New Recommendations on Screening Children for Obesity
Screening Children and Adolescents for Overweight and Obesity
Recent headlines have highlighted confusion about the costs and consequences of obesity and how it should be treated. This brief is meant to clarify the latest recommendations from the authoritative US Preventive Services Task Force on screening children and adolescents for overweight.
US Preventive Services Task Force
The Task Force is a panel of medical experts that is charged by the US Public Health Service to review scientific evidence and make recommendations about health screenings, counseling, and immunizations (called clinical preventive services). The Task Force will only make a recommendation for a clinical preventive service if they are able to find high-quality research studies in sufficient quantity to prove that a specific preventive service improves the health outcomes of individuals and that the benefits of that preventive service outweigh the risks and costs associated with the service.1
What Employers Need to Know
There is no question that overweight is a widespread and serious health problem for children and adolescents in the United States. But the research community isn't sure that screening children and adolescents for overweight prevents the adverse health outcomes of obesity and they aren't sure which treatments for obesity are most effective among children and adolescents. Because of the lack of research regarding child overweight the USPSTF could not recommend screening and instead gave it an "I" rating (for insufficient evidence). An "I" rating is a call to action for researchers and clinicians as it means there are more questions about childhood overweight than there are answers.
Childhood overweight can be prevented and it must be addressed
- The rate of child and adolescent overweight has tripled over the past 20 years; today approximately 15% of children and adolescents aged 6-19 years are overweight.1
- Overweight puts children at risk for immediate health problems such as elevated blood pressure, high cholesterol, and sleep apnea. Overweight also puts children at risk for long-term health problems such as diabetes, heart disease, some types of cancer, and arthritis.2
- Overweight children >8 and adolescents are at high risk of becoming obese adults.1
- The cost of child and adolescent overweight is substantial. The Task Force estimates that hospital costs related to childhood overweight have more than tripled in the past two decades.1 And the CDC estimates that that the annual cost of overweight and obesity (child and adult) to private insurers exceeds $28.1 billion (based on data from 1998 dollars).3
What Employers Can Do:
Action: Encourage health plans and providers to continue screening children and adolescents for overweight.
Follow the Institute of Medicine's (IOM) lead on child and adolescent obesity prevention and work with "the best available evidence —as opposed to waiting for the best possible evidence." The best available evidence, according to the IOM, the Maternal and Child Health Bureau, the American Academy of Family Physicians (AAFP), and the American Academy of Pediatrics (AAP) is to continue routine, universal, screening for children and adolescents.1 The American Academy of Pediatricians (AAP) and the American Academy of Family Physicians (AAFP) recommend that clinicians monitor the height and weight of all children and calculate the BMI of all children at least once a year in order to identify children at risk of excessive weight gain and to identify children who are overweight. The AAP also recommends that clinicians:
- Encourage and support breastfeeding.
- Encourage parents and caregivers to promote healthy eating patterns.
- Promote physical activity.
- Recommend that parents limit television/video time to a maximum of 2 hours per day.
- Recognize and monitor changes in obesity-associated risk factors for adult chronic disease, such as high blood pressure, high cholesterol, impaired glucose tolerance, and sleep apnea.4
Action: Augment clinician screening and counseling with health education. Employers can help prevent childhood overweight by giving parents education, resources, and support. For parent education materials see the Business Group's Employer Toolkit: Reducing Child & Adolescent Obesity - Addressing Healthy Weight For Employees and Their Children.
For more information on child and adolescent overweight visit the following sites:
1 US Preventive Services Task Force. Screening and interventions for overweight in children and adolescents: Recommendation statement. Guide to Clinical Preventive Services. Agency for Healthcare Research and Quality. Rockville, MD; 2005.
2 Centers for Disease Control and Prevention. Press release CDC's National Leadership Role in Addressing Obesity
http://www.cdc.gov/od/oc/media/pressrel/r050614.htm. 6/14/056/14/05
3 Centers for Disease Control and Prevention. Overweight and obesity: Economic consequences. http://www.cdc.gov/nccdphp/dnpa/obesity/economic_consequences.htm. Accessed 7-11-05.
4 American Academy of Pediatrics: Committee on Nutrition. Prevention of pediatric overweight and obesity: Policy statement. Pediatrics, 2003; (112)2: 424-430.
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