January 16th, 2024
We appreciate the opportunity to comment on the United States Preventive Services Task Force (USPSTF): “High Body Mass Index in Children and Adolescents: Interventions.”
The National Center for Health Research (NCHR) is a nonprofit think tank that conducts, analyzes, and scrutinizes research on a range of health issues, with a particular focus on which prevention strategies and treatments are most effective for which patients and consumers. We do not accept funding from companies that make products that are the subject of our work, so we have no conflicts of interest.
NCHR agrees with the USPSTF’s recommendation that physicians provide comprehensive, intensive behavioral interventions for children six years or older with a body mass index in the 95th percentile for age and sex. Currently, there is insufficient evidence to clearly demonstrate the benefits and harms of weight loss pharmacotherapy among this age group, and more research is needed to understand the role of pharmacotherapy in adolescent weight management. We also agree that more research is needed to demonstrate the long-term health outcomes of weight reduction within this population, especially in regard to cardiometabolic and psychosocial outcomes.
However, while we support the use of behavioral interventions to manage unhealthy weight gain in adolescents over six, we also recommend that patients are screened for medications that may be a contributing factor for weight gain. Many adolescents with high body mass indexes are also screened for bullying, depression, and other psychiatric disorders.1 Although we agree that this screening is appropriate, we are concerned that it may lead to the initiation of antidepressants or atypical antipsychotic medications that cause dyslipidemia and unhealthy weight gain, adding to they cycle of bullying and depression.2 Therefore, we encourage the USPSTF to include screening for medications as a contributing factor for unhealthy weight gain in adolescents and recommend that medical management for other chronic diseases is optimized using a multidisciplinary team.
It is important to recognize that while one in five children ages 2-19 have a body mass index in at least the 95thpercentile for their age and sex, there is a higher prevalence in Hispanic, Indigenous, and Black patients as well as those from lower-income families.3,4 Since the burden of disease is higher among these patient populations, we strongly support the USPSTF’s recommendation that adolescent weight management research be inclusive and representative of these populations. We also urge the USPSTF to recommend that high-quality research be conducted to identify and address systemic barriers influencing healthy weight management among adolescents from these communities. Further, we encourage the USPSTF to include recommendations regarding the effectiveness of upstream interventions that work to prevent adolescents from unhealthy weight gain as part of its approach to managing adolescents with high body mass indexes. Specific upstream interventions that prevent unhealthy weight gain in adolescents have been reviewed and reported in the Cochrane Database and should be considered an integral part of disease management.5
Overall, we strongly support the USPSTF’s draft recommendation to manage unhealthy weight gain in adolescents over six years of age with a body mass index in at least the 95th percentile for their age and sex with behavioral interventions. We agree that more research is needed to clearly delineate the role of pharmacotherapy in this patient population. Our main recommendations to improve the draft statement include: (1) adding a screening process to identify medications potentially contributing to unhealthy adolescent weight gain; (2) supporting high-quality studies that identify effective interventions that reduce systemic barriers contributing to healthy weight management in populations with a high burden of disease; and (3) incorporating upstream interventions into the disease management framework.