Pediatric Obesity Can Be Treated Safely and Effectively

New guidelines from the American Academy of Pediatrics emphasize evidence for safe, effective treatment of pediatric obesity for long-term benefit of children and adolescents.

More than 14.4 million U.S. children and adolescents have obesity, making it one of the most common chronic conditions facing American youth and families.

Obesity is a chronic disease associated with short- and long-term health complications including cardiovascular disease, diabetes, liver disease, renal dysfunction, musculoskeletal disorders and impaired quality of life. The disease is complicated by complex genetic, physiologic, socioeconomic and environmental factors and a long history of bias and stigma.

“For a long time, obesity has been stigmatized as a condition driven entirely by willpower and personal responsibility,” says Ihuoma Eneli, MD, MS, FAAP, director of the Center for Healthy Weight and Nutrition at Nationwide Children’s Hospital and co-author of comprehensive guidelines on childhood obesity recently published by the American Academy of Pediatricians (AAP). “But the reality is that obesity is a common, chronic disease that results from numerous complex and interacting factors. Our recent understanding of the genetic, biological, social and economic determinants of health risk factors of obesity clearly tells us that this common chronic disease cannot be overcome with willpower alone. A good analogy is that our genes and biology set the table and numerous other factors singly or in combination interact with the setting to decide what meal is served.”

The newly released clinical practice guidelines highlight that fact that there is more evidence than ever that obesity treatment is safe and effective.

“The new guidelines are the culmination of five years of work and represent the first major update on childhood obesity treatment strategies in 15 years” says Marc Michalsky, MD, MBA, surgical director for the Center for Healthy Weight and Nutrition and director of Metabolic and Bariatric Surgery at Nationwide Children’s. “Dr. Eneli and I are incredibly proud to be part of the team that developed these important recommendations.”

In addition to seeking input from experts at Nationwide Children’s and across the nation, the AAP also consulted parent advocates during the formulation of the guidelines.

“We are proud that the parent advocate for these guidelines, Doug Lunsford, who is also a co-author, is a parent from the Center for Healthy Weight and Nutrition at Nationwide Children’s,” says Dr. Eneli. “Parental support is vital to successful treatment of pediatric obesity. Having that parent perspective present from the beginning was an indispensable contribution to the guidelines.”

These guidelines more important than ever. Obesity rates among youth have been rising steadily and have recently been shown to be accelerating as a result of the COVID-19 pandemic. Two publications, one from the Nationwide Children’s team and one based on data from the Agency for Healthcare Research and Quality (AHRQ) show the dramatic effect of the pandemic on pediatric obesity.

“During the COVID-19 pandemic, we saw an increase in rates of weight gain in children, similar to rates reported during summer months when children are out of school,” says Dr. Eneli, who is also a professor of Pediatrics at The Ohio State University College of Medicine and director of the Center for Healthy Weight and Nutrition.

Key highlights from the guidelines include:

• Primary care providers should measure height and weight, calculate BMI and assess BMI percentile using age- and sex-specific CDC growth charts or growth charts for children with severe obesity at least annually for all children who are 2 to 18 years old to screen for overweight, obesity and severe obesity.
• Primary care providers should comprehensively evaluate children who are 2 to 18 years old with overweight and obesity for obesity-related comorbidities using patient histories, mental and behavioral health screenings, social determinants of health evaluations, physical examinations and diagnostic studies.
• Primary care providers should treat obesity and comorbidities concurrently.
• Comprehensive obesity treatment can include motivational interviewing, lifestyle behavioral therapy, medications, and metabolic and bariatric surgery.
• Intensive health behavior and lifestyle treatment is challenging to deliver and not universally available, but it is the most effective known behavioral treatment for child obesity.
• Evidence-based treatment delivered by trained health care professionals with active parent or caregiver involvement has no evidence of harm and can result in less disordered eating.
• Primary care providers should consider offering adolescents with obesity who are ages 12 years and older weight loss medications, according to medication indications, risks and benefits, in addition to health behavior and lifestyle treatment.
• Evaluation for metabolic and bariatric surgery should be considered for teens with severe obesity who are age 13 and older.

“Metabolic and bariatric surgery is a life-saving approach that can be done safely and effectively during the pediatric time frame. Nearly two decades of research show that benefits appear to be long lasting with clinical outcomes, particularly related to improvements in cardiometabolic health are significant,” says Dr. Michalsky, MD, who is also a professor of clinical surgery and pediatrics at The Ohio State University College of Medicine.

The Center for Healthy Weight and Nutrition at Nationwide Children’s offers a full range of obesity treatment options. The center has been accredited by the American College of Surgeons Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) since 2015.

“We are dedicated to meeting the needs of patients and families where they are,” says Dr. Eneli. “We offer all the recommended treatments and have the experience and expertise to use shared-decision making to navigate options to improve their health.”

References:

Hampl SE, Hassink SG, Skinner AC, Armstrong SC, Barlow SE, Bolling CF, Avila Edwards KC, Eneli I, Hamre R, Joseph MM, Lunsford D, Mendonca E, Michalsky MP, Mirza N, Ochoa ER, Sharifi M, Staiano AE, Weedn AE, Flinn SK, Lindros J, Okechukwu K. Executive summary: Clinical practice guideline for the evaluation and treatment of children and adolescents with obesity. Pediatrics. 2023 Jan 9;151(2).

Hampl SE, Hassink SG, Skinner AC, Armstrong SC, Barlow SE, Bolling CF, Avila Edwards KC, Eneli I, Hamre R, Joseph MM, Lunsford D, Mendonca E, Michalsky MP, Mirza N, Ochoa ER, Sharifi M, Staiano AE, Weedn AE, Flinn SK, Lindros J, Okechukwu K. Clinical practice guideline for the evaluation and treatment of children and adolescents with obesity. Pediatrics. 2023 Jan 9;151(2).

Image credit: Nationwide Children’s