Updated American Academy of Pediatrics guidelines for the treatment of obesity recommend prompt use of behavioral therapy and lifestyle changes, and indicate that surgery and medication should be used for some young people.
The guidelines, published Monday in the journal Pediatrics, are the first comprehensive update to the academy’s obesity treatment guidelines in 15 years. They provide advice for the treatment of children as young as 2 years old and throughout adolescence.
The guidelines recognize that obesity is complex and linked to access to nutritious food and health care, among other factors.
Treatment for young children should focus on addressing the behavior and lifestyle of the whole family, including nutritional support and increased physical activity. For children 12 and older, the use of weight-loss medications is appropriate, in addition to health behavior therapy and lifestyle treatment, the AAP says. Adolescents 13 years 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, guideline author and practice guideline subcommittee vice-chair. AAP Obesity Clinic, in a statement. “The goal is to help patients change their lifestyle, behaviors or environment in a lasting way and to involve families in decision-making every step of the way.”
For children and adolescents, 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 both recognizing that the causes of childhood obesity are complex and that his treatments should be a team effort.
“It’s not a cause for all children,” he says. “There hasn’t been this kind of report to say that there are more options and that we shouldn’t automatically discount the possibility of drugs, that we shouldn’t discount 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 address obesity prevention; it will be addressed in another upcoming AAP policy statement, he says.
“These are the most comprehensive, patient-centered guidelines we’ve had that address childhood overweight and obesity,” said Dr. Rebecca Carter, pediatrician at University Children’s Hospital. of Maryland and Assistant Professor at the University of Maryland School of Medicine. an email on Monday.
“New to these recommendations are several new medication management strategies that have been shown to be highly effective in treating obesity as a chronic disease in adults, and are now recommended for use in children and adolescents,” said Carter said. “This is a major step in allowing overweight and obesity to be seen as the chronic diseases that they are.”
She added that the recommendations were also a “big step forward” in helping parents and medical teams “take ownership” of a child’s long-term health risks related to overweight and obesity.
“They give a variety 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 easy fixes and certainly deflect our attention away from outdated or unhealthy dieting strategies,” says Carter.
The new guidelines are designed for health care providers, but Carter said parents should speak with their child’s doctor if they have concerns about weight and discuss strategies to optimize health and monitor changes.
“It is also appropriate to do this in a child-centred way, taking care not to stigmatize or make them feel bad about themselves, while allowing the child to feel that they have the tools to keep your body healthy over time.”
The new guidelines are “much needed progress” in aligning holistic care with current science, Dr. Jennifer Woo Baidal, assistant professor of pediatrics and director of the Pediatric Obesity Initiative at Columbia University in New York, said Monday. .
“Passing the new guidelines will help reverse the epidemic of childhood obesity,” she said. “More work at the policy level will be needed to mitigate policies and practices that propagate racial, ethnic and socio-economic disparities in childhood obesity. While the guidelines support the advocacy efforts of paediatricians, we as a society must voice our support for healthy environments for children nationwide.
The AAP indicates that more than 14.4 million children and adolescents live with obesity. According to the US Centers for Disease Control and Prevention, overweight or obese children are at higher risk for asthma, sleep apnea, bone and joint problems, type 2 diabetes and heart disease.
Separate research, published last month in the American Diabetes Association’s journal Diabetes Care, suggests that the number of young people under the age of 20 with type 2 diabetes in the United States could increase by nearly 675% from by 2060 if current trends continue.
Last month, the CDC released updated growth charts that can be used to track children and teens with severe obesity.
Growth charts are standardized tools used by health care providers to track growth from infancy through adolescence. But as obesity and severe obesity have become more prevalent over the past 40 years – more than 4.5 million children and adolescents suffered from severe obesity in 2017-2018, according to the agency – graphics had not followed.
The growth chart used since 2000 is based on data from 1963 to 1980 and did not extend beyond the 97th percentile, the agency said. Newly expanded percentiles incorporate more recent data and provide a way to monitor and visualize very high body mass index values.
Existing growth charts for children and adolescents without obesity will not change, the CDC said, while the expanded growth chart will be useful for health care providers treating patients with severe childhood obesity.
“Before today’s publication, growth charts did not extend high enough to plot BMI for the growing number of children with severe obesity. The new growth charts associated with high 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, in a statement. “Providers can working with families on a comprehensive care plan to address childhood obesity.