Intensive lifestyle intervention after obesity screening significantly improved body mass index z scores in children aged 2-5 years, compared with children aged 6-21 years, based on data from 462 children enrolled in a tertiary-care clinical obesity program.
"Children 2 to 5 years old responded nearly seven times more favorably than [did] older children aged 6 to 21 years old after completion of 6 months within our obesity program," Dr. Carl A. Sather of Indiana University, Indianapolis, said in a press conference. The complete study findings will be presented on May 9 at the annual Digestive Disease Week.
The findings contrast with the current U.S. Preventive Services Task Force guidelines, which suggest screening children aged 6-18 years (not younger) for obesity and referring them for comprehensive therapy if needed, he said.
The study population included 44 children aged 2-5 years and 418 children and adolescents aged 6-21 years. All participants were referred to the program and had a body mass index above the 95th percentile for age and sex, or had a BMI greater than the 85th percentile with comorbidities.
During the lifestyle intervention, changes in BMI z scores were significantly greater in the younger group, compared with the older group after 3 months (–0.23 vs. –0.05) and after 6 months (–0.64 vs. –0.094).
The 12-month program began with a 3-month clinic-based intervention that included sessions with a dietitian, physical therapist, child psychologist, and pediatrician. Children and their caregivers were taught behavior change techniques including goal setting, accountability, self-monitoring, and stimulus control.
The children and caregivers met in group sessions once a month during months 4-6 and bimonthly during months 7-12. Interventions included the use of a food journal and a pedometer. Program completion rates were similar between the younger and older groups at 3 months (43% vs. 44%) and 6 months (11% vs. 14%).
The mean age of the younger patients was 4.6 years, with a mean BMI z score at baseline of 3.46. The mean age of the older patients was 12.2 years, with a mean BMI z score at baseline of 2.55.
The baseline rate of dyslipidemia (HDL cholesterol less than 40 mg/dL) was similar in the younger vs. older groups (56% vs. 59%, respectively), and the baseline rate of transaminitis, or elevated levels of aspartate transaminase and alanine transaminase, also was similar for the two groups (7% vs. 7.5%, respectively). Follow-up lab testing for dyslipidemia at 6-12 months showed similar gains in HDL in both the younger and older groups (increases of 2.84 mg/dL vs. 2.00 mg/dL, respectively).
Although the findings suggest that obesity screening is appropriate for preschoolers, it is important for the parent or caregiver to monitor the use of pedometers and food/activity journals by the youngest children, Dr. Sather noted in an interview.
"We had to take some specific strategies to address developmental limitations in the 2- to 3-year-old group," he said. But pedometers can be used by children if they are monitored by adults, and the food and activity journal also can be used easily by young children with adult supervision, he said.
"We don’t see any reason that younger children should be excluded from behavioral interventions [for obesity]" said Dr. Sather. "Although our numbers are small, our completion rate is consistent with other centers," he said, and the data are sufficiently convincing to recommend that all children aged 2-18 years should receive obesity screening, similar to the American Academy of Pediatrics’ current recommendations. "We hope that our data will prompt some further research and examine the positive impacts of BMI screening at younger ages, and that it will contribute to stronger conclusions and healthier pediatric populations," he said.
Dr. Sather said he had no financial conflicts to disclose.