WASHINGTON—Starting at age 6, children should be screened for obesity, and if necessary, referred to medium- to high-intensity weight-loss programs focused on diet, physical activity and behavioral counseling, according to the U.S. Preventive Task Force, which released a report in the journal Pediatrics (doi:10.1542/peds.2009-1955). These new guidelines replace older recommendations by the panel that said evidence didn’t show children could benefit from weight-loss programs.
These new instructions come after the panel reviewed 15 clinical trials of weight-loss programs that showed the most intensive programs have the best results. The trials covered obese and overweight children and adolescents aged 4 to 18 years.
They found comprehensive behavioral interventions of medium-to-high intensity were the most effective behavioral approach with 1.9 to 3.3 kg/m2 difference favoring intervention groups at 12 months. The programs recommended by the U.S. Preventive Task Force include at least 25 hours of weight management training over a period of at least six months. They said successful programs should include an initial assessment, goal-setting and follow-up, and should engage parents. The researchers reported limited evidence suggested these improvements can be maintained past the 12 months of treatments and little harm was found with behavioral interventions.
They also took at look at medication use among overweight and obese children and found two medications combined with behavioral interventions resulted in small (0.85 kg/m2 for orlistat) or moderate (2.6 kg/m2 for sibutramine) body mass index (BMI) reduction in obese adolescents on active medication. However, only one medication (orlistat) has been approved by the FDA for prescription use in those aged 12 years, they did not find any studies on weight changes after medication use ended.