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American Academy of Pediatrics Releases First Guideline to Treat Childhood Obesity

Obesity affects about one in five children in the United States and can lead to many health issues down the road, including type 2 diabetes. For the first time, the AAP released guidance for evaluating and treating children with obesity. ​ 

The American Academy of Pediatrics (AAP) has taken a significant step forward in recognizing childhood obesity as a disease that requires evaluation and treatment. 

The new guideline recommends lifestyle intervention as a core component of childhood obesity treatment along with considering anti-obesity medications and bariatric surgery when specific conditions are met. 

Obesity is one of the most common chronic diseases facing children and adolescents in the US (ages 2-19 years), affecting about 14.7 million, or one in five, children. Childhood obesity can lead to serious health issues, such as high blood pressure, high cholesterol, asthma, and joint problems. Obesity also significantly increases one’s risk for type 2 diabetes. 

Similar to diabetes, childhood obesity is more common among Hispanic children (26.2%) and non-Hispanic Black children (24.8%) than non-Hispanic White children (16.6%). Obesity prevalence is also higher among children in the lowest income group (18.9%) compared to children in the highest income group (10.9%). 

Inequities cause these health disparities, which is why attention to social determinants of health is crucial to obesity treatment. Read more about how race affects diabetes here.

For lifestyle intervention, according to the AAP guideline, foundational care should include “intensive health behavior and lifestyle treatment” (or IHBLT) for children ages 6 years and older. The guideline further suggests that this treatment is most effective when it is face-to-face and engages the whole family. Additionally, 26 hours of nutrition, physical activity, and behavior change support should be provided over three to 12 months. Regardless of the child’s age, the greater number of contact hours with the healthcare team, the greater the treatment effect. 

Depending on the degree of obesity in the child, the AAP guideline further recommends integrating anti-obesity medications (such as metformin and GLP-1 receptor agonists) and potentially bariatric surgery with IHBLT to treat the condition. These medications have been shown to be safe and effective treatment options for children 12 years and older especially when combined with lifestyle treatment.

Just this year, the FDA also approved Wegovy (semaglutide) as a weight loss treatment for adolescents above age 12 years, increasing options for teens struggling with unhealthy weight.

Bariatric surgery should also be considered in children ages 13 years and older with severe obesity, according to the new AAP guidance. Although a more drastic approach, bariatric surgery can be particularly successful in maintaining a lower and healthier BMI. Anti-obesity medications and bariatric surgery are approaches that are more often used in adult populations but evidence suggests that they are safe and effective for some children as well.

“While these guidelines are meant to help pediatricians evaluate and treat childhood obesity,” said Dr. Francine Kaufman, pediatric endocrinologist at the Children’s Hospital of Los Angeles, “it is important for parents, guardians and children themselves to understand the role lifestyle programs have in improving health, and when it might be appropriate to consider medications and bariatric surgery to address more severe obesity and its complications.”

Obesity is defined as a Body Mass Index (BMI) at or above the 95th percentile for children and teens of the same age and sex. You can learn more about BMI here. If you have concerns about your child’s weight, be sure to discuss these issues with your pediatrician. Be sure you know their BMI, which you can calculate here.

The AAP guideline emphasizes a “whole child” approach that recognizes that several factors can affect one’s risk and affect treatment, including individual and family risk factors as well as systemic inequities that may contribute to obesity and block treatment success. Because obesity is such a complex disease, the guideline authors consider various factors that can influence a child’s living condition, such as proximity to recreation areas or green spaces, or food insecurity, which is when someone does not have consistent access to nutritious foods. 

Relying on nutrient inadequate foods can lead to type 2 diabetes and obesity. Pediatricians need to be aware of these risk factors to provide care and guidance to their patients. Read more about the social determinants of health here.

​​If you are someone who experiences food insecurity, here are a few resources that can help:

Childhood obesity increases the likelihood that unhealthy weight will continue into adulthood, which is why the AAP recommends an approach that continues through childhood, adolescence, and young adulthood. This approach can start as early as pre-pregnancy with doctors making sure that any pregnant person achieves a healthy weight before getting pregnant and maintain a healthy weight during pregnancy, as maternal weight often influences an infant’s birth weight.

The guideline also recommends several policy changes that are needed to efficiently combat rising levels of childhood obesity and to reach the broader population in an accessible manner. These policies include limiting the marketing of unhealthy foods and investigating the impact that under-resourced communities and food insecurity have on obesity treatment.

“This is a big step forward in realizing the gravity of childhood obesity,” Kaufman said. “It’s putting it in a disease category where it deserves to be placed. Understanding the potential impact that we can make by offering lifestyle programs, and considering pharmacotherapy and bariatric surgery, is important to help improve the health of the next generations of adults.”