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JAMA Patient Page
June 20, 2017

Screening for Obesity in Children and Adolescents

JAMA. 2017;317(23):2460. doi:10.1001/jama.2017.7044

The US Preventive Services Task Force (USPSTF) has recently published recommendations on screening for obesity in children and adolescents.

The Problem of Childhood Obesity

Obesity in children is defined as having a body mass index (BMI) that is in the top 5% of all children of the same age and sex. Based on growth charts of US children from the year 2000, today approximately 1 in every 6 children aged 2 to 19 years is obese. When expanded to children who are either overweight or obese, which is defined as having a BMI in the top 15% (in the year 2000), this number increases to 1 in every 3 children today.

Obesity in children and adolescents is related to problems with mental health, problems with the bones and joints, and obstructive sleep apnea. Children who are obese often remain obese as adults, which can lead to more serious long-term health problems such as diabetes and heart disease.

The best way to reverse childhood obesity is to provide intensive interventions aimed at changing behavior such as counseling and education on healthier food choices and more active lifestyles. The more time spent on these interventions, the better (at least 26 hours based on current studies). These interventions can be provided by primary care clinicians, dietitians, psychologists, social workers, physical therapists, and exercise physiologists.

What Tests Are Used to Screen for Childhood Obesity?

Screening for obesity in children and adolescents is done by measuring height and weight at the doctor’s office. Body mass index is calculated from this information (weight in kilograms divided by height in meters squared). Body mass index percentiles are determined based on population norms from the Centers for Disease Control and Prevention.

What Is the Patient Population Under Consideration for Screening for Childhood Obesity?

This USPSTF recommendation applies to all children and adolescents aged 6 years and older.

What Are the Potential Benefits and Harms of Screening for Childhood Obesity?

The benefit of screening for obesity is the ability to offer interventions to reverse it. There is adequate evidence that providing intensive behavioral counseling leads to improvements in BMI up to 12 months later. There is some evidence that these BMI improvements are linked to improvements in blood pressure and blood glucose levels, but this evidence is limited. In general, more studies are needed on the effects of screening for obesity on obesity-related health outcomes. The potential harms of screening for obesity have not been well studied but are likely few or none. Any harm would likely be due to side effects of medications (such as metformin or orlistat), which are sometimes but not commonly used to promote weight loss in children.

How Strong Is the Recommendation to Screen for Childhood Obesity?

The USPSTF concludes with moderate certainty that the benefits of screening for childhood obesity and offering comprehensive, intensive behavioral interventions to children who are obese outweigh the harms.

Bottom Line: Current Recommendation for Screening for Childhood Obesity

The USPSTF recommends screening for obesity and offering behavioral interventions to treat it in children and adolescents (a “B” recommendation).

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Article Information

Source: US Preventive Services Task Force. Screening for obesity in children and adolescents: US Preventive Services Task Force Recommendation Statement. doi:10.1001/jama.2017.6803

Topic: Preventive Medicine

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