Does Routine Childhood BMI Screening Help or Hurt?
A new study in Pediatrics raises a critical question. Do the current guidelines for routine childhood BMI screening and counseling help more than they hurt?
Leslie Sim and colleagues conducted a meta-analysis of BMI screening and counseling in pediatric primary care. Their analysis of ten randomized controlled trials and two quasi-experiments found little effect on BMI z scores and no effect on body satisfaction. They conclude:
This review suggests that primary care interventions that incorporate a systematic approach to addressing pediatric overweight and obesity have only a marginal effect on reducing pediatric overweight and obesity in the short term. Furthermore, the clinical significance of this finding remains questionable, and there continue to be several important knowledge gaps in primary care prevention and weight management interventions. It appears that a paradigm shift might be indicated.
In a companion editorial Sarah Armstrong and Asheley Skinner expressed disappointment that “only ten randomized controlled trials were found for this meta-analysis after an epidemic that has spanned nearly 50 years.” They also raised the important question of whether BMI was the right outcome measure for screening and brief interventions. “Failing to reduce BMI should not be equated with failing to adopt healthier behaviors,” they said.
These findings should jolt pediatricians into rethinking obesity. We need more rigorous research to power robust guidelines backed by real evidence.
But the findings raise an even broader question. If pediatricians screening for BMI don’t provide a clear benefit, why in the world does it make sense to have schools doing it? We have grave doubts. Research finds no benefit. In fact, we suspect that the harms are vastly outweighing the benefits.
Click here for the study and here for the commentary. Click here for more perspective from Medscape.
Baby Face, photograph © Ray Dumas / flickr
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September 14, 2016
September 14, 2016 at 9:02 am, Angela Meadows said:
Apparently the American Academy of Paediatrics has reviewed the evidence and come down more forcefully against routine BMI screening: https://medium.com/@rebeccascritchfield/why-the-new-rules-for-talking-to-kids-about-weight-is-a-really-big-deal-262519074851#.upe1fijmp
September 15, 2016 at 5:01 am, Ted said:
Note that the revised guidance is for adolescents. Guidance for younger kids had not yet been revised.
September 14, 2016 at 10:44 am, Allen Browne said:
Correct. BMI screening is OK but then what? And the “then what” is the problem. Appropriate goals need to be set and resources need to be available for the children and their families to each those goals. Obesity in children needs to be taken seriously and the kids and their families need access. Most primary care offices do not have the resources to help the children with a BMI over 95th %tile. And pediatric weight management providers need more tools for this same group.
Lot’s of work to do but “don’t throw the baby out with the bath water”.