Obesity Interventions by Pediatricians Barely Cut BMI – Medscape

Pediatric practice guidelines recommend body mass index (BMI) surveillance and routine weight management counseling in the primary care setting, but a new systematic review and meta-analysis shows this has little effect on BMI.

Leslie A. Sim, PhD, from the Department of Psychiatry and the Department of Psychology at the Mayo Clinic in Rochester, Minnesota, and colleagues published their findings online September 12 in Pediatrics. They compared office-based interventions for weight management, such as motivational interviewing and education on changing lifestyle behaviors, with any control intervention, such as usual care, no intervention, or feedback only, on BMI in children and adolescents aged 2 to 18 years.

The researchers found that compared with usual care or control treatment, the interventions resulted in a significant but small reduction in BMI z score (−0.04; 95% confidence interval, −0.08 to −0.01; P < .02), with no inconsistency across studies (I ² index = 0%); and a nonsignificant effect on body satisfaction (standardized mean difference, 0.00; 95% confidence interval, −0.21 to 0.22; P = .98; I ² index = 64.1%).

“To put the finding in context, for a 10-year-old girl with a BMI at the 90th percentile, the effect is equivalent to a difference between the intervention and control groups of 1 kg over a 0- to 3-year follow-up period,” the authors write.

They note that because a BMI z score reduction of 0.5 to 0.6 is needed to show health benefit, the interventions are “generally ineffective,” and perhaps resources could be better used.

In addition to having little effect, they say, counseling kids about weight could have potential harms.

Previous evidence suggests that physicians’ conversations about weight loss may have unintended consequences of adding weight-related stigma, consequent binge eating and weight gain, and higher risk for eating disorders, the researchers explain.

They say the results of the meta-analysis highlight the need for revised practice guidelines and new approaches.

Is BMI The Right Measure of Success?

In an accompanying editorial, Sarah C. Armstrong, MD, from the Department of Pediatrics, and Asheley Cockrell Skinner, PhD, from the Duke Clinical Research Institute, both at Duke University in Durham, North Carolina, agree the findings should compel clinicians, researchers, and policy makers to reevaluate interventions.

“This lack of effect is particularly striking given their use of only published trials; many more ineffective trials were probably never reported,” they write.

However, they also question whether BMI is the right measure of screening success.

“Failing to reduce BMI should not be equated with failing to adopt healthier behaviors,” Dr Armstrong and Dr Skinner write.

Just as quitting smoking leads to reduced morbidity from chronic obstructive pulmonary disease and lung cancer, improving diet and changing behaviors can lead to improved glucose levels, lipid profiles, and blood pressure, they explain.

So by not talking about BMI in a primary care visit, physicians will miss the chance to talk with a family motivated to make changes. Also, by not mentioning concerns about weight, the family may be left with the impression that everything is fine.

In addition, if reduction in BMI is the only measure of success, families will not be praised for other health gains they may have achieved.

They say the researchers are right to highlight potential harms, but they also note that previous studies have shown parents want nonjudgmental conversations about weight conducted in a trusted medical home, and that those talks have not increased risk for unsafe dieting and have increased desire to change behaviors.

“We believe moving the field will require not only ‘methodologically rigorous’ randomized controlled trials but the use of innovative designs, such as pragmatic trials, to determine the effectiveness of obesity care and the use of networked data systems to better understand the development and trajectories of obesity in children,” they write.

The authors and editorialists have disclosed no relevant financial relationships.

Pediatrics. Published online September 12, 2016. Article abstract, Editorial extract

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