AAP Issues New Guidance on Treatment for Obese Children
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In an effort to provide better evaluation and treatment tools for children who are overweight or obese, the American Academy of Pediatrics recently released a 73-page document, its first on the subject in 15 years.
The goal? To destigmatize the condition and further the understanding, among both clinicians and the public, that the complex disease has serious health implications but can nevertheless be treated effectively.
Lisa Gwynn, D.O., M.B.A., M.S.P.H., a pediatrician with the University of Miami Health System, calls it “long overdue” but also praises the academy for the new guidance.
“I’m so glad they did this because, as pediatricians, we have been talking and observing [weight issues] among our patients for a long time,” Dr. Gwynn says. “Obesity is one of the hardest conditions to treat. It’s not like an ear infection where you give the patient medicine for 10 days, and they get better. There are many factors that contribute to obesity, and each of these factors must be addressed.”
Like other physicians, Dr. Gwynn has seen the number of overweight or obese patients steadily tick up for years.
About 14.7 million children and adolescents are considered obese in the U.S., according to the Centers for Disease Control and Prevention, and the prevalence rates increases with age. For example, obesity prevalence was 12.7% among 2- to 5-year-olds, 20.7% among 6- to 11-year-olds, and 22.2% among 12- to 19-year-olds.
Obesity is also more common among minorities.
Its prevalence was 26.2% among Hispanic children and 24.8% among non-Hispanic Black children. In comparison, non-Hispanic White children’s prevalence rate was 16.6%. The lowest was among non-Hispanic Asian children, with 9.0%.
Those figures are particularly alarming because studies show that the rate of childhood obesity has more than tripled over the last four decades. However, the growth has slowed somewhat in the past few years as parents, schools, and child experts address this common chronic disease.
The new AAP report recognizes that several factors, including genetic, socioeconomic, and environmental elements, contribute to the disease.
In short, losing weight cannot be dismissed as a simple matter of personal choice.
“It’s not about willpower,” says Dr. Gwynn. “We now know this is multi-factorial and that addressing it should involve not just parents and children but also schools and the community.”
Treating the disease early and aggressively is paramount because left untreated, it can lead to life-threatening conditions, including Type 2 diabetes, high cholesterol, and cardiovascular disease.
Obesity isn’t something you grow out of.Dr. Lisa Gwynn
The AAP report moves away from the gradual approach used in the past and recommends early intervention, calling on primary care physicians and pediatricians to promptly refer patients to specialized treatment programs.
Drawing from evidence-based medical literature, the new guidelines state that the most effective treatment is intensive health behavior therapy. This kind of therapy involves nutrition coaching, exercise guidelines, and lifestyle changes not just for the child but usually for the entire family.
While the best treatment would include at least 26 hours of in-person counseling over three or more months, Dr. Gwynn and other physicians say these guidelines may be hard to follow for some.
This intensive therapy is usually not covered by insurance, nor is it easily accessible for certain families, particularly those in disadvantaged areas. Most of these programs are based at academic medical centers or larger community hospitals and clinics because they offer the service of many specialists, from social workers to nutritionists and exercise physiologists.
“The behavior recommendations should be at the forefront of treatment, but we also know that not everyone will have access to them,” Dr. Gwynn acknowledges.
Nevertheless, pediatricians can do their part in changing lifestyle behaviors. Parents are key, as they are the food shoppers, meal makers, and appointment keepers.
“What I like to do is really make it known that this disease has serious short-term and long-term consequences,” she says. “I don’t want to scare the parents, but I do want them to be aware of what can happen.”
She also imparts this message to the child at a level they can understand.
Close follow-ups and lots of encouragement are important, too. “I try to get across that I’m on their team, that we’re all in this together, so the child feels supported instead of isolated.”
In addition to early and intensive behavioral treatment, the AAP report also gives a nod to weight loss drugs and surgery in the case of older children when other interventions haven’t been successful.
The possibility of drug intervention should be discussed for children 12 years and older. As for weight loss surgery, this should be an option only for teenagers (13 and older) with severe obesity.
Such recommendations have received pushback on social media, with some worrying these suggestions are too much too early. In reality, “this would be for a small subset of patients,” Dr. Gwynn explains. “Surgery and medication are definitely not first-line treatment and may be reserved for refractory, severe cases. These cases would be very few and far between.”
Ana Veciana-Suarez is a regular contributor to the University of Miami Health System. She is a renowned journalist and author who has worked at The Miami Herald, The Miami News, and The Palm Beach Post. Visit her website at anavecianasuarez.com or follow @AnaVeciana on Twitter.