AHRQ says obesity-related interventions understudied

There are a number of studies showing that some school-based interventions for the prevention of childhood obesity can be effective, says a draft review from the Agency for Healthcare Research and Quality (AHRQ), the key federal agency charged with improving quality and effectiveness in health care.

According to the review Childhood Obesity Prevention Programs: A Comparative Effectiveness Review and Meta-analysis, "Modest evidence shows that school-based interventions could prevent childhood obesity."

However, the agency could find only 2 studies on primary care-initiated activities to include in its recent review and only 1 small diet intervention study showing a significant change in body mass index (BMI).

The draft report, published by the Effective Health Care Program of the AHRQ, examined 27,916 citations in the medical literature but excluded all but 113 intervention studies. Eighty-two of those studies tested school-based interventions, although some also included activities in the home or other settings.

One study demonstrating effectiveness in the primary care setting was by Marian Tanofsky-Kraff, PhD, and colleagues, reported in the December 2010 International Journal of Eating Disorders. That study randomized 38 girls aged 12 to 17 years and at risk for obesity to interpersonal psychotherapy or standard-of-care health education.

It found that over a year, the girls in the interpersonal psychotherapy group were less likely to increase their BMI as expected for their age and BMI percentile.

In response to the AHRQ review, Stephen Pont, MD, MPH, chair of the American Academy of Pediatrics (AAP) Provisional Section on Obesity, says that there is a growing research base on dealing with obesity in primary care. But one reason so little study has been completed in that setting is the lack of coverage for interventions by private insurance and Medicaid.

A 2010 analysis in Public Health Reports (125[4]:596-604) states that only 10 state Medicaid programs appear to cover obesity-related treatment in children and "most states are not regulating the insurance market with regard to use of obesity in medical underwriting."

Pont notes that Medicare now pays for interventions for obesity, and sometimes Medicaid follows Medicare's lead, "but it's not a done deal." He also says AAP will be coming out with new tools to help combat obesity beginning this fall.

In regard to the finding that most studied programs are based in the schools, Pont says there is often a "spectacular opportunity" for physicians to serve as health advocates in that setting. He says that physicians often communicate with the schools about children's medications and other issues anyway. And, they can reinforce the idea that children who are obese may not do as well in school or on standardized tests.

The AHRQ report says that although its review looked at changes such as dietary intakes and physical activity, it did not look at psychosocial or environment outcomes. A better understanding of enabling factors might allow for better-designed interventions.

The review finds strong support for effectiveness in school-based efforts targeting physical activity and those targeting diets. Head-to-head tests were rare, however, so it's unknown whether one focus is better than the other.

The report concludes that there should be more attention and resources going to disseminate successful intervention programs and to their evaluation.