Department of Preventive Medicine and Biostatistics, Uniformed Services University, Bethesda, Maryland
Johns Hopkins Berman Institute of Bioethics, Baltimore, Maryland.
Pediatrics. 2021 Jul;148(1). doi: 10.1542/peds.2020-048009. Epub 2021 Jun 29.
Childhood obesity represents a serious and growing concern for the United States. Its negative consequences for health and well-being can be far-reaching, devastating, and intergenerational. In 2017, the US Preventive Services Task Force (USPSTF) issued a grade B recommendation for screening children and adolescents for obesity and offering or referring to comprehensive, intensive behavioral interventions as indicated. However, many communities in the United States have limited access to such interventions. The USPSTF's mission is to review and grade research evidence for clinical preventive services and does not include cost or population-based operationalization and implementation logistics considerations for its recommendations. Yet implementing recommendations without considering cost and operationalization may lead to equity and access challenges. These are essential considerations, but oversight of the implementation of these recommendations is not standardized or assigned to any one agency or organization. As such, a central ethical feature inherent to the implementation of USPSTF recommendations calls for stakeholder collaborations to take on the next step beyond the establishment of evidence-based recommendations: to ensure the ethical application of such guidelines across diverse populations. Furthermore, the screening-intervention relationship inherent to this USPSTF recommendation raises ethical concerns regarding US societal norms surrounding obesity, particularly when contrasted against other screening-intervention modalities. More efforts, such as increased incentives or expansion of clinical services in low-resource areas, should be taken to facilitate this recommended intervention by expanding access to childhood obesity interventions to fulfill ethical responsibilities to equity and to ensure the right to open futures for children.
儿童肥胖问题是美国面临的一个严重且日益严重的问题。肥胖对健康和福祉的负面影响可能是深远的、毁灭性的，而且还会代际传递。2017 年，美国预防服务工作组（USPSTF）发布了一项 B 级推荐，建议对儿童和青少年进行肥胖筛查，并根据需要提供或转介全面、强化的行为干预。然而，美国许多社区获得此类干预的机会有限。USPSTF 的使命是审查和评估临床预防服务的研究证据，并不包括其建议的成本或基于人群的操作化和实施后勤方面的考虑。然而，不考虑成本和操作化而实施建议可能会导致公平性和可及性方面的挑战。这些都是至关重要的考虑因素，但对这些建议的实施的监督并没有标准化，也没有分配给任何一个机构或组织。因此，USPSTF 建议实施所固有的一个核心伦理特征是，利益相关者合作采取超越基于证据的建议的下一步措施：确保在不同人群中对这些指南进行合乎伦理的应用。此外，该 USPSTF 建议中固有的筛查-干预关系引发了关于美国社会对肥胖问题的规范的伦理问题，特别是与其他筛查-干预模式相比时。应该采取更多的措施，如增加激励措施或扩大资源匮乏地区的临床服务，以通过扩大儿童肥胖干预措施的获取机会来促进这一推荐的干预措施，从而履行公平和确保儿童拥有开放未来的权利。
