Updated obesity treatment guidelines for children and teens include medications, surgery for some young people

Updated American Academy of Pediatrics guidelines for treatment of obesity urge prompt use of behavior therapy and lifestyle changes, and they say surgery and medications 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 guidance for treatment of children as young as 2 and through the teen years.

The guidelines acknowledge that obesity is complex and tied to access to nutritious foods and health care, among other factors.

Treatment for younger children should focus on behavior and lifestyle treatment for the entire family, including nutrition support and increased physical activity. For children 12 and older, use of weight loss medications is appropriate, in addition to health behavior therapy and lifestyle treatment, the academy says. Teens 13 and older with severe obesity should be evaluated for surgery, according to the guidelines.

“There is no evidence that ‘watchful waiting’ or delayed treatment is appropriate for children with obesity,” Dr. Sandra Hassink, an author of the guideline and vice chair of the group’s Clinical Practice Guideline Subcommittee on Obesity, said in a statement. “The goal is to help patients make changes in lifestyle, behaviors or environment in a way that is sustainable and involves families in decision-making at every step of the way.”

For children and teens, 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 childhood eating behaviors and obesity, praised the new report for acknowledging that the causes of childhood obesity are complex and that its treatments must be a team effort.

“It’s not one cause for all kids,” he said. “There’s not been this kind of report to say that there are more options and that we shouldn’t automatically discount the possibility of medication, that we shouldn’t discount the role of surgery. For some families, it might be something to consider,” said Faith, who was not involved in the creation of the guidelines.

The new guidelines do not discuss obesity prevention; it will be addressed in another policy statement to come, the American Academy of Pediatrics says.

“These are the most comprehensive, patient-centered guidelines we have had that address overweight and obesity within childhood,” Dr. Rebecca Carter, pediatrician at the University of Maryland Children’s Hospital and assistant professor at the University of Maryland School of Medicine, said in an email Monday.

“New to these recommendations are several new medication management strategies that have proven very successful in the treatment of obesity as a chronic disease for adults, and are now being recommended for use in children and adolescents,” Carter wrote. “This is a major step in allowing overweight and obesity to be considered as the chronic diseases that they are.”

She added that the recommendations are a “major step forward” in helping parents and medical teams “take ownership” over 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 solutions and certainly take our focus away from outdated or unhealthy dieting strategies,” Carter wrote.

The new guidelines are designed for health care providers, but Carter said parents should talk with their children’s doctor if there are concerns about weight, and discuss strategies to optimize health and monitor changes.

“It is also appropriate to do this in a child-focused manner, taking care not to stigmatize them or make them feel bad about their body, while empowering the child to feel they have the tools needed to keep their body healthy over time.”

The new guidelines are a “much-needed advancement” to align holistic care with current science, Dr. Jennifer Woo Baidal, assistant professor of pediatrics and director of the Pediatric Obesity Initiative at Columbia Vagelos College of Physicians & Surgeons and pediatrician at NewYork-Presbyterian, said in an email Monday.

“Uptake of the new guidelines will help reverse the epidemic of childhood obesity,” she wrote. “More work at policy levels will be needed to mitigate policies and practices that propagate racial, ethnic, and socioeconomic disparities in obesity starting in early life. Although the guidelines support advocacy efforts of pediatricians, we as a society need to voice our support for healthful environments for the nation’s children.”

Concerns about obesity

The American Academy of Pediatrics says more than 14.4 million children and teens live with obesity. Children with overweight or obesity are at higher risk for asthma, sleep apnea, bone and joint problems, type 2 diabetes and heart disease, according to the US Centers for Disease Control and Prevention.

Separate research, published last month in the American Diabetes Association journal Diabetes Care, suggests that the number of young people under age 20 with type 2 diabetes in the United States may increase nearly 675% 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 became more prevalent in the past 40 years — more than 4.5 million children and teens had severe obesity in 2017-18, the agency says — the charts hadn’t kept up.

The growth chart in use since 2000 is based on data from 1963 to 1980 and did not extend beyond the 97th percentile, the agency said. The newly extended percentiles incorporate more recent data and provide a way to monitor and visualize very high body mass index values.

The existing growth charts for children and adolescents without obesity will not change, the CDC said, while the extended growth chart will be useful for health care providers treating patients with severe childhood obesity.

“Prior to today’s release, the growth charts did not extend high enough to plot BMI for the increasing number of children with severe obesity. The new growth charts coupled with high-quality treatment can help optimize care for children with severe obesity,” Dr. Karen Hacker, director CDC’s National Center for Chronic Disease Prevention and Health Promotion, said in a statement. “Providers can work with families on a comprehensive care plan to address childhood obesity.”

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