The U.S. Preventive Services Task Force (USPSTF) on Tuesday reaffirmed its 2005 recommendations advising health care providers to screen children and teens ages 6 to 18 for obesity and for obese children to receive intensive behavioral interventions.
According to the panel, about 17 percent of children ages 2 to 18 are obese. The panel noted that the obesity rate among children generally has stabilized over the past decade, but in certain populations—such as African American girls and Hispanic boys—the rates continue to rise.
USPSTF in its latest recommendation determined that obesity screenings and intensive behavioral interventions, such as comprehensive weight management programs, can result in weight improvements with minimal associated risks for children and adolescents ages 6 and older. The panel assigned the recommendations a "B" grade. Under the Affordable Care Act, insurers are required to cover preventive services that receive a "B" grade or higher from USPSTF without cost-sharing.
USPSTF found intensive interventions, which provided at least 26 hours of contact with behavioral specialists over two to 12 months, led to weight loss for up to 12 months. The panel said interventions with at least 52 hours of contact resulted in even greater weight loss and prompted improvements in cardiovascular and metabolic risk factors.
USPSTF said intensive interventions rarely occurred in the primary care setting. The panel wrote, "These types of interventions were often delivered by multidisciplinary teams, including pediatricians, exercise physiologists or physical therapists, dietitians or diet assistants, psychologists or social workers, or other behavioral specialists."
The panel said there was insufficient data to make a determination on the effects of other interventions for obesity, such as pharmacotherapies and school-based obesity program.
Access to care poses barriers
Jason Block and Emily Oken of Harvard Medical School in an accompanying editorial wrote that most U.S. regions do not have intensive behavioral intervention programs. For example, they wrote only 60 percent of U.S. children's hospitals have programs that meet the panel's criteria, and only 25 percent of those programs last a full year. Block and Oken wrote that a "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."
USPSTF Chair David Grossman of the Kaiser Permanente Washington Health Research Institute said the panel hopes "that these types of programs could someday be offered over telephone or televideo and that could overcome the access issues."
Rachel Thornton, Raquel Hernandez, and Tina Cheng of Johns Hopkins University School of Medicine in another accompanying editorial wrote, "The USPSTF recommendation should provide an impetus to redouble efforts to invest in practice, community, policy, and multilevel intervention research focused on achieving primary prevention and sustained improvements in health and health trajectories for children and adolescents and their families," adding, "The approach to childhood obesity must go beyond the clinician's office."
They warned, "At best, implementing the USPSTF recommendation will have modest effects on obesity prevalence in the United States. At worst, implementation could divert resources from population health approaches to prevention and push practitioners to refer obese children and adolescents to intensive weight management programs that are ill-equipped to meet the demand and rarely exist within local communities" (Seaman, Reuters, 6/20; Kaplan, "Science Now," Los Angeles Times, 6/20; USPSTF recommendation statement, 6/20).
Key insights on medical weight loss programs
As obesity and its related comorbidities remain top concerns nationwide, many hospitals are considering how to enhance their services to this patient group. Understanding that weight loss demands a comprehensive approach to care, many hospitals have launched non-surgical weight loss programs to support those patients who are not candidates for surgery.
These weight management programs vary greatly in their organization, program offerings, patient referral patterns, payment structure, and marketing strategies, though all aim to help patients lose excess weight. This brief profiles three non-surgical weight loss programs at community and teaching hospitals to identify the variety of services available.