There's been mixed news recently on childhood and adolescent obesity, the tricky issue that will be the subject of an initiative led by first lady Michelle Obama. According to statistics released last week, obesity rates for both kids and adults seem to be leveling off. The prevalence of high body mass index among kids and teens seemed to plateau between 1999 and 2006, according to research published in the Journal of the American Medical Association. But that leaves almost 32 percent of kids weighing more than they should, with a full 17 percent classified as obese. And the heaviest boys between the ages of 6 and 19 actually seem to be getting heavier.
Childhood and adolescent obesity is a particularly tricky problem because, as my colleague Deborah Kotz reported in 2007, the emphasis on losing weight—even in kids who really need to do so—may do more harm than good. A solution has remained elusive, and, until the last few years, there hasn't been a lot of quality research published on what actually works. On Monday, the U.S. Preventive Services Task Force—the same folks who brought you the controversial new breast cancer screening recommendations—said children 6 and up should now be screened for obesity.
The USPSTF's updated recommendations, published in the journal Pediatrics, said that it now makes sense to calculate the body mass index of kids. In 2005, the task force said that there wasn't enough evidence to say whether there was anything to do for these kids, so it made little sense to screen. But now, the agency says, some weight-loss programs for obese kids appear to work, at least over a period of up to 12 months.
But seeing a benefit requires a medium- to high-intensity, comprehensive program that involves more than 25 hours of contact with the kid and/or his family over a six-month period. It should include counseling and behavioral management to target diet and physical activity, the USPSTF said. (Three such programs found differences between the intervention and control groups of between 4 and 7 pounds after 6 to 12 months.) Notably, the USPSTF said that lower-intensity programs more suited to a primary-care setting didn't produce a significant improvement in BMI.
So there's still much to be learned: how long any benefits from interventions can last, what solutions can be implemented by primary-care physicians rather than specialized programs, and what might work for kids who are overweight but not obese. And there is the question of whether a child's environment should be as much of a focus as his or her behavior. As I reported last year, many in the field have come to believe that more research money needs to go toward studying community-based efforts that tackle the problem from multiple angles. As I wrote then:
Towns might build more bike paths and playgrounds, students might get more physical education in schools, nutritionally vacant foods might be taxed to discourage consumption, families might have access to free counseling. The point isn't that any one of these measures has been so proved to work that it should be rolled out nationwide but that these components need to be studied.
What do you think?
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