by Todd Neale, Staff Writer, MedPage Today

Overweight and obese children who received counseling from a family doctor did not lose more weight or get more exercise than youngsters who did not receive counseling, Melissa Wake, MD, of Royal Children’s Hospital in Melbourne, and colleagues reported online in the British Medical Journal.

Because the screening and counseling are so expensive, the researchers questioned recommendations that the approach be used in the U.S., U.K., Australia, and other countries.

“These findings cast doubt on many countries’ current policies that support universal surveillance coupled with brief, individualized secondary prevention by the primary care sector to reduce childhood obesity,” they wrote.

After surveying 3,958 children who visited general practitioners in the Melbourne area, researchers enrolled 258 who were overweight and obese to participate in the randomized trial, which included 66 family physicians from 45 practices.

The children, ages 5 to 9, were assigned either to usual care (119 youngsters) or to a 12-week intervention comprising up to four consultations in which the physician tried to help families set goals for changing eating habits, increasing physical activity, reducing sedentary time, and increasing water consumption (139 children).

Children who received the intervention attended a mean of 2.7 consultations.

At both six-month and one-year follow-ups, there were no significant differences between the two groups on the main outcomes.

Although body mass index tended to be slightly lower in the intervention group, the difference was not statistically significant at either six months (P=0.38) or 12 months (P=0.51).

In addition, waist circumference, overall nutrition, physical activity, and quantities of fruits, vegetables, fat, and water consumed were all similar in the two groups (P>0.05 for all).

These findings, the researchers said, were consistent with two smaller trials exploring a similar approach.

“Therefore”, they said, “the most likely interpretation is that such interventions are ineffective in reducing BMI.”

There was no evidence of a detrimental effect from the intervention, other than a higher cost.

Cost per child — including BMI surveillance, recruitment and training of the physicians, and the visits themselves — was about $1,100, compared with $67 for care as usual.

The cost would drop if physicians treated more children, according to the authors, but only to about $342 if each doctor managed 30 youngsters.

They acknowledged some limitations of the study, including the method of selecting general practitioners who volunteered to participate, the low rate (about 33%) of participation among eligible families, and the inability to blind families to group assignment.

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