Screening for Obesity in Children and Adolescents: US Preventive Services Task Force Recommendation StatementUS Preventive Services Task ForcePediatrics201012536136720083515
Agency for Healthcare Research and Quality, Center for Primary Care, Prevention, and Clinical Partnerships, 540 Gaither Rd, Rockville, MD 20850, USA. PEDIATRICS
(Impact Factor: 5.47).
02/2010; 125(2). DOI: 10.1542/peds.2009-2037
DESCRIPTION: Update of the 2005 US Preventive Services Task Force (USPSTF) statement about screening for overweight in children and adolescents. METHODS: The USPSTF examined the evidence for the effectiveness of interventions that are primary care feasible or referable. It also exam- ined the evidence for the magnitude of potential harms of treatment in children and adolescents. RECOMMENDATION. The USPSTF recommends that clinicians screen children aged 6 years and older for obesity and offer them or refer them to intensive counseling and behavioral interventions to promote improvements in weight status (grade B recommendation). Pediatrics 2010;125:361-367
Available from: Kristoffer S. Berlin
- "As a result, they are available for only a small percentage of children and adolescents struggling with excess weight. The need for identifying alternative, more broadly accessible delivery systems for these interventions increased with the USPSTF recommendation that primary care providers refer youth to behavioral intervention programs . "
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ABSTRACT: There is a pressing need to develop effective and broadly accessible interventions to address pediatric obesity. An important dimension in translating interventions to community settings is evaluating the fidelity with which the intended treatment is delivered and the level of facilitator needed to deliver the intervention with efficacy.Purpose: The primary objectives of this study were to: 1) provide descriptive information regarding adherence to protocol and non-specific facilitator characteristics (e.g. interpersonal characteristics, group management skills) within the context of a community based pediatric weight control intervention delivered by paraprofessionals; and 2) examine the relationships among facilitator adherence and characteristics and rate of change in percent overweight demonstrated by youth over the course of the 24-week intervention.
The intervention was conducted between February and September of 2011. Children (6-16 years) and parents completed primary outcome measures at baseline, 12, and 24 weeks (i.e. end of treatment). A 2-part rating form was developed to assess facilitator adherence to weekly content and general provider characteristics at two different time points during the intervention.
Youth participating in this study were on average 11.3 years old (SD = 2.8), with most being under the age of 13 years (74.2%). Over half were female (54.8%) and over two-thirds were White (68.4%). On average, facilitators were adhered to 96.0% (SD = 5.2%) of the session content at Time 1 and 92.6% (SD = 6.8%) at Time 2. Higher Content Adherence at Time 1 and Time 2 were associated with greater loss in percent overweight.
Our data suggest that paraprofessionals without prior expertise in pediatric weight control can be trained to successfully deliver an intervention that is evidence based and incorporates behavioral and educational components. These findings need to be considered in light of some limitations, including the fact that facilitator domains were assessed with a modification of a standardized tool and we did not obtain inter-rater reliability of observations. These limitations not withstanding, investing time in training facilitators to adhere to a given protocol is critical and may be of higher priority than focusing on more general facilitator characteristics.
Available from: jpepsy.oxfordjournals.org
- "Both treatment conditions included 20 weekly sessions across 21 or 22 weeks (one intentional 'skip' week and one holiday skip week in two cohorts), consistent with U.S. Preventive Services Task Force recommendation for moderate-to high-intensity interventions (>25 contact hours) for childhood obesity treatment (Barton, 2010). For both treatment conditions, weekly treatment consisted of a 20–30-min individual family session where each parent–child dyad met with a family interventionist and 40–50-min separate child and parent group sessions immediately before or after individual family sessions. "
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ABSTRACT: To examine the efficacy of an adjunct motivational and autonomy-enhancing intervention (self-directed) for behavioral family-based pediatric obesity relative to the standard prescription of uniform behavioral skills use and interventionist goal assignment (prescribed).
In this randomized clinical trial, 72 overweight/obese children and their parents/caregivers were assigned to either self-directed or prescribed intervention for 20 weeks, with approaches diverging after week 5. Anthropometric measurements from child and participating parent at baseline, posttreatment, and 3-month, 6-month, 1-year, and 2-year follow-ups were evaluated for change (n = 59 in follow-up analyses).
The approaches demonstrated similar child body mass index (BMI) z-score and parent BMI change from baseline to posttreatment and throughout follow-up, with child and parent weight status lower than baseline at 2 years after treatment cessation.
An adjunct motivational and autonomy-enhancing approach to behavioral family-based pediatric obesity treatment is a viable alternative to the standard intervention approach.
Available from: Margaret Hargreaves
- "Annual assessment of weight status through the use of BMI compared with age-sex BMI percentiles in growth charts in children and adolescents is widely recognized as a standard of care in the primary care setting [2, 9, 28]. Although a healthy weight assessment routinely involves some form of measuring body weight, evidence suggests that a complete assessment should also include indicators of healthy diet, active living, and child and family health history [8, 9]. "
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ABSTRACT: Although pediatric providers have traditionally assessed and treated childhood obesity and associated health-related conditions in the clinic setting, there is a recognized need to expand the provider role. We reviewed the literature published from 2005 to 2012 to (1) provide examples of the spectrum of roles that primary care providers can play in the successful treatment and prevention of childhood obesity in both clinic and community settings and (2) synthesize the evidence of important characteristics, factors, or strategies in successful community-based models. The review identified 96 articles that provide evidence of how primary care providers can successfully prevent and treat childhood obesity by coordinating efforts within the primary care setting and through linkages to obesity prevention and treatment resources within the community. By aligning the most promising interventions with recommendations published over the past decade by the Institute of Medicine, the American Academy of Pediatrics, and other health organizations, we present nine areas in which providers can promote the prevention and treatment of childhood obesity through efforts in clinical and community settings: weight status assessment and monitoring, healthy lifestyle promotion, treatment, clinician skill development, clinic infrastructure development, community program referrals, community health education, multisector community initiatives, and policy advocacy.
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