USPSTF Recommends Intensive, Behavioral Interventions for Children and Adolescents with Obesity

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The US Preventive Services Task Force (USPSTF) issued a draft statement recommending that clinicians provide or refer children and adolescents with a high body mass index (BMI) to intensive, comprehensive behavioral interventions (B grade recommendation).

The draft recommendation, issued December 12, 2023, applies to children and adolescents aged ≥6 years with a high BMI (≥95th percentile for age and sex). When final, the recommendation will update the 2017 USPSTF recommendation statement on screening for obesity in children and adolescents.

“There are a variety of effective, evidence-based interventions that can help children and teens maintain a healthy weight,” said USPSTF member John M. Ruiz, PhD, in the task force announcement. “Healthcare professionals should work with children and their families to find the intervention that is the best fit.

The USPSTF commissioned a systematic evidence review on interventions (behavioral counseling and pharmacotherapy) for weight management in children and adolescents, and “found adequate evidence that comprehensive, intensive (≥26 contact hours) behavioral interventions in children and adolescents aged 6 years or older with a high BMI can lead to improvements in weight status and quality of life. The magnitude of this benefit is moderate.”

Behavioral interventions included education on healthy eating habits, counseling on behavioral change techniques (eg, goal setting, problem solving), and supervised exercise sessions.

The USPSTF found “inadequate evidence” on the potential benefits of pharmacotherapy. Potential harms of pharmacotherapy interventions are “no greater than moderate” due to studies reporting gastrointestinal symptoms such as fecal incontinence, flatus, and gall stones, according to the USPSTF.

The USPSTF also noted that research is needed on long-term health outcomes and the benefits of behavioral and pharmacotherapy interventions.

“Studies should include outcomes such as improvement in weight/BMI, cardiometabolic outcomes, psychosocial outcomes (eg, global quality of life, weight-related quality of life, psychosocial functioning outcomes, and improved depressive symptoms), and dietary patterns,” wrote the task force. “Trials should include populations with a higher prevalence of high BMI (eg, Hispanic/Latino, Native American/Alaska Native, and non-Hispanic Black children and adolescents).”

The USPSTF’s draft recommendation statement and draft evidence review are posted for public comment until January 16, 2024.