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Screening for Obesity and Intervention for Weight Management in Children and Adolescents: Evidence Report and Systematic Review for the US Preventive Services Task Force.

Abstract Obesity is common in children and adolescents in the United States, is associated with negative health effects, and increases the likelihood of obesity in adulthood.
PMID
Related Publications

Effectiveness of weight management programs in children and adolescents.

Screening for Obesity in Children and Adolescents: US Preventive Services Task Force Recommendation Statement.

Drug interventions for the treatment of obesity in children and adolescents.

Authors

Mayor MeshTerms

Advisory Committees

Mass Screening

Keywords
Journal Title jama
Publication Year Start




PMID- 28632873
OWN - NLM
STAT- MEDLINE
DA  - 20170620
DCOM- 20170710
LR  - 20170713
IS  - 1538-3598 (Electronic)
IS  - 0098-7484 (Linking)
VI  - 317
IP  - 23
DP  - 2017 Jun 20
TI  - Screening for Obesity and Intervention for Weight Management in Children and
      Adolescents: Evidence Report and Systematic Review for the US Preventive Services
      Task Force.
PG  - 2427-2444
LID - 10.1001/jama.2017.0332 [doi]
AB  - Importance: Obesity is common in children and adolescents in the United States,
      is associated with negative health effects, and increases the likelihood of
      obesity in adulthood. Objective: To systematically review the benefits and harms 
      of screening and treatment for obesity and overweight in children and adolescents
      to inform the US Preventive Services Task Force. Data Sources: MEDLINE, PubMed,
      PsycINFO, Cochrane Collaboration Registry of Controlled Trials, and the Education
      Resources Information Center through January 22, 2016; references of relevant
      publications; government websites. Surveillance continued through December 5,
      2016. Study Selection: English-language trials of benefits or harms of screening 
      or treatment (behavior-based, orlistat, metformin) for overweight or obesity in
      children aged 2 through 18 years, conducted in or recruited from health care
      settings. Data Extraction and Synthesis: Two investigators independently reviewed
      abstracts and full-text articles, then extracted data from fair- and good-quality
      trials. Random-effects meta-analysis was used to estimate the benefits of
      lifestyle-based programs and metformin. Main Outcomes and Measures: Weight or
      excess weight (eg, body mass index [BMI]; BMI z score, measuring the number of
      standard deviations from the median BMI for age and sex), cardiometabolic
      outcomes, quality of life, other health outcomes, harms. Results: There was no
      direct evidence on the benefits or harms of screening children and adolescents
      for excess weight. Among 42 trials of lifestyle-based interventions to reduce
      excess weight (N = 6956), those with an estimated 26 hours or more of contact
      consistently demonstrated mean reductions in excess weight compared with usual
      care or other control groups after 6 to 12 months, with no evidence of causing
      harm. Generally, intervention groups showed absolute reductions in BMI z score of
      0.20 or more and maintained their baseline weight within a mean of approximately 
      5 lb, while control groups showed small increases or no change in BMI z score,
      typically gaining a mean of 5 to 17 lb. Only 3 of 26 interventions with fewer
      contact hours showed a benefit in weight reduction. Use of metformin (8 studies, 
      n = 616) and orlistat (3 studies, n = 779) were associated with greater BMI
      reductions compared with placebo: -0.86 (95% CI, -1.44 to -0.29; 6 studies; I2 = 
      0%) for metformin and -0.50 to -0.94 for orlistat. Groups receiving
      lifestyle-based interventions offering 52 or more hours of contact showed greater
      improvements in blood pressure than control groups: -6.4 mm Hg (95% CI, -8.6 to
      -4.2; 6 studies; I2 = 51%) for systolic blood pressure and -4.0 mm Hg (95% CI,
      -5.6 to -2.5; 6 studies; I2 = 17%) for diastolic blood pressure. There were mixed
      findings for insulin or glucose measures and no benefit for lipids. Medications
      showed small or no benefit for cardiometabolic outcomes, including fasting
      glucose level. Nonserious harms were common with medication use, although
      discontinuation due to adverse effects was usually less than 5%. Conclusions and 
      Relevance: Lifestyle-based weight loss interventions with 26 or more hours of
      intervention contact are likely to help reduce excess weight in children and
      adolescents. The clinical significance of the small benefit of medication use is 
      unclear.
FAU - O'Connor, Elizabeth A
AU  - O'Connor EA
AD  - Kaiser Permanente Research Affiliates Evidence-based Practice Center, Center for 
      Health Research, Portland, Oregon.
FAU - Evans, Corinne V
AU  - Evans CV
AD  - Kaiser Permanente Research Affiliates Evidence-based Practice Center, Center for 
      Health Research, Portland, Oregon.
FAU - Burda, Brittany U
AU  - Burda BU
AD  - Kaiser Permanente Research Affiliates Evidence-based Practice Center, Center for 
      Health Research, Portland, Oregon.
FAU - Walsh, Emily S
AU  - Walsh ES
AD  - Kaiser Permanente Research Affiliates Evidence-based Practice Center, Center for 
      Health Research, Portland, Oregon.
FAU - Eder, Michelle
AU  - Eder M
AD  - Kaiser Permanente Research Affiliates Evidence-based Practice Center, Center for 
      Health Research, Portland, Oregon.
FAU - Lozano, Paula
AU  - Lozano P
AD  - Kaiser Permanente Research Affiliates Evidence-based Practice Center, Group
      Health Research Institute, Seattle, Washington.
LA  - eng
PT  - Journal Article
PT  - Review
PL  - United States
TA  - JAMA
JT  - JAMA
JID - 7501160
RN  - 0 (Anti-Obesity Agents)
RN  - 0 (Hypoglycemic Agents)
RN  - 0 (Lactones)
RN  - 9100L32L2N (Metformin)
RN  - 95M8R751W8 (orlistat)
SB  - AIM
SB  - IM
CIN - JAMA. 2017 Jun 20;317(23 ):2378-2380. PMID: 28632849
MH  - Adolescent
MH  - *Advisory Committees
MH  - Anti-Obesity Agents/adverse effects/therapeutic use
MH  - Body Mass Index
MH  - Body Weight/drug effects
MH  - Child
MH  - Child, Preschool
MH  - Humans
MH  - Hypoglycemic Agents/adverse effects/therapeutic use
MH  - Lactones/adverse effects/therapeutic use
MH  - *Mass Screening/adverse effects
MH  - Metformin/adverse effects/therapeutic use
MH  - Non-Randomized Controlled Trials as Topic
MH  - Overweight/complications/diagnosis/therapy
MH  - Pediatric Obesity/complications/*diagnosis/*therapy
MH  - Randomized Controlled Trials as Topic
MH  - United States
MH  - Weight Loss
EDAT- 2017/06/21 06:00
MHDA- 2017/07/14 06:00
CRDT- 2017/06/21 06:00
AID - 2632510 [pii]
AID - 10.1001/jama.2017.0332 [doi]
PST - ppublish
SO  - JAMA. 2017 Jun 20;317(23):2427-2444. doi: 10.1001/jama.2017.0332.