Today in JAMA, the U.S. Preventive Services Task Force (USPSTF) recommended that clinicians either provide or refer children aged 6 and older who are overweight or obese to intensive behavioral therapies. Based on an updated systematic review of the evidence, the USPSTF affirmed its 2017 stance that such multidisciplinary interventions focusing on physical activity, healthy eating, and behavioral modifications are more beneficial than medications like semaglutide (Ozempic).
In fact, a study published in JAMA Pediatrics yesterday demonstrated that an intervention that combines prepared healthy meals with financial incentives can lead to significant weight loss in adolescents with severe obesity after one year.
Amy C. Gross, Ph.D., of the University of Minnesota Center for Pediatric Obesity Medicine and colleagues enrolled 126 adolescents (aged 13-17) who had a body mass index (BMI) of at least 35 or 120% above the 95th percentile for their age and sex. Half the adolescents received standard meal replacement therapy, in which they were provided healthy, well-balanced meals free of charge to their homes, along with monthly meetings with research staff. The other half received the meal-replacement therapy along with a $20 gift card for every 0.5% reduction of baseline body weight, paid out every two months.
After 52 weeks, the adolescents who could earn financial incentives lost an average of 6.1 kg (13.4 pounds), compared with 1.3 kg (2.9 pounds) in the meal replacement-only group. The weight loss in the financial incentive group equated to about a 6.6% reduction in BMI and an average payout of $330 per participant.
In an accompanying editorial, Aaron Carroll, M.D., M.S., of AcademyHealth in Washington, D.C., said the weight loss achieved in this study was encouraging, but questioned whether paying teens to lose weight on top of providing free meals (averaging around $700 a month) was a sustainable strategy at scale. He noted that even with these favorable parameters, 30% of the participants still did not complete the study.
“Behavioral interventions keep getting more and more complicated because they don’t work well, except in extreme circumstances and often in ways that defy implementation,” he wrote. “Maybe it’s time to stop focusing on them.”
The USPSTF recommendations acknowledged that behavioral interventions for obesity provide small benefits unless they offer regular clinician contact and physical activity sessions (as opposed to encouraging physical activity); and that such “comprehensive, intensive behavioral interventions remain inaccessible for the vast majority of U.S. children and adolescents with obesity.”
Carroll suggested that more research should be dedicated to enabling the safe use of medications like semaglutide in children, which have shown robust weight loss results as of now and will become more available once the price comes down. (Carroll disclosed that he has successfully lost weight with these drugs.)
The USPSTF did not offer any recommendations of weight loss medications for children, noting that while “several medications demonstrated greater weight loss than placebo, the totality of the evidence was found to be inadequate. An important limitation of the pharmacotherapy studies was that there was only a single trial for each effective medication (i.e., phentermine/topiramate, semaglutide, and liraglutide) that lasted longer than 2 months.”
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