(CNN) — The U.S. Preventive Services Task Force has updated its final recommendations on how primary care clinicians can best support children who have a high body mass index, the measure most doctors use to determine whether someone is obese.
The task force suggested that broad-based, intensive behavioral interventions are the best way to help children maintain a healthy weight.
Recent studies have shown that popular weight loss medications and surgery are also highly effective treatments for children. American Academy of Pediatrics Guidelines.
But neither option is included in the USPSTF's latest recommendations, and that, combined with the long times the task force recommended for behavioral interventions, has left some doctors frustrated. Many health care professionals have called the new recommendations unrealistic or problematic.
Contents of the Recommendation
The latest recommendations from the task force, a volunteer panel of independent health professionals, suggest that clinicians provide intensive behavioral interventions to children with a high BMI at least at age 6, or refer the children to such services.
The criteria for what constitutes a high BMI in children are slightly different than for adults, but both use height and weight to estimate weight. A BMI of 30 or higher is within the obese range for adults, but for children, anything over 30 is considered high BMI. 95th percentile Depending on age and sex, a BMI of 95th percentile or higher means the child has a BMI higher than 95% of other children of the same age or sex, based on the Centers for Disease Control and Prevention growth charts. Parents should follow the CDC's Online calculator Estimate your child's body fat percentage.
Interventions recommended by the USPSTF include self-monitoring, goal setting, supervised physical activity, healthy eating advice and screen time limits. Healthcare providers can tailor these options to patients and their families, according to the expert panel, but interventions must involve at least 26 hours per calendar year and include supervised physical activity.
Studies the USPSTF reviewed before making its recommendation found that most kids who participated in these intensive programs lost some weight and lowered their BMI after six months to a year. Kids with better outcomes spent more time with clinicians and engaged in physical activity as part of the program.
Why are recommendations important?
If a child has a high BMI, Some important It can also lead to life-threatening health conditions such as diabetes, respiratory diseases, bone and joint diseases, liver disease, skin diseases, high blood pressure and high cholesterol, which can themselves lead to heart disease. Obesity can also make children a target for bullying and affect their emotional well-being and self-esteem.
About 20% of American children have high blood pressure. BMI. The number of obese children has increased significantly, tripling in the past 40 years. Research suggests.
The USPSTF recommendations help primary care providers determine what preventive care is effective and what is not, and insurers use them to decide which treatments to cover.
The task force assigns letter grades to the guidelines based on the latest science. Affordable Care ActPrivate insurers must cover preventive services that receive an A or B rating, and the new recommendations on childhood obesity received a B rating.
Some doctors say the guidelines are unrealistic
Dr Susma Vaidya, a paediatrician, Weight Loss Clinic Doctors at Children's National Hospital in Washington say intensive behavioral intervention is essential and important, but they believe the recommended 26 hours per year (on average, one hour every other week) is a nearly impossible goal.
“Unfortunately, we don't currently have the infrastructure in place to provide this intensive behavioral health management,” she says. “It's very difficult for providers. It's difficult for parents and children to commit to that amount of time. And we know that the amount of improvement in BMI is very small.”
Mona Sharifi, PhD, associate professor of pediatrics and biostatistics at the Yale University School of Medicine, American Academy of Pediatrics Guidelines “We're pleased that the USPSTF recommendation reemphasizes the strength of the evidence for intensive behavioral therapy, a guideline released last year to help doctors manage patients with obesity. But the group's last two recommendations on the topic (in 2010 and 2017) are similar and have changed little,” she said.
“Fifteen years after the first version, access to this type of treatment is still abysmal, and it may get even worse after the pandemic,” Sharifi said.
Many programs remain inaccessible to the majority of children and adolescents who need them most, according to an editorial published Tuesday in JAMA alongside the updated guidelines. Even past recommendations “are not routinely implemented in clinical practice,” wrote Dr. Thomas Robinson of Stanford University's Solution Science Institute and Department of Pediatrics, and Dr. Sarah Armstrong, professor of pediatrics and chief of the division of general pediatric and adolescent health at Duke University School of Medicine.
Sharifi said some highly effective pediatric programs also closed during the pandemic and have yet to reopen. Some doctors are trying to revive those programs, but “it's very difficult because there's no proper coverage from insurance companies,” she said.
Dr. Justin RyderA childhood obesity researcher at the Stanley Mann Children's Institute at the Ann & Robert H. Lurie Children's Hospital of Chicago said the high 26-hour bar could mean insurers will refuse to cover less-intensive programs.
“I think these recommendations are very problematic,” he said. “I think they're going to really harm obese kids.”
A 26-hour intervention would be “extremely difficult” to achieve in a clinical setting, he said. “In a primary care setting, it's virtually impossible.”
Lack of surgical recommendations
Some doctors have been critical of the USPSTF's decision not to recommend the surgery.
Procedures such as bariatric surgery are among the options the American Academy of Pediatrics encourages doctors to consider, but the task force said it did not review the latest research on the issue and considers the surgery “outside the scope of primary care.”
“We now have 10 years of data on bariatric surgery in adolescent patients,” Ryder said. “Bariatric surgery has the most robust and best long-term follow-up and outcomes data in this patient population, so to not even mention it as a potential option is clearly misguided.”
Lack of drug therapy recommendations
Some of the biggest disagreements with the recommendations concern weight-loss drugs, for which the USPSTF said “the overall evidence was found to be insufficient.”
But the task force looked at studies on the drugs liraglutide, semaglutide, orlistat, phentermine and topiramate (sold under the brand names Saxenda, Wegovy, Ally, Lomaira and Topamax, respectively).
In most trials, the drug It's associated with greater reductions in BMI than placebo, but there's not enough evidence to determine what its long-term effects might be, task force members said. doctor John LewisHe is a professor of clinical psychology at the University of Arizona. The drug can also cause side effects such as nausea, vomiting and gallstones.
“Very limited studies have been done, so we don't know if the results are reliable or generalizable,” he said, “and it's important to know if there are any harms, especially with long-term use of these drugs.”
Vaidya says the drug has significantly transformed her practice in Washington.
“We understand that our patients are children, and we always use great caution with medications, but these are FDA-approved medications, and in some cases, these medications can make it easier for families and children to adhere to the lifestyle changes that we recommend,” she said.
Vaidya said he has seen kids struggle for years to reach a healthy weight through lifestyle changes alone, only to eventually “snap out” with the help of weight-loss drugs.
“I honestly think the role of medication cannot be underestimated,” she said.
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