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Children ages 6 years and older should be screened for obesity by healthcare providers, the U.S. Preventive Services Task Force (USPSTF) recommended.

In an update of the 2010 USPSTF recommendation for childhood obesity screening, the task force suggested clinicians refer children who are screened as overweight or obese to a comprehensive, intensive behavioral intervention for weight control following screening of BMI measurement.

The level B recommendation was published online in .

According to the 2000 CDC growth charts, around 32% of all U.S. youth are identified as being overweight or obese, defined by age- and sex-specific BMI in the 85th or higher percentile. Although the rates of childhood obesity have leveled off within the past 10 years, rates among certain populations continue to rise, particularly among Hispanic males and African-American females, due to a combination of genetic and environmental factors.

A systematic literature review of articles in MEDLINE, PubMed, and others identified 59 trials for inclusion (n=8,583). Forty-five of the included trials assessed behavioral-based interventional (n=7,099), eleven trials examined the oral treatment metformin and orlistat (n=1,395), while three others assessed harms of metformin specifically for weight loss (n=89).

Comprehensive, intensive behavioral-based interventions reported the greatest weight-loss with the lowest risk for overweight and obese children, according to an by Elizabeth A. O'Connor, PhD, of Kaiser Permanente Research Affiliates in Portland, Ore. The report, also in JAMA, was the basis of the revised task force recommendation.

This type of intervention with 26 hours or more of contact lasting between 2 to 12 months duration reported around a 0.20 absolute reduction in BMI z-score or greater of baseline weight within a mean of 5 lbs compared with control groups. Less intensive interventions reported inadequate evidence for their effectiveness.

Similarly, lifestyle-based interventions with 52 hours or greater of contact reported significant drops in both systolic (-6.4 mm Hg, 95% CI -8.6 to -4.2; I²=51%), and diastolic blood pressure (-4.0 mm Hg, 95% CI -5.6 to -2.5; I²=17%).

This type of weight loss intervention, which was found to have no evidence of any notable associated harm, is often comprised of several components led by a multidisciplinary team of providers, including individual sessions, combined parent and child sessions, dietary counseling, self-monitoring coaching, and supervised physical activity sessions, among others.

Additionally, the Community Preventive Services Task Force advises that such behavioral-based interventions also reduce sedentary screen time, specifically among youth 13 years or younger.

"This recommendation confirms what pediatric primary care clinicians and others do in the everyday care of children: monitor growth, counsel on healthy lifestyles, and refer when appropriate," wrote Rachel L. J. Thornton, MD, of Johns Hopkins School of Medicine in Boston, and colleagues in one of three accompanying JAMA editorials. However, Thornton's group argued that this type of recommended intervention is "impractical for many families," citing the reimbursement frameworks for such treatment.

"At best, implementing the 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," they stated, adding that access is one of the greatest challenges that the highest-risk populations face.

Jason P. Block, MD, and Emily Oken, MD, both of Harvard Medical School in Boston, agreed, noting that these types of recommended obesity treatment programs lack sufficient access "even in the absence of financial barriers."

"In one survey of children's hospitals, only about 60% offered programs with the intensity recommended by the USPSTF," they stated in their editorial. Block and Oken encouraging future research be directed at assessing effective obesity prevention methods for high-risk youth.

The evidence report also found oral medication use of metformin and orlistat for overweight and obese youth also reported significant weight loss compared to placebo (-0.86, 95% CI -1.44 to -0.29; I2=0% for metformin; -0.50 to -0.94 for orlistat). Dosage of metformin ranged between 1-2 g/day among the trials included, with adherence ranging from 60% to 93.2%.

Data on harms linked to metformin use in youth were not adequate from the trials assessed. Use of orlistat was associated with moderate harms, including abdominal pain, cramping, fecal incontinence, and other side effects.

Teresa Quattrin, MD, of the University at Buffalo in New York, and Denise E. Wilfley, PhD, of University School of Medicine in St Louis, suggested that the intervention-based recommendation is largely unattainable due to lack of insurance coverage for such care.

"Reimbursing for evidence-based childhood obesity treatment represents an opportunity to prevent obesity-related comorbidities like heart disease and diabetes, so that the upfront costs of childhood obesity treatment may be offset by a reduction in costs to treat these diseases in adulthood," they wrote in their editorial, advocating for future research on new pharmacotherapies for obese and overweight youth.