Defining “Success” in Childhood Obesity Interventions in Primary Care

In “Brief Primary Care Obesity Interventions: A Meta-Analysis,” Sim and coauthors find that primary care interventions are not associated with a clinically significant effect on BMI.1 This lack of effect is particularly striking given their use of only published trials; many more ineffective trials were probably never reported. Ultimately, they conclude that current guidelines recommending universal BMI surveillance and counseling for those with high BMI should be revised. This well-conducted meta-analysis compels us as responsible clinicians, researchers, and policymakers to take a hard look at our interventions. After all, primary care is not free. However, this study also compels us to pass that same level of scrutiny over the targeted outcome. Is BMI the right measure of screening success? Let us reconsider the purpose of primary care–based screening and the expected outcomes. BMI is a screening tool, like vision charts or the Modified Checklist for Autism in Toddlers. The number of conditions we could screen for is limitless; therefore, well-established criteria help sort out which are most likely to improve the health of populations. A good screening test should identify an important health problem in an early stage; be inexpensive, easy to perform and interpret, and accurate and … Address correspondence to Sarah C. Armstrong, MD, Duke University, 4020 North Roxboro St, Durham, NC 27701. E-mail: sarah.c.armstrong{at}dm.duke.edu