Nearly 20 percent of kids in the U.S. have a high BMI or body mass index — and the problem is growing. In the past four decades, the number of obese children has tripled.

In light of the increasing problem, the U.S. Preventive Services Task Force (USPSTF) has updated its recommendations. The Task Force now says that extensive and intensive behavioral interventions are the best way to help a child get to a healthy weight.

Children are still growing, so a child's BMI is calculated differently from an adult's. Although both use height and weight, a child is considered to have a high BMI if they fall at or above the 95th percentile in weight for their age and sex.

A high BMI in children can lead to several significant, even life-threatening, health conditions — including diabetes, joint problems and high blood pressure.

To address the epidemic of high BMIs among children, the USPSTF recommendations call for 26 hours of interventions spread over the course of a calendar year. The program includes self-monitoring, goal-setting, supervised physical activity, instruction in healthier eating and limits on screen time.

This rather extensive intervention time reflects the seriousness of the problem. A high BMI in children can lead to several significant, even life-threatening, health conditions. These include diabetes, difficulties breathing, bone and joint problems, liver issues, skin disturbances, high blood pressure and high cholesterol, which can cause heart diseases.

Obesity can also make a child a target of bullying which will negatively affect their self-esteem and overall emotional wellbeing.

Not all doctors are satisfied with the new recommendations. Some are critical of the Task Force's decision not to recommend bariatric surgery. They point to the fact that the American Academy of Pediatrics suggests doctors consider surgery and that over 10 years of surgical data have provided robust and good long-term results.

Critics also point to the lack of recommendations regarding weight-loss medications. But according to the Task Force, “The totality of the evidence was found to be inadequate.” They did, however, consider newly popular medications such as drugs sold under brand names Saxena, Wegovy, Lomaira, Alli and Topamax.

Obesity can also make a child a target of bullying which will negatively affect their self-esteem and overall emotional wellbeing.

The medications were associated with larger BMI reductions than with placebos in most trials, but the evidence is not yet solid enough. “There's just such a limited set of studies done that one doesn't know if those results are reliable and to whether they are generalizable,” USPSFT task force member John Ruiz, a professor of clinical psychology at the University of Arizona, said in a press release.

“And whether there's any harms that have come about, particularly, in longer-term use of those medications. That would be important to know,” he added.

Although some experts feel the 26 hours of intervention is impractical and may be difficult to achieve, the USPSFT panel stressed that its recommendations will help primary care providers determine what preventive care works and what doesn't.

“Fortunately, there are a variety of effective intensive behavioral interventions available that can help kids with a high BMI achieve a healthy weight, while improving quality of life,” Ruiz said.

If your child's BMI is high, the National Institutes of Health (NIH) recommends you find ways to change your child's diet. Here's what they suggest:

  • Eat fast food less often. When you do, order healthier side dishes — such as soup or fruit salad — instead of fries.
  • Replace high-fat protein foods — such as sausage and fried chicken—with leaner options, such as turkey breast, beans or tofu.
  • Replace highly processed foods with whole foods like fruits, vegetables, whole grains, nuts and seeds.
  • Instead of sugary sodas, serve water, low-fat or fat-free milk, or fortified nondairy beverages.
  • Place healthy foods and beverages where they are easy to see and reach. Keep high-calorie foods and beverages out of sight — or don't buy them at all.
  • Replace the cookie jar with a fruit bowl.

The USPSTF report can be found here. An article on the USPSTF Statement is published in JAMA.