US panel advises intensive behavioural counselling for children with obesity
A panel of experts in the United States has revised its guidance for paediatric obesity screening, with new recommendations highlighting the necessity for intensive behavioural interventions for children over the age of six who have a high body mass index (BMI). This update, issued by the U.S. Preventive Services Task Force, was published in the Journal of the American Medical Association (JAMA) Tuesday, 18th of June, 2024.
Replacing their 2017 advice, the Task Force previously suggested that primary care providers merely screen children for obesity. The urgency of the update is underscored by data showing that nearly 20% of U.S. children are classified as having obesity, a condition defined as having a BMI at or above the 95th percentile for a child’s age and sex. The prevalence of obesity is notably higher among Latino, Native American, and Black children, as well as those from lower-income backgrounds.
Dr. Wanda Nicholson, Chair of the Task Force and a professor of prevention and community health at George Washington University, emphasised the complexity of factors contributing to childhood obesity but pointed to strong evidence supporting intensive counselling. “Fortunately, we know that there are proven ways that primary care clinicians can help many children and teens to address the high BMI,” Dr. Nicholson stated. She highlighted that “Our evidence shows that the behavioural counselling intervention of 26 or more hours can help them achieve a healthy weight and improve their quality of life.”
Notably, the new recommendations do not advocate for the prescription of weight-loss drugs such as Ozempic or other GLP-1 medications for children, citing insufficient research on the benefits and potential harms of such treatments in younger populations. “We’re calling for more research into both the benefits and potential harms of medication therapy for kids and teens,” Dr. Nicholson explained.
The advised behavioural interventions typically encompass three core elements: education on healthy eating habits, counselling on weight-related behavioural changes—including goal-setting—and supervised exercise sessions.
The Task Force has awarded these recommendations a ‘B’ grade, reflecting a high degree of confidence in the moderate benefits of the interventions. Importantly, this grade also mandates that the recommended services be covered by most private health insurance plans in the U.S. without a copayment, as per federal law.
Despite the clear benefits, Dr. Nicholson acknowledged the challenges these recommendations might pose for affected families. “Twenty-six hours of counselling is a commitment both by the child or teen and their parents,” she remarked, noting that obstacles such as finding a provider who offers intensive counselling or reliable transportation to sessions could limit access to these essential services.
Dr. Nicholson expressed optimism about the potential outcomes of these investments in health. She mentioned that most of the research reviewed by the Task Force spanned six to twelve months of counselling, but stressed the need for further studies to explore the impacts of longer-term counselling initiatives.