LAUSR

The publication of the recommendation statement1 and evidence review2 by the United States Preventive Services Task Force (USPSTF) on screening for obesity in children is a call to arms to address a prevalent disorder that has immediate health consequences and sets the affected children on a trajectory for a myriad of behavioral and physical health challenges later in life. The USPSTF presents a balanced set of recommendations to guide pediatricians and health care practitioners in managing this public health crisis that they confront on a daily basis. We will briefly review the recommendations and highlight important issues in implementation. The USPSTF statement1 recommends screening for obesity—defined as ageand sex-specific body mass index (BMI) above the 95th percentile—in children 6 years or older.1,2 The recommendations indicate that measurement of height and weight to calculate BMI is a reliable method for detecting obesity that can be implemented in primary care settings. As noted by the USPSTF,1,2 these recommendations are consistent with recommendations by other organizations. The evaluation technique carries very few risks, and the tools for accurately measuring height and weight should be in place in all practices. While the USPSTF did not find sufficient evidence for screening children younger than 6 years,1 we recommend that health care professionals who care for children follow height and weight progress of all children and counsel parents appropriately, depending on anthropometric parameters and risk factors for development of obesity.1,2 While BMI can be plotted on a growth chart, electronic health records can also calculate and plot BMI, making it easier for clinicians to track BMI percentiles and detect obesity. There exists a great opportunity for researchers and clinicians to collaborate in developing standard protocols to measure height and weight, which is crucial because deviations in collecting these basic measures can confound findings on whether children meet overweight or obesity criteria. As noted in the USPSTF evidence report,2 the percentage of children who have overweight or obesity and who receive accurate diagnoses has increased, but there is room for improvement. Researchers adopt standard practices such as removing the child’s shoes and heavy clothing and emptying the child’s pockets when measuring weight; and having the child stand up tall, feet a standard distance apart, with the height board touching the top of the scalp when measuring height. These procedures may be challenging to implement in busy practices due to time constraints and differing staff members collecting the measures. A valuable discussion would be how to translate height and weight measurement protocols from the research setting to the primary care practice. Childhood obesity is listed as a top health concern by parents.3 The USPSTF recommends that children with obesity be offered or referred to intensive behavioral interventions, consistent with recommendations by other organizations.4,5 In a study conducted in 1994 that included 158 children, aged 6 to 12 years (average 45% over the median BMI for age and sex), behavioral interventions showed both short-term and longterm (10-year) effectiveness.6 Furthermore, behavioral treatments not only focus on weight per se, but on overall health and the development of healthful behaviors in the context of the family. Such treatments target changes in eating, physical activity, and sedentary behaviors, with an additional emphasis on improving parenting techniques, thus equipping parents with tools (eg, goal setting, self-monitoring, providing contingent rewards, and problem solving) that can be used to manage a myriad of child issues well beyond obesity. In addition, a hallmark of family-based behavioral treatment (FBT) is that both parents and children are targeted for eating, activity, and weight changes.7 Both parents and children lose clinically significant amounts of weight in these programs, and there is a strong relationship between parent and child weight changes.8 Concurrent treatment of multiple generations may be more cost-effective than separate obesity treatment for the parents by their primary care physician and the children by their pediatrician.9 Moreover, parents may be more motivated for their children to participate in behavioral treatments if they can gain health benefits themselves. Treating the child and parent simultaneously, changing the shared family environment, and arming the parent with new parenting tools are all elements of family-based behavioral treatments that may allow these positive health behaviors to be generalized to other family members. The effectiveness of behavioral interventions is dose dependent. Low-dose treatments are associated with minimal treatment effectiveness. A minimum effective dose is approximately 26 sessions, but effectiveness increases with higherintensity interventions (≥52 sessions), indicating a need for high-dose treatments to achieve robust response.1,2 Studies have found that a BMI z score (zBMI) reduction of 0.25 or higher resulted in improved cardiovascular risk factors (eg, hyperRelated articles at jama.com Opinion