Woman Plaiting Her Hair

Has USPSTF Lost Touch with Reality on Obesity in Youth?

This week in JAMA, the United States Preventive Services Task Force (USPSTF) published an evidence review and recommendation for youth with obesity. In a word, it is disappointing. The task force seems to have completely lost touch with advances in obesity care in young persons. They recommend only that youth with a BMI in the range of obesity receive intensive coaching for weight management by changing their behavior.

New obesity medicines that are transforming the lives of many young persons? The task force dismisses them as lacking evidence for a sustained benefit after patients stop taking them. Imagine that. Medicine for a chronic disease that doesn’t work if you don’t take it.

Fortunately, the task force does not apply the same standard to treatments for diabetes, hypertension, or asthma.

Digging Deeper

Professor Aaron Kelly is Co-Director of the Center for Pediatric Obesity Medicine at the University of Minnesota Medical School. He expressed disappointment in these USPSTF reports on obesity in youth:

“Digging deeper into the USPSTF evidence report we find that it takes 26-51 contact hours over one year to reduce mean BMI by only 0.75 kg/m2, which is not clinically meaningful. It takes a minimum of 52 hours to reduce BMI by 2 kg/m2, which itself is only borderline clinically significant. I would venture to guess that only a very small percentage of patients/families would be able to commit to an hour per week for an entire year even if programs like this existed, which they don’t. So, the totality of the evidence is telling us that the ‘maximum tolerated dose’ of lifestyle modification therapy produces, on average, insignificant results.

“Therefore, we must grapple with the reality that lifestyle and behavioral therapy is not an effective treatment for pediatric obesity. Somehow this primary message got lost in the report. I believe it’s time to fundamentally reexamine how we should approach treatment of obesity in children and adolescents. Lifestyle modification therapy will likely have a role in the future of pediatric obesity care. Not as a first-line or primary treatment, but as an adjunct to effective interventions like pharmacotherapy and bariatric surgery.”

More of the Same Ineffective Strategies

Even the relatively mild editorial published in JAMA with these reports should be enough to shock us. Tom Robinson and Sarah Armstrong suggest that behavioral interventions are not working because they’re not reaching the kids who need them. Maybe so, but is it reasonable to think they ever will?

Regardless, their bottom line is harsh:

“Child and adolescent obesity is not going away with current approaches; in fact, it is worsening.”

We could go on at great length. But this is the very definition of insanity, misattributed to Einstein:

“The definition of insanity is doing the same thing over and over again and expecting a different result.”

It is well past time to stop pretending that coaching young persons to be thin is the cure for obesity.

Click here for the evidence review, here for the recommendations, here and here for editorials. For further perspective, click here and here.

Woman Plaiting Her Hair, painting by Pablo Picasso / WikiArt

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June 21, 2024

3 Responses to “Has USPSTF Lost Touch with Reality on Obesity in Youth?”

  1. June 21, 2024 at 9:01 am, Allen Browne said:

    Beam me up, Scotty. There is no intelligent life down here!

    Thanks to Aaron Kelly and Ted for speaking up. The kids, their families, and the world needs more intelligence, objectivity, love.


  2. June 21, 2024 at 12:02 pm, Mary-Jo said:

    Copper, mercury, quinine, blood-letting were also recommended with “modest” results until penicillin discovered. If there’s better, more effective treatments, why not include them as part of recommendations?

  3. June 22, 2024 at 9:45 am, Valerie M. O'Hara, DABOM said:

    Thank you Ted – this is disappointing. Agree with Dr Kelly.
    Having been providing care for over 20 years, and providing the 26 contact hours across the multidisciplinary team since 2009- not until we began to address the biology of this disease fully – which includes pharmacotherapy and in some instances MBS- most patients did not see an improvement. Asking families to meet this very high contact with the best data of 1-3% BMI declination which has not been shown to be durable in the face of more effective therapies is problematic, and likely adds to internalized bias for even our youngest of patients.
    Well said Mary-Jo!!!