A recent meta-analysis of the efficacy of primary care obesity interventions reveals several inefficiencies in current practices. Researchers propose more in-depth studies to address long-term follow-up procedures and potential negative effects of preventative behavioral counseling to determine how primary care can reduce youth obesity rates most effectively.
Increasing concerns over pediatric obesity, weight stigma, and negative body image in youths has driven public health efforts to incorporate weight management intervention into primary care practice. How effective is this integrated process? With limited data to suggest how primary care can reduce youth obesity to a significant degree, researchers seek to identify room for improvement to increase efficacy and sustainability in future public health initiatives.
In a new meta-analytical study in Pediatrics (2016), researchers screened 800 publications ranging from January 1976 to March 2016 to summarize and critique available evidence regarding primary care-level intervention practices for weight management in youths (age 2-18). Fifteen eligible studies (13 articles on 10 randomized control trials, or RCTs, and 2 quasi-experimental studies) were selected for review using a systematic search to identify relevant publications pertaining to ‘primary health care’, ‘BMI’, ‘intervention’, and ‘youths’. Of these studies, only those citing weight management interventions carried out by primary care staff for children and/or adolescents from age 2 to 18 were included in this study. Studies in which patients sought specialty clinics for targeted weight-loss and management or “intensive behavioral treatment of obesity” were excluded.
Results found “little evidence” pertaining to the effectiveness of primary care-level obesity programs for children and adolescents. For instance, data demonstrates marginal effects in BMI reduction (the equivalent of a difference in 1 kg over a follow-up period of 0-3 years) for primary care-level early intervention in pediatric obesity. A z-BMI, or BMI percentile, score of 0.5-0.6 is required to confirm fat reduction and health benefit associated with weight loss, however, the average effect noted in included studies was -0.37. Systematic review of primary care-level obesity-related behavioral treatments for adults found these interventions to produce more “clinically meaningful” results, but there is insufficient evidence to indicate the viability of incorporating such programs into primary care practices.
Potential harms, such as public health funding allocation and program efficacy, financial cost to families, and effects on weight stigma and self-esteem in youths, were largely underrepresented in the included studies. These limitations highlight areas for potential improvement in public health campaigns regarding weight management, as it is vital to identify and mitigate the risks of possible adverse effects of this type of youth intervention (e.g. low self-esteem, increased weight stigma, spikes in extreme dieting/eating disorder behaviors, etc.).
Ultimately, this study aims to increase awareness about inefficiencies in current practices regarding weight management intervention in pediatric primary care as well as the marginal clinical significance of their short-term effects. By identifying existing issues and drawing attention to long-term lack of compliance in weight management behaviors due to lack of follow-up, researchers can examine possible public health solutions to benefit patients in significant and sustainable ways.
Written By: Jennifer Newton