Are Childhood Obesity Screening Guidelines Misguided?

Yesterday the news wires were swamped with reports on a new recommendations by the U.S. Preventive Services Task Force to screen school kids for obesity:

The USPSTF recommends that clinicians screen children aged 6 years and older for obesity and offer them or refer them to intensive counseling and behavioral interventions to promote improvements in weight status.

The recommendation appears largely based on a paper by Evelyn Whitlock and colleagues who performed a systematic review on the effectiveness of weight management interventions in children just published in Pediatrics. The review concludes that despite important gaps, available research supports at least short-term benefits of comprehensive medium- to high-intensity behavioral interventions in obese children and adolescents.

In their recommendations, the USPSTF includes the previous American Medical Association Expert Committee recommendation on childhood obesity, namely to use

a stepwise approach that divides treatment into several stages including counseling, providing a structured weight management plan, and using a comprehensive multidisciplinary intervention/ tertiary care intervention delivered by multidisciplinary teams with expertise in childhood obesity.

So the recommended response to a “positive” screen is not 20 extra minutes of phys-ed per day or sitting through a class on healthy eating; no, the recommended response to a “positive” screen is comprehensive medical and behavioural intervention by a multidisciplinary team with expertise in childhood obesity…

…and herein lies the problem!

How many overweight and obese kids will actually have access to this kind of multidisciplinary weight management?

Indeed, it is only too easy to screen kids, label them as overweight or obese, and thereby destroy whatever is left of their self-esteem while amplifying their existing body-image concerns. Screening can probably also also point fingers and help heap blame on the parents, who may or may not be able to deal with these results in a constructive fashion.

Nowhere in the recommendations do I see any concern expressed about how these screening recommendations could possibly affect weight-bias and discrimination, have the potential to promote weight-based bullying and teasing, or result in potentially devastating outcomes including setting the poor kids off on unsustainable weight-loss attempts and weight cycling.

As I have blogged before, there is increasing evidence that weight bias and discrimination can increase depression and unhealthy eating behaviours – blame and ridicule has never been a good motivator for lifestyle change.

While I am as concerned as the next guy about the catastrophic increase in childhood obesity, I do not for a minute believe that screening and labeling 6 year-olds is the solution.

I can only imagine what some of my readers may have to say regarding this post.

Edmonton, Alberta