Many U.S. children do not receive evidence-based care for obesity despite USPSTF recommendations

Six years following the U.S. Preventive Services Task Force (USPSTF) recommendation that clinicians screen and treat (or refer) children age six and older for obesity, most U.S. children still do not receive evidence-based care for obesity. The finding comes alongside key recommendations for next steps to address the epidemic in a new consensus report representing the input of 43 multidisciplinary, cross-sector stakeholders, including clinical, scientific, policy and insurance experts. The experts identify several barriers to care impeding implementation of the USPSTF recommendation, and point to family-based behavioral therapy, an integrated chronic care model and a multi-disciplinary care team as three key components to address childhood obesity.

The Obesity Society (TOS), the Agency for Healthcare Research and Quality (AHRQ), and the American Academy of Pediatrics (AAP) Institute for Healthy Childhood Weight spearheaded the conference of 43 cross-sector stakeholders in July of 2015 at AAP national offices in Elk Grove Village, IL. The recommendations are now available online in advance of the January 2017 issue of Obesity, TOS's scientific journal.

"With nearly one in three children in the United States with overweight or obesity there is an urgent need to help these children get access to the evidence-based care they need to get healthy," said Denise E. Wilfley, PhD, lead author of the paper, Scott Rudolph University professor at Washington University School of Medicine, TOS Fellow and past-chair of TOS Pediatric Obesity Section, and member of the AAP Institute for Healthy Childhood Weight Advisory Board. "The consensus group was successful in identifying several barriers to care that impede widespread implementation of the USPSTF recommendation, including lack of health insurance coverage for treatment."

Despite substantial evidence that obesity warrants early and comprehensive treatment, many health plans do not provide coverage for childhood obesity treatment, say researchers.

"When coverage is offered it is often limited in scope and does not support treatments of adequate duration or breadth to effectively impact children with obesity," continued Dr. Wilfley. "We cannot reach USPSTF-recommended care for children unless we advance efforts to secure payment for that care."

The conference brought together all stakeholders to address these challenges, including public and private insurance providers.

"We're pleased to have had the input of state and federal level officials, Medicaid representatives, private health insurers, large employers and even a patient and her mother," said Stephen Cook, MD, MPH, senior author of the paper, associate professor at University of Rochester and Associate Director of the AAP's Institute for Healthy Childhood Weight. "The participation of the professional organizations, policy makers and health insurers was very insightful when it comes to thinking about the direction of childhood obesity care delivery and payment."

Consensus recommendations developed at the conference to improve access and to treat childhood obesity are based on scientific evidence and current clinical and payment practices. The conference also identified that there are not enough professionals trained in evidence-based care for childhood obesity - another barrier to care. Further, the group looked at new payment models that could be applied to treating childhood obesity such as centers of excellence and integrating community-based services with health care.

Consensus recommendations from the conference focused on several components, including treatment format, outcome measures, treatment setting and provider training, among others. The following three key recommendations are highlighted:
1.Family-based multi-component behavioral therapy - This method is a family-centered, comprehensive approach to behavior change to improve nutrition and dietary behaviors, promote physical activity and reduce sedentary behavior. Family-based therapy is designed to help parents and children build and establish lasting changes in these behaviors through the application of self-regulatory skills, behavioral economics, and social and learning theory principles to the practice of weight maintenance behaviors across multiple socioenvironmental contexts. Additionally, a cornerstone of family-based behavioral treatment is that parents are active participants in the intervention and as such, parents who are overweight or have obesity are assisted in achieving their own weight loss goals.
2.Integrated chronic care model - This model of care calls for clinic to community linkages and allows for the integration of follow-up visits, and facilitates more frequent and intense treatments to achieve meaningful outcomes.
3.Multi-disciplinary team - A team approach to care will facilitate an integrated system of care, with core team members including a medical professional partnered with a behavioral interventionist trained in childhood obesity.

"Childhood obesity is a serious public health issue with long-term ramifications," said Nancy Butte, PhD, spokesperson for The Obesity Society and professor at Baylor College of Medicine. "It's crucial that we not just identify the best way to treat childhood obesity, but also how it will be paid for so that families can access the care. Payers should take a close look at these recommendations, as addressing obesity during childhood will reduce chronic diseases and associated costs in adulthood."

In an accompanying editorial also published in Obesity, Robert I. Berkowitz, MD, Perelman School of Medicine at the University of Pennsylvania, pointed out that "treatment programs have not developed in part because of lack of funding …. Health care reform should include greater and sufficient funding for evidence-based lifestyle programs to treat childhood obesity."

Dr. Berowitz also points to the considerable interest from insurers in supporting ways to improve funding, and recommends public and private insurers fund demonstration projects to create a roadmap for further implementation.