Childhood obesity in the United States has long been a multifaceted disorder that health professionals have struggled to battle effectively. Strategies that if implemented at an early enough age and applied consistently afterwards can lessen obese children’s current health problems and the multitude that can appear later in adulthood such as cardiovascular disease. An article in JAMA Pediatrics discusses some of the strategies recommended by the United States Preventive Services Task Force (USPSTF).
The main measure used to determine obesity in children and adults is the body-mass index (BMI). This is calculated by using a patient’s height and weight and has long been considered an acceptable and accurate measure of obesity. The USPSTF has recommended that health professionals standardize the measurement of both height and weight since it is a simple procedure that can be done by most health professionals and easily be tracked over time. Standardization would include proper placement of the height board and posture during measurement of height, emptying of pockets and disrobing to a certain degree for weight measurement, as well as other straightforward procedures of that nature. Since tracking of BMI over a period of time gives greater insight into the nature of obesity, the USPSTF also suggested that all height and weight measurements be tracked in an electronic health system for greatest accuracy.
Behavioral therapy was most strongly recommended and has shown the greatest promise in the short-term and long-term (1o years). Behavioral therapy is also beneficial because it focuses on both the physical weight reduction aspect as well as on the development of healthy behaviors that keep the weight off and improve mental health. Further, family-based behavioral treatment (FBT) has demonstrated that it is also a viable and efficient method to deal with both childhood and adult obesity. By including the child’s parents in treatment, a partnership between them that can be very self-motivating is created. This is also a cost effective way of dealing with obesity across different generations. It should be noted that this kind of therapy has been shown to be dose-dependent meaning the more sessions that are attended the more likely it is that the treatments will be effective and results will be seen. The minimum effective dose was determined to be 26 sessions, while the most effective interventions were shown to be over 52 sessions. Although shown to be effective, FBT can be difficult to implement because in many cases it is administered by a behavioral health specialist or nutritionist who is not likely stationed at their primary care providers’ offices. Further, it is not covered by many insurances. To improve this unfortunate reality, the USPSTF suggests the implementation of the patient-centered medical home (PCMH). In short, this model would mean that the patients would be handed-off to the specialist administering the behavioral therapy by the referring physician, making the environment more easily accessible for the patient and more team oriented.
The mentioned measures all make perfect sense to implement and evidence has shown their effectiveness, unfortunately there are still obstacles that are keeping behavioral therapy as a treatment for childhood obesity from reaching its full potential. Primarily, the lack of insurance coverage and ability to implement successfully in a busy primary care practice are the main obstacles, but reviews of current and future methods like that of the USPSTF are important for honing in on the most effective way to implement new strategies of treatment.
Written By: Clifton Lewis
References: Quattrin T, Wilfley DE. The Promise and Opportunities for Screening and Treating Childhood ObesityUSPSTF Recommendation Statement. JAMA Pediatr. Published online June 20, 2017. doi:10.1001/jamapediatrics.2017.1604