The National Center for Health Research is a nonprofit research center that analyzes and reviews research on a range of health issues, with particular focus on which prevention strategies and treatments are most effective for which patients and consumers.
Childhood obesity is a serious problem and intensive behavioral interventions to promote improvements in weight status have benefits for some children and adolescent populations. However, we are concerned that due to limitations in the quality of the research supporting the recommendations, they may not be appropriate for all children and adolescents.
We strongly agree with USPSTF’s concern about the lack of long-term follow-up studies to determine if interventions continue to help participants maintain healthy weight into adulthood. This will help justify the time and resources needed for patients, their families, and their doctors to commit to the recommended screening and treatments.
We further agree that there is a need for more studies that address behavioral interventions in diverse populations. There is substantial variability in obesity prevalence across different racial, ethnic, and socioeconomic groups (Ogden et. al. 2014) (May et. al. 2013). The inability to include studies of these diverse demographic groups limits the generalizability of the recommendation. Obesity disproportionality affects blacks, Hispanics and lower socioeconomic groups (May et. al. 2013). The lack of inclusion of these important demographic groups, make it impossible to determine whether these recommendations are suitable for all children and adolescents.
Research on mental and behavioral outcomes in intervention studies should be used to help determine additional risks and benefits of early screening and treatments, in addition to BMI and waist circumference. Quality of life can be as important as physical outcomes. Outcome measures that include quality of life would allow a more holistic evaluation of the risks and benefits of the interventions.
In addition to cost, the lack of studies looking at potential harms of screening and intervention ignores possible risks for children and adolescents. Without research, it is not possible to know the impact of a physician labeling a child as obese or overweight on the well-being of children and adolescents.
In conclusion, we are concerned that the lack of evidence limits the generalizability of the recommendations and the ability to weigh risks and benefits.
The National Center for Health Research can be reached through Diana Zuckerman at dz@center4research.org or at (202) 223-4000.
References
Ogden CL, Carroll MD, Kit BK, et al. Prevalence of childhood and adult obesity in the United States, 2011-2012. JAMA. 2014;311(8):806-14. PMID: 24570244.
May, Ashleigh L., Phd, Liping Pan, MD, BettyLou Sherry, Phd, Heidi M. Blanck, Phd, Deborah Galuska, Phd, Karen Dalenius, MPH, Barbara Polhamus, PhD, Laura Kettel-Khan, PhD, and Laurence M. Grummer-Strawn, PhD. “Vital Signs: Obesity Among Low-Income, Preschool-Aged Children — United States, 2008–2011.” Morbidity and Mortality Weekly Report. Centers for Disease Control and Prevention, 09 Aug. 2013. Web. 18 Nov. 2016.