Start Obesity Screening as Early as Age 2

According to Carl A. Sather, MD, of Indiana University in Indianapolis, and colleagues, in a 21-month clinical obesity program that included 462 children, those who were ages 2 to 5 years responded nearly seven times more favorably than those who were 6 to 21 years.  

At baseline, the average body mass index (BMI) z score was higher in the younger group, at 3.46, compared with 2.55 in the older group. But at both three and six months, the younger children had significantly greater changes in BMI z scores than the older children (−0.23 versus −0.05, and −0.635 versus −0.094, respectively, P<0.001 for both), Sather reported at Digestive Disease Week in Chicago.

The U.S. Preventive Services Task Force currently recommends obesity screening for children ages 6 to 18.

To see if a comprehensive obesity program for younger children could improve weight control and prevent metabolic problems that increasingly are being seen in the pediatric population, Sather's group enrolled children whose BMI was above the 95th percentile for age and sex, or above the 85th percentile if comorbidities were present.

Nearly 10% of the patients were 2 to 5 years old (median 4.6 years). The median age of those 6 to 21 years was 12.2. The program consisted of a three-month intensive clinic-based phase followed by a nine-month community group phase, during which patients and families received care and support from dietitians, physical therapists, and child psychologists in addition to their pediatrician or nurse practitioner.

Participants learned multiple techniques for behavior change, including setting goals, self-monitoring, and stimulus control. Family members were instructed in the use of food/activity diaries and given pedometers.

At baseline, the younger and older groups both had similar rates of dyslipidemia, with levels of high-density lipoprotein (HDL) below 40 mg/dL in 56% and 59%, respectively. By six to 12 months, HDL had risen by 2.84 mg/dL and 2 mg/dL in the two groups, respectively, a difference that was not statistically significant.

In addition, the younger and older children had similar rates of liver enzyme elevations, at 7% and 7.5%, respectively, which is of concern because of the possibility of nonalcoholic fatty liver disease, Sather explained.

Completion rates at three and six months were similar for the two groups (43% versus 43.5%, and 11.4% versus 13.8%).

Sather said during a press briefing, "Our numbers are small but the data are sufficiently convincing for us to recommend that all children ages 2 to 5 years should be screened for obesity, much like the recommendations of the American Academy of Pediatrics."

Practice Pearls: 

• Note that this study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.
• Explain that children ages 2 to 5 achieved greater changes in BMI z score in a comprehensive obesity program than those ages 6 to 21, leading the investigators to recommend yearly BMI screening starting at age 2.
• Note that changes in lipids were not significantly different between the younger and older children.

Sather CA, et al "BMI screening starting between ages two to five years impacts obesity and related morbidity better than current recommendations" DDW 2011; Abstract Mo1347.