American Academy of Pediatrics Recommends Quicker Action in Treating Childhood Obesity

The American Academy of Pediatrics (AAP) issued its first comprehensive guidelines on evaluating and treating children with obesity, noting that evidence shows obesity should be treated sooner rather than later with safe and effective treatments.

A forthcoming report will address obesity prevention in children.

The AAP is an organization of 67,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults.

In 2007, the AAP recommended waiting to treat childhood obesity, but since then, the group has collected evidence that delaying treatment has no benefits and that treatments such as physical activity treatment as well as pharmacotherapy, and metabolic and bariatric surgery are effective and safe.

“There is no evidence that ‘watchful waiting’ or delayed treatment is appropriate for children with obesity,” said Dr. Sandra Hassink, an author of the guideline and vice chair of the Clinical Practice Guideline Subcommittee on Obesity. “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.”

More than 14.4 million U.S. children and teens are obese. Obesity is defined as a BMI at or above the 95th percentile for children and teens of the same age and sex. When left untreated, this chronic disease can cause serious short and long-term health concerns, including cardiovascular diseases and diabetes.

Obesity can be treated with the recognition that complex genetic, physiologic, socioeconomic, and environmental factors are at play, according to AAP.

Evidence-based recommendations on medical care for those age 2 and older are included within a new “Clinical Practice Guideline for the Evaluation and Treatment of Children and Adolescents With Obesity,” published in the February 2023 Pediatrics (published online Jan. 9). The guideline is accompanied by an executive summary and two technical reports, “Appraisal of Clinical Care Practices for Child Obesity Treatment. Part I: Interventions,” and “Appraisal of Clinical Care Practices for Child Obesity Treatment. Part II: Comorbidities.”

“Weight is a sensitive topic for most of us, and children and teens are especially aware of the harsh and unfair stigma that comes with being affected by it,” said Dr. Sarah Hampl, chair of the Clinical Practice Guideline Subcommittee on Obesity and a lead author of the guideline, which was created by a multidisciplinary group of experts in various fields, along with primary care providers and a family representative. “Research tells us that we need to take a close look at families — where they live, their access to nutritious food, health care and opportunities for physical activity — as well as other factors that are associated with health, quality-of-life outcomes and risks. Our kids need the medical support, understanding and resources we can provide within a treatment plan that involves the whole family.”

Treatment recommendations include physical activity treatment, nutrition support, motivational interviewing, intensive health behavior and lifestyle treatment, pharmacotherapy and metabolic and bariatric surgery.

The approach considers the child’s health status, family system, community context and resources.

Intensive health behavior and lifestyle treatment (IHBLT), while challenging to deliver and not universally available, is the most effective known behavioral treatment for child obesity, according to AAP. The most effective treatments include 26 or more hours of face-to-face, family-based, multicomponent treatment over a three- to 12-month period.

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.

AAP also said that physicians should offer adolescents ages 12 years and older with obesity weight loss pharmacotherapy, according to medication indications, risks, and benefits, as an adjunct to health behavior and lifestyle treatment.

Teens who are 13 years old and older with severe obesity (BMI equal to or greater than 120 percent of the 95th percentile for age and sex) should be evaluated for metabolic and bariatric surgery.

The guideline discusses increased risks for children with special health care needs, as well as inequities that promote obesity in childhood, such as the marketing of unhealthy food, low socioeconomic status and household food insecurity. The role of structural racism has played in obesity prevalence is also discussed.

The AAP encourages strong promotion of supportive payment and public health policies that cover comprehensive obesity prevention, evaluation, and treatment.

The guideline calls for policy changes within and beyond the health sector to improve health and well-being of children. Policy changes should address structural racism that drives alarming and persistent disparities in childhood obesity, according to the guideline’s executive report.

“The medical costs of obesity on children, families and our society as a whole are well-documented and require urgent action,” Dr. Hampl said. “This is a complex issue, but there are multiple ways we can take steps to intervene now and help children and teens build the foundation for a long, healthy life.”