番茄社区

The U.S. Preventive Services Task Force (USPSTF) intensive behavioral interventions -- but not pharmacologic therapies -- for kids with a high body mass index (BMI).

In its draft recommendation statement, the task force said clinicians should provide or refer patients ages 6 years and older with a high BMI (defined as 95th or higher percentile for age and sex) to comprehensive and intensive behavioral interventions (Grade B). To reap the "moderate net benefit," kids should have 26 or more contact hours with the behavioral interventions for up to a year, they advised.

"These interventions often include education about healthy eating habits, supervised exercise sessions, and counseling and support around how to set goals and make behavioral changes," task force member John Ruiz, PhD, of the University of Arizona in Tucson, told 番茄社区. "We are hopeful that connecting kids and teens to the care they need will help them manage their weight while improving their overall health."

That said, USPSTF fell short of recommending pharmacologic therapy, citing a lack of evidence. This did not mean the group recommended against this type of treatment; however, behavioral interventions should be the primary effective intervention for kids' weight loss, the task force said.

"After a thorough review of the research, the task force did not find enough evidence to make a recommendation about weight loss medications for kids and teens at this time," Ruiz said. "That is why we're calling for more research to understand the long-term health outcomes for prescribing these medications to kids."

"What we do know is that intensive behavioral interventions consisting of 26 or more hours with a healthcare professional are effective in helping children and teens achieve a healthy weight and stay healthy," he added.

This is in contrast to the first American Academy of Pediatrics clinical practice guideline, released in 2023, that recommended a wider array of interventions -- intensive behavioral treatment, weight-loss pharmacotherapy, metabolic surgery -- in young patients with high BMI. However, the USPSTF pointed out that its guidance is intended to be provided in, or referred from, a primary care setting, and surgical weight loss interventions are outside of that scope of practice.

When finalized, the statement will replace the on screening for obesity in kids for ages 6 and older, although the current recommendations shift the focus away from screening and more on intervention. Since the 2017 recommendations, the prevalence of obesity among U.S. youth (ages 2-19 years) increased from 17% to 20%.

The USPSTF performed an evidence review of 58 randomized control trials (RCT) with nearly 9,000 individuals: 50 RCTs on behavioral interventions and eight on pharmacotherapies. For the latter, semaglutide (-6.0 kg/m² for 2.4 mg Wegovy) and phentermine/topiramate (-5.4 for 15 mg/92 mg Qsymia) yielded the largest BMI reductions, while liraglutide (-1.6 for 3 mg Saxenda) and orlistat (-0.9) were linked with smaller reductions. Semaglutide and phentermine/topiramate also improved some lipid measures, but there was "little to no improvement" in other cardiometabolic outcomes with these drugs.

Although serious side effects were rare, the GLP-1 receptor agonist pharmacotherapies (liraglutide, semaglutide) were associated with gastrointestinal side effects -- a commonly reported occurrence with this class of medication -- which led to some discontinuation. But the task force highlighted that there was no available evidence on pharmacotherapy adverse effects beyond 1 month after discontinuation or for longer than 17 months on any of the medications.

For behavioral weight management interventions, there were small BMI reductions after 6 to 12 months (on average a 0.7 drop). As expected, this BMI reduction increased as kids engaged in these interventions longer. Though the evidence was sparse for other outcomes, the systematic review found these behavioral interventions were also associated with improvements in blood pressure and fasting plasma glucose.

While there weren't really any harms to behavioral interventions, USPSTF emphasized that this type of intervention may pose an access challenge to families, as they often involve a multidisciplinary team, including pediatricians, exercise physiologists or physical therapists, dietitians or diet assistants, psychologists or social workers, or other behavioral specialists. It also takes effort from the parent and child to become educated on healthy eating, reading food labels, and engaging in exercise.

"It's important for clinicians to know that these interventions work best when both children and their parents are engaged with the intervention," said Ruiz. "We understand the challenges that intensive interventions present for families and know that young children will need extra support to make these changes."

"The task force encourages clinicians to work with children and their families to make sure that the interventions are accessible in their specific situation. Finding the right fit for each kid will help them have the best possible chance to manage their weight and stay healthy over time," he concluded.

The draft recommendation statement and draft evidence review are open for through Jan. 16, 2024.

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