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Comprehensive behavioral interventions lasting longer than this, involving 52 or more contact hours, will need a referral from does the quick weight loss program really work physicians, who clearly cannot provide such a program in a primary-care setting, the USPSTF authors point out. As for either metformin or orlistat, the USPSTF members conclude that both medications were associated with weight loss in adolescents but the amount of weight loss attributed to these medications was very small. They thus conclude that the clinical significance of medication-induced weight loss remains "unclear." Practically Speaking, Access to Weight-Loss Interventions Is Limited A number of separate editorials accompany the published recommendations and comment on the background evidence supporting them. Jason Block, MD, MPH, and Emily Oken, MD, MPH, both from Harvard Medical School and the Harvard Pilgrim Health Care Institute, in Boston, Massachusetts, find fault with the main USPSTF recommendation to refer obese children and adolescents to a comprehensive, intensive behavioral intervention for weight loss. "Most children with obesity do not have access to the intensive multicomponent behavioral treatments recommended by the USPSTF," they point out. "[And] absent or inadequate insurance coverage is a major barrier to care," they add. Even if families can afford a comprehensive intervention, treatment programs are usually found only in urban centers, limiting access for children and adolescents who live outside these centers. "Sustained advocacy, innovative means of improving access such as telehealth programs, and enhanced focus on training healthcare professionals in multiple care roles are critical to moving this evidence into action," Drs Block and Oken conclude. In another editorial, Rachel Thornton, MD, PhD, of Johns Hopkins School of Medicine, Baltimore, Maryland, and colleagues agree that intensive interventions as recommended by the USPSTF are "impractical" for many families. They also stress that reimbursement is a major obstacle for most patients to access such programs. "At best, implementing the USPSTF recommendation will have modest effects on obesity prevalence in the United States," Dr Thornton and colleagues argue. Furthermore, they point out that this particular recommendation will likely divert resources from much-needed population-based approaches to prevent obesity in children and adolescents in the first place. "The approach to childhood obesity must go beyond the clinician's office," Dr Thornton argues. Policy makers need to take into consideration the multiple factors that make up the "social determinants of health" and that deeply affect how children evolve into healthy adults. "The USPSTF recommendation should provide an impetus to redouble efforts to invest in practice, community, policy, and multilevel intervention research focused on achieving primary prevention and sustained improvements in health and health trajectories for children and adolescents and their families," she and her colleagues write. "Such a focus is critical for reversing the obesity epidemic," they conclude.
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Are Weight Loss Programs Effective?
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