NEW YORK (Reuters Health) – In an update to their 2005 recommendation, the US Preventive Services Task Force now recommends that clinicians screen children and adolescents ages 6 to 18 years old for obesity.

In addition, for patients who are obese based on body mass index (BMI) percentile for age and gender, the Task Force advises referral to a comprehensive program that includes dietary, physical activity, and behavioral counseling components to promote weight loss.

Skyrocketing rates of obesity have reached approximately 12% to 18% of 2- to 19-year-olds, increasing up to 6-fold since the 1970s, task force members report in the February issue of Pediatrics. For their update, they reviewed 13 behavioral intervention trials involving 1258 primarily obese children and adolescents aged 4 to 18 years.

They define obesity as having an age- and gender-specific BMI equal to or greater than the 95th percentile.

Evidence supports the benefits of moderate- to high-intensity programs, involving more than 25 hours of contact with the child and/or the family over a 6 month period. The authors found that such programs resulted in a decrease in BMI 12 months after the beginning of the intervention.

In addition to dietary and physical activity counseling, effective programs included behavioral management techniques such as self-monitoring, stimulus control, eating management, contingency management, and cognitive-behavioral techniques. However, programs were effective only in children who followed through on treatment.

Harms of screening, for example, adverse effects on growth, eating-disorder pathology, or mental health issues, were judged to be minimal.

The Task Force found inadequate evidence to support efficacy of interventions of lower intensity than 25 hours contact per 6 months, or for screening children below age 6. Moreover, they could not tell if their recommendations can be applied to children who are overweight but not obese.

In a related commentary, Dr. Sandra G. Hassink takes issue with the recommendation to not start screening for obesity before age 6.