Prevention task force recommends intensive counseling for kids with obesity

A panel of experts has updated their recommendations for doctors screening children for obesity. The U.S. Preventive Services Task Force now recommends intensive behavioral interventions for kids aged 6 and older with a high body mass index.

These recommendations were published Tuesday in JAMA.

The new advice replaces the task force’s 2017 guidance which recommended that primary care providers should simply screen children for obesity.

Nearly one in five U.S. kids has obesity, defined as having a high BMI at or above the 95th percentile for age and sex. Prevalence is higher among Latino, Native American and Black children as well as children from lower-income families.

Dr. Wanda Nicholson, the task force chair, acknowledges there are many complex factors driving childhood obesity but says the evidence supports intensive counseling.

“Fortunately, we know that there are proven ways that primary care clinicians can help many children and teens to address the high BMI,” she says. “Our evidence shows that the behavioral counseling intervention of 26 or more hours can help them achieve a healthy weight and improve their quality of life.”

The recommendation doesn’t include prescribing drugs such as Ozempic or the other GLP-1 drugs. Nicholson says there wasn’t enough research to assess the value of medication for this age group. “We’re calling for more research into both the benefits and potential harms of medication therapy for kids and teens,” she says.

Nicholson, who is also a professor of prevention and community health at George Washington University, says the review of relevant research pointed to effective forms of behavioral counseling.

There are three key components usually involved, she says. These are: education about healthy eating habits; counseling on weight-related behavioral changes, such as goal-setting, and supervised exercise sessions.

The task force gave its recommendations a B grade, indicating a high degree of certainty of moderate benefits. That rating also means that, by law, the task force’s recommended services must be covered by most private health insurance plans, without a copay.

However, Nicholson acknowledges the recommendations will pose challenges for many children and parents. Twenty-six hours of counseling is "a commitment both by the child or teen and their parents,” she says. Obstacles that can limit access to this kind of care also include finding a provider who offers the intensive counseling or finding reliable transportation to get to the sessions.

But, Nicholson says, the evidence shows that such investments would be worth it. She adds that most of the research they looked at was for 6 to 12 months of counseling, but the task force would like to see more research into the impact of longer-term counseling.