U.S. Task Force: ‘Behavioral Interventions’ Urged for Children, Adolescents with a High BMI

Obesity among adults and children in the U.S. continues to pose a public health threat, according to public health officials and medical organizations. This week, a leading panel of independent U.S. health experts, the U.S. Preventive Services Task Force, released a final recommendation urging pediatricians or primary care physicians to “provide or refer children and teens with a high BMI (body mass index) to intensive, comprehensive behavioral interventions.” 

The Task Force’s recommendation applies to children and adolescents, age 6 years and older, with a high BMI. Nearly 20 percent of children and teens in the U.S. have a high BMI that reaches the level designated as obesity. BMI is calculated based on a child’s height and weight, which are then plotted on a growth chart. “Obesity is defined as a BMI at or above the 95th percentile” for age and sex on the growth chart, states the Task Force.

“Comprehensive, intensive behavioral interventions may include education about healthy eating habits, counseling on behavioral change techniques, such as goal setting and problem-solving, and supervised exercise sessions,” explains the Task Force in a news release.

Effective interventions include at least 26 or more hours with a healthcare professional over one year, which requires commitment from children and their families. The Task Force adds that it “encourages all kids and their families to follow healthy habits.”

Javier A. Hiriart, M.D., a pediatrician and internal medicine physician with Baptist Health Primary Care, Family Medicine Center at West Kendall Baptist Hospital.

Last year, the American Academy of Pediatrics (AAP) updated its guidelines for treating childhood obesity for the first time in 15 years, stressing that there is “more evidence than ever” that early and aggressive treatment of obesity in children and adolescents is “safe and effective.”

“Children with obesity are more likely to have numerous health conditions,” states the U.S. Centers for Disease Control and Prevention (CDC). “These include high blood pressure and type 2 diabetes. Children with obesity are also more likely to have obesity as adults.”

The AAP reiterates that Intensive behavioral and lifestyle changes should continue to be the initial approach taken to combat childhood obesity. But, for the first time, the AAP last year set age-based recommendations for providing anti-obesity medications, and possibly surgery, for some patients. Adolescents, ages 12 years and older, should be evaluated for medications as “an adjunct to health behavior and lifestyle treatment,” the AAP said. Teens, ages 13 and older, with severe obesity (BMI equal to 120 percent of the 95th percentile for age and sex) “should be evaluated for metabolic and bariatric surgery,” the AAP adds.

“Parents should understand that these guidelines have been updated because more needs to be done to combat obesity in children, which is the biggest contributor to other serious underlying health conditions – diabetes being the most common issue,” said Javier A. Hiriart, M.D., a pediatrician and internal medicine physician with Baptist Health Primary Care, Family Medicine Center at West Kendall Baptist Hospital.. “It always starts with lifestyle modifications. But if weight issues persist, intervention with medication therapy or other treatments may be necessary.”

According to the most recent update from the CDC on children and adolescents aged 2-19 years, the prevalence of childhood obesity was at about 20 percent, and affected about 15 million children and adolescents. But those statistics are derived before the COVID-19 pandemic began in early 2020. Most indicators point to an increase in childhood obesity since the pandemic. Obesity prevalence was even higher among minorities: 26 percent among Hispanic children and 25 percent among non-Hispanic Black children, the CDC states. 

The AAP also states that the guidelines also address “increased risks for children with special health care needs, as well as inequities that promote obesity in childhood, such as the marketing of unhealthy food, low socioeconomic status and household food insecurity.”

“Physical fitness has too many benefits to ignore, including helping to increase focus in school, improve sleeping habits and promote overall health,” says Dr. Hiriart. “It starts with decreasing ‘screen time’ on TVs, laptops and smartphones and increasing physical activity.”

U.S. guidelines call for children 6 years and older to get at least 60 minutes a day of physical activity. This can include participating in team sports, going to park, playground or walking/bicycle trails, dog walking, or opting for walking more often as a family to a destination, rather than driving, according to the AAP.