Updated guidelines for treating obesity in children include drugs, surgery for some young people
Updated guidelines from the American Academy of Pediatrics for the treatment of obesity call for prompt use of behavioral therapy and lifestyle changes, and say that surgery and medication should be used in some young people.
The guidelines, published Monday in the journal Pediatrics, are the first comprehensive update of the Academy’s obesity treatment guidelines in 15 years. They provide treatment guidelines for children from 2 years of age to the teenage years.
The guidelines recognize that obesity is complex and related to access to nutritious food and health care, among other factors.
Treatment of younger children should focus on behavior and lifestyle of the whole family, including nutritional support and increased physical activity. For children 12 years of age and older, the use of weight-loss medications is appropriate, along with behavioral and lifestyle therapy, the AAP says. Teenagers 13 years of age and older with severe obesity should be evaluated for surgery, according to guidelines.
“There is no evidence that ‘watchful waiting’ or delayed treatment is appropriate for obese children,” said Dr. Sandra Hassink, author of the guidelines and vice chair of the AAP’s Clinical Practice Guidelines Subcommittee on Obesity. statement. “The goal is to help patients make lifestyle, behavioral or environmental changes in a way that is sustainable and involves families in decision-making every step of the way.”
For children and teenagers, overweight is defined as a body mass index at or above the 85th percentile and below the 95th percentile; obesity is defined as a BMI at or above the 95th percentile.
Myles Faith, a psychologist at the State University of New York at Buffalo who studies eating behaviors and childhood obesity, praised the new report for recognizing that the causes of childhood obesity are complex and that treating it must be a team effort.
“It’s not one goal for all kids,” he says. “There was no report like this that said there are more options and that we shouldn’t automatically dismiss the possibility of drugs, that we shouldn’t dismiss the role of surgery. For some families, that might be something to consider,” said Faith, who was not involved in creating the guidelines.
The new guidelines do not talk about obesity prevention; it will be addressed in another AAP policy statement to come, it said.
“These are the most comprehensive patient-centered guidelines we’ve had that address childhood overweight and obesity,” said Dr. Rebecca Carter, a pediatrician at the University of Maryland Children’s Hospital and an assistant professor at the University of Maryland School of Medicine. e-mail on Monday.
“New in these recommendations are several new drug management strategies that have been shown to be very successful in treating obesity as a chronic disease for adults and are now being recommended for use in children and adolescents,” Carter said. “This is a big step in allowing overweight and obesity to be recognized as the chronic diseases that they are.”
She added that the recommendations are also “a big step forward” in helping parents and medical teams “take ownership” of the long-term health risks to children associated with being overweight and obese.
“They provide a set of tools to help families feel empowered that there are ways to treat these medical conditions and that there are nuanced causes for these conditions that go beyond simple solutions and certainly take our focus away from outdated or unhealthy eating strategies,” Carter said.
The new guidelines are designed for health care providers, but Carter said parents should talk to their child’s doctor if there are concerns about weight and discuss strategies to optimize health and monitor changes.
“It’s also appropriate to do this in a child-centered way, making sure not to stigmatize or make them feel bad about their body, while empowering the child to feel they have the tools they need to keep their body healthy over time.”
The new guidelines are a “much-needed advance” in aligning holistic care with modern science, Dr. Jennifer Woo Baidal, assistant professor of pediatrics and director of the Pediatric Obesity Initiative at Columbia University in New York, said in a separate email Monday.
“Implementing the new guidelines will help reverse the childhood obesity epidemic,” she said. “More work will be needed at policy levels to mitigate policies and practices that propagate racial, ethnic, and socioeconomic disparities in obesity starting early in life. While the guidelines support pediatricians’ advocacy efforts, we as a society must voice our support for a healthy environment for the nation’s children.”
The AAP says more than 14.4 million children and teens are living with obesity. Children who are overweight or obese are at greater risk of asthma, sleep apnea, bone and joint problems, type 2 diabetes and heart disease, according to the US Centers for Disease Control and Prevention.
A separate study, published last month in the Journal of the American Diabetes Association Diabetes caresuggests that the number of young people under 20 with type 2 diabetes in the United States could increase by nearly 675% by 2060 if current trends continue.
Last month, the CDC announced updated growth charts which can be used to monitor children and teenagers with severe obesity.
Growth charts are standardized tools used by healthcare providers to track growth from childhood to adolescence. But as obesity and severe obesity have become more prevalent over the past 40 years – more than 4.5 million children and teenagers were severely obese in 2017-2018, the agency says – the rankings have not kept pace.
The growth chart used since 2000 was based on data from 1963 to 1980 and did not exceed the 97th percentile, the agency said. The newly expanded percentiles include more recent data and provide a way to track and visualize very high BMI values.
Existing growth charts for non-obese children and adolescents will not change, the CDC said, while the expanded growth chart will be useful for health care providers treating patients with severe childhood obesity.
“Prior to today’s release, growth charts were not high enough to plot BMI for the increasing number of severely obese children. New growth charts combined with high-quality treatment can help optimize care for children with severe obesity,” said Dr. Karen Hacker, director of the CDC’s National Center for Chronic Disease Prevention and Health Promotion. it is stated in the press release. “Caregivers can work with families on a comprehensive care plan to address childhood obesity.