Children and teens with high body mass index should be guided toward intensive lifestyle interventions to manage their weight, an influential panel of experts is recommending.
This week, the U.S. Preventive Services Task Force issued its final guidelines for the care of children with high body mass index, which remain largely unchanged from the previous iteration. Notably, and unlike some other health organizations, the USPSTF chose not to endorse the use of newer obesity medications for teens, arguing that not enough evidence has been gathered yet to determine whether their benefits outweigh the potential risks.
The USPSTF is technically under the umbrella of the U.S. Department of Health and Human Services, but task force members are voluntary outside experts brought in to review the evidence and provide recommendations on a variety of topics related to the prevention of health problems. Their guidelines are widely heeded by health care professionals and even influence the insurance coverage of certain medications like vaccines.
Nearly 20% of children older than six in the U.S. are thought to have obesity, defined as having a BMI in the 95th percentile of their age and sex. These children may be at greater risk of health problems than other children and often go on to develop more health issues as adults, such as type 2 diabetes.
In 2017, the USPSTF recommended that children should be routinely screened for obesity. Children with obesity should then be referred to “comprehensive, intensive behavioral interventions.” In their newest guidelines, released Tuesday, the USPSTF has dropped the edict to screen children for obesity, noting that doctors nowadays routinely do so. But they are continuing to champion the use of intensive behavioral interventions for child obesity.
“So that means interventions that are 26 hours or more in terms of the time. And these interventions are largely focused on three areas,” Wanda Nicholson, a public health researcher, physician and chair of the task force, told Gizmodo over the phone. Children might be taught about healthy eating habits, for instance; counseled on how to make better food choices; or be encouraged to participate in supervised exercise programs.
These interventions, the USPSTF determined, can lead to “moderate weight loss, as well as an improvement in quality of life for children and teens,” Nicholson said.
In January 2023, the American Academy of Pediatrics endorsed the use of weight loss medications for teenagers with obesity—a decision that came a month after the Food and Drug Administration approved Novo Nordisk’s Wegovy for this age group. The active ingredient in Wegovy, semaglutide, has proven to be much more effective at treating obesity than diet and exercise alone in clinical research, which has included a large-scale trial of teens.
The AAP’s recommendation was met with some criticism by outside experts, who have argued that too little is still known about the potential long-term effects of these drugs to wholeheartedly embrace their use in younger people. Some (but not all) research has suggested that a majority of people regain most of their lost weight once they stop taking the drug, for instance—an especially important consideration for teens, given the possibility that they might have to stay on these medications for decades.
For now, at least, the USPSTF has agreed that it’s too early to make a judgment either way. “We found at this time, based on our review, that there was not enough evidence for us to make a recommendation about weight loss medications at this time,” Nicholson said.
The USPSTF typically revisits its guidelines every five years. So it’s certainly possible that their verdict will change by then. And the group is openly pushing for scientists to collect the information needed to know for sure.
“As part of our recommendation, we are strongly calling for more research, particularly on these medications, and particularly on their long term benefits and harms,” Nicholson said. “So we really want researchers to prioritize this question.”
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