popular weight-loss drugs and surgical procedures are also highly successful treatments for children, and they are recommended as viable options under American Academy of Pediatrics guidelines.”
The panel did not include weight-loss drugs or surgery in its recommendation, noting that while there is not clear evidence that long-term use is harmful, use of such medication in young people has not been well studied and can create some side effects like gastrointestinal problems such as nausea. The recommendation leans instead toward changing how children eat and exercise.
Because 26 hours is a lot and neither medication or surgery is recommended, CNN reported that the panel’s work “has left some doctors frustrated. Several providers characterize the new recommendations as unrealistic or problematic.”
Several doctors told CNN that medication has proven to be helpful, as has surgery.
As The Washington Post reported, “The Food and Drug Administration approved use of the drug Wegovy in children 12 and older in 2022.”
“Having the option of medication in the appropriate clinical scenario is very important,” Susma Vaidya, an associate medical director at the IDEAL Clinic, the weight-loss program at Children’s National Hospital in Washington, D.C., told the Post. “I am a big believer in medication, and I think that we have been advocating for lifestyle change for a long time and haven’t made a whole lot of progress.”
Vaidya noted there’s no long-term data on weight-loss drugs, but points out that there is long-term data on the health risks of carrying too much weight.
The task force didn’t consider the potential value of surgery, as it is “outside the scope of the primary care setting.”
High BMI and health
Health experts warn that children with high BMI are more likely than others to have respiratory problems, bone and joint issues and other negative health effects, including some related to cardiovascular health, such as high blood pressure and high cholesterol. They may also have a greater risk of diabetes and liver problems.
Their emotional well-being can also suffer from self-image problems or because other children may bully them.
CNN reports that “the task force gives its guidelines letter grades based on the most up-to-date science. Under the Affordable Care Act, private insurers must cover preventive services that get a grade of A or B; the new child obesity recommendations got a B grade.”