To help combat an emerging national epidemic, pediatricians should screen children as young as 6 for obesity and refer them to intensive weight-loss programs that focus on diet, physical activity and behavioral counseling, an influential government advisory panel said today.
Too often, when a parent brings an obese child in for a routine checkup, they leave with little more than advice to eat better and exercise. That's not good enough, says the U.S. Preventive Task Force.
Previously, the independent panel said there wasn't enough evidence that weight-loss programs could help children shed pounds. The new guidelines come after a review of 20 clinical trials of weight-loss programs that showed the most intensive programs have the best results.
"A simple comment to eat less and exercise more is not sufficient to actually address problems in obese children," said Dr. Ned Calonge, a member of the task force and chief medical officer of the Colorado Department of Public Health and Environment. "It really requires a program that we call moderate- to high-intensity."
That means at least 25 hours of weight management over six months, according to the task force report appearing in today's issue of the journal Pediatrics. Successful programs should include an initial assessment, goal-setting and follow-up and should engage parent and child alike.
While government statistics released last week suggest the stunning three-decade rise in child obesity rates is leveling off, the rate is still too high, say public health officials. A third of U.S. children are obese or overweight, putting them at risk for diabetes, high blood pressure, sleep problems and depression.
Children are considered overweight when their body mass index is between the 85th and 95th percentile for their age and gender. Obese children have BMIs at or above the 95th percentile.
Last week, first lady Michelle Obama declared her intention to tackle childhood obesity in 2010. U.S. Health and Human Services Secretary Kathleen Sebelius said a national focus is "overdue."
"I am glad they are doing this," Dr. Alan M. Lake, a Lutherville pediatrician and chairman of the obesity prevention task force of the Maryland chapter of the American Academy of Pediatrics, said of the task force guidelines. "It will be important to the next step of not only establishing more of these programs, but more effectively evaluating their value."
Still, there are many stumbling blocks to getting children into weight-loss programs, he said. For now, intensive obesity prevention programs are scarce - there are just nine in Maryland for kids younger than 16, according to a review Lake did two years ago.
For the few that exist, insurance companies rarely cover the cost of all the services, forcing parents to pay out of pocket, a proposition that's impossible for many low-income families.
Calonge said he hopes the task force recommendations can influence carriers to cover the services.
Insurance coverage is also a stumbling block when diagnosing obesity, so many doctors don't go beyond routine screening. "There's no coverage at all for diagnosing obesity," said Lake, unless a child has another related illness such as diabetes or high blood pressure.
The needs are critical: In Maryland, 32 percent of children are obese or overweight by the time they enter kindergarten, said Lake, whose group issued a report to the state health department recently calling for increased awareness of childhood obesity and the need for more programs and services to treat it and insurance to cover the costs.
Dr. Dwight Fortier, managing partner of the large practice Annapolis Pediatrics, is working on developing obesity screening guidelines for all clinicians in the practice to follow. "We're trying to see if we can get a half-step beyond screening them and sending them to the nutritionist and see if we can we spend some quality time with these kids in counseling."
But other physicians said they fear child weight loss programs run the risk of stigmatizing overweight children. Instead, successful programs should target the child, parents and the entire community, said Dr. Maureen Black, a pediatric psychologist and professor at the University of Maryland School of Medicine.
"The difficulty is if a family decides to restrict what a child is eating, the evidence suggests that there is a boomerang effect," she said. "The family restricts, that over-emotionalizes food, the child eats more and gains weight."
A better strategy is helping families together develop healthy eating and exercise habits such as limiting TV time and going for family walks after dinner, she said.
"The idea is to focus on things the whole family can do," said Black, "not focusing on the child as having a medical problem."