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Jul 6

Should your kids be screened for obesity? –

With obesity still rising among certain groups of children, a US government panel is renewing its advice that all children and adolescents ages six to 18 be screened for obesity.

Screening is just the first step. Kids who are obese should then be referred to treatment programmes that use a variety of approaches to change their behaviour and help them slim down.

The recommendations were issued recently by the US Preventive Services Task Force, a group of experts appointed by the Department of Health and Human Services Agency for Healthcare Research and Quality. The task forces advice influences healthcare providers and the coverage offered by health insurers.

The new recommendations, which were published in the Journal of the American Medical Association, earned a B grade from the task force. That means the experts determined with moderate certainty that the overall benefit of obesity screening and treatment referral is moderate.

Here are more details about the new recommendations.

Is screening really necessary? Cant you tell if a child is obese just by looking at them?

You may not necessarily be able to tell if a child is obese just by looking at them. As extra pounds become the new normal, fewer parents are able to recognise when their childs weight is too high.

Besides, the medical definition of childhood obesity is pretty specific.

You start by measuring a childs height and weight, and using that to calculate his or her body mass index (BMI). Thats weight (measured in kilograms) divided by height (measured in meters) squared. There are online calculators to help you.

To determine if a child meets the criteria for obesity, you compare his or her BMI to the BMIs of other children who are the same age.

Doctors use growth charts from 2000 as a baseline for these comparisons. If a childs BMI is high enough to land him or her in the top 5%, he or she is considered obese. Today, about 17% of Americans ages two to 19 are in this category, according to the US Centers for Disease Control and Prevention (CDC).

Whats wrong with having a high BMI?

Children with obesity are at greater risk for a variety of health conditions. These include asthma, high blood pressure, insulin resistance, high cholesterol, orthopaedic problems and obstructive sleep apnoea.

The task force also noted that obese children are more likely to experience mental health and psychological issues, as well as to be teased or be targeted by bullies.

What if its just baby fat?

Kids may not be able to just grow out of their baby fat phase. Tracking studies show that about 64% of pre-teens who are obese, grow up to become obese adults.

By the time kids become teenagers, the odds are even more stacked against them nearly 80% of obese teens go on to become obese adults.

Adults who are obese (defined as having a BMI of 30 or higher) are more likely to develop serious chronic diseases such as type 2 diabetes and heart disease as well as certain types of cancer.

OK, lets say my paediatrician tells me my kid is obese. Now what?

The task force advises doctors to help their patients find a comprehensive, intensive behavioural intervention. Thats a fancy way of describing a weight-loss counselling programme.

What am I looking for?

In clinical trials, the programmes that were most effective shared several features:

They included at least 26 contact hours with patients, spread out over a period of months. The ones with the best results had 52 contact hours, enough for one hour per week for an entire year.

They involved not just the child, but also his or her parents and siblings.

They included instruction on healthful eating, including steps such as how to read nutrition information on food labels.

They showed kids how to exercise safely and supervised some of their workouts.

They taught kids the value of reducing their access to junk food, limiting their screen time and steering clear of other triggers that could undermine their progress.

They helped kids learn how to set goals for themselves, monitor their progress and reward themselves when appropriate.

Where am I going to find that?

A programme like this can involve not just doctors, but also dietitians, psychologists, exercise physiologists and other kinds of specialists.

The task force acknowledged that some families would have limited access to programmes like this, but it didnt dwell on this problem.

Others did. In an editorial published recently in JAMA Internal Medicine, Drs Jason Block and Emily Oken of Harvard Medical School pointed out that in most areas of the United States, programmes like this simply arent available.

Among childrens hospitals, for instance, only 60% have something that meets the task forces criteria, and only 25% have a programme that lasts a full year.

Even if a child is fortunate enough to live near one of these hospitals, his or her family might not be able to afford to use it, they added.

Three other doctors from Johns Hopkins University School of Medicine were even more critical.

In a JAMA editorial, Drs Rachel Thornton, Raquel Hernandez and Tina Cheng wrote that the task forces recommendations could wind up diverting resources from more practical public health measures that would probably do more to reduce childhood obesity.

Like what?

The trio touted efforts to keep junk foods out of schools and prevent companies from marketing sugary drinks to kids.

Drs Block and Oken mentioned some other policies that have been shown to improve kids eating habits, such as taxes on sugar-sweetened beverages or changes in the rules governing the Special Supplemental Nutrition Program for Women, Infants, and Children.

Greater focus on policies that support healthful behaviours across all settings will be essential not only in ensuring the sustained success of treatment for established obesity, but also in preventing its onset, the Harvard pair wrote.

Cant the doctor just prescribe some kind of medicine?

The task force considered two medications that are sometimes used to help kids lose weight, orlistat and metformin.

Clinical trials have found that both drugs helped children lose about five to seven pounds (2.3 to 3.2kg).

But that wasnt enough to reduce their BMIs by even one point.

However, the drugs did cause side effects, such as vomiting, cramping and uncontrolled passage of stool, according to the panels report.

Overall, the experts concluded that the clinical benefit of these drugs was uncertain.

Didnt I hear that the childhood obesity epidemic had stabilised?

Thats true for American children overall its been around 17% for about the past decade, according to data from the CDCs National Health and Nutrition Examination Surveys. At the turn of the century, that figure was about 14%; in the 1970s, it was under 6%.

But some groups of kids are still getting fatter. For instance, obesity rates are still rising among African-American girls and Latino boys.

Also, the proportion of kids who are severely obese continues to grow. Los Angeles Times/Tribune News Service/Karen Kaplan

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