Clinical Question

Should children and adolescents be screened for body mass index (BMI) and be given brief counseling if overweight?

Bottom Line

Calculating the BMI of children and adolescents in primary care practices and counseling those who are overweight is ineffective to reduce BMI in children over several years of follow-up. (Level of Evidence = 1a)

Synopsis

These investigators searched five databases, including the Cochrane Central Library, as well as reference lists of retrieved studies and review articles, to identify 10 randomized studies and two quasi-experimental studies that evaluated the effect of brief interventions to reduce BMI in children between the ages of two years and 18 years. They looked at any primary care weight-management interventions (e.g., lifestyle modification education, BMI feedback and lifestyle counseling, motivational interviewing). Two reviewers independently selected articles and abstracted the data. The quality of the research was not good. Brief interventions produced a very small reduction in the BMI z score, which is the measure of the relative weight adjusted for the child's age and sex (effect size compared with usual care = −0.04; 95% confidence interval, −0.08 to −0.01), with good agreement across the studies. A change of 0.5 to 0.6 is necessary to be sure of a clear reduction in fat and associated health benefit. Body satisfaction scores were similar between treatment group and control group patients, as were child- and parent-reported quality-of-life and self-worth scores, although there was significant heterogeneity among these results. Adverse effects were not measured in most studies.

Study design: Meta-analysis (randomized controlled trials)

Funding source: Self-funded or unfunded

Setting: Various (meta-analysis)

Reference: SimLALebowJWangZKoballAMuradMHBrief primary care obesity interventions: a meta-analysis. Pediatrics2016;138(4):e20160149.