January 9, 2023 – Parents of youngsters ages 12 and older who’re obese or obese ought to be offered options resembling weight reduction medications, and surgery ought to be considered for teenagers, new guidelines from the American Academy of Pediatrics.
The authors of the rules also encourage GPs to work with other healthcare professionals to treat associated conditions, associated with obesityas an alternative of taking over the complete challenge yourself.
“It's impossible to treat obesity within the four walls of a clinic. That's one thing I've learned,” says Dr. Ihuoma Eneli, deputy director of the organization's Institute for Healthy Childhood Weight.
For example, a general practitioner could work with a gastroenterologist if a baby has nonalcoholic fatty liver disease, added Eneli, a professor of pediatrics at Ohio State University who helped draft the recommendations.
The latest document updates the American Academy of Pediatrics' 2007 recommendations for treating obese or obese children and adolescents. The earlier statement focused on behavioral changes and healthy eating habits and paid less attention to weight-loss medications or bariatric surgery in young people. That document didn’t provide specific advice for health care providers on treating obese or obesity in children.
The 2023 guidelines recommend that pediatricians offer weight-loss medications to all people ages 12 and older with obesity—defined as a BMI above the ninety fifth percentile—along with ongoing support for lifestyle changes, resembling increasing exercise and eating a healthier weight loss program.
The same approach applies to bariatric surgery Once children reach age 13, and the AAP stressed that no doctor should ever stigmatize children or assume they’re answerable for their weight.
When children reach certain BMI limits, doctors should perform comprehensive physical examinations and order blood tests to get a more comprehensive picture of the patient's health.
The guidelines are the Academy's first geared toward providing pediatricians and other primary care providers with concrete guidance on managing obese and obesity in younger patients.
“Obesity is a complex chronic disease, and this represents a game-changer,” says Dr. Sandra S. Hassink, leader of the rule of thumb group and director of the AAP Institute for Healthy Childhood Weight.
Hassink compared obesity to asthma, one other chronic disease that requires immediate attention and ongoing treatment. A health care provider would never leave a baby with asthma untreated until his respiratory problems are so severe that he turns blue, Hassink says; similarly, he should treat obesity in young people promptly and over a protracted time period.
While some elements of treating obese and obesity are the identical in children and adults, Hassink notes significant differences. “Every child is embedded in a family and extended support network,” Hassink says, which implies any obesity treatment techniques also require the consent and support of the kid's family.
A comprehensive approach
The AAP’s latest suggestion reflects the present understanding that obese or obesity in children is a consequence of biological and social aspects, resembling living in a Food Desert or experience the consequences of structural racism.
The authors recommend that healthcare professionals calculate a baby's BMI starting at age 2, paying particular attention to those that are at or above the eighty fifth percentile (which can be defined as obese), at or above the ninety fifth percentile (obese), or at or above the a hundred and twentieth percentile (severely obese) for his or her age and sex. Clinicians also needs to monitor blood pressure and cholesterol of their obese or obese patients, particularly starting at age 10.
Starting at age 6, providers should ask patients and their families what would motivate them to shed weight after which tailor interventions to those motivations somewhat than simply making blanket statements that weight reduction is mandatory. This step ought to be accompanied by intensive support—ideally a minimum of 26 hours of face-to-face support over the course of a yr, although more is healthier—on effective exercise and dietary habits that result in weight reduction.
The intensive care model would proceed throughout childhood and adolescence, coupled with referrals for weight-loss medications or bariatric surgery if needed once children reach 12 or 13. These age limits are based on current evidence of when weight-loss medications or surgery develop into effective, Hassink says, and could possibly be moved to lower age groups if latest evidence shows this.
“Intensive health, behavioral and lifestyle treatment is the foundation for all further treatment extensions,” says Eneli.
Young patients who needed weight-loss medications previously had fewer options, says Dr. Aaron S. Kelly of the Children's Health Administration University of Minnesota.
No longer.
Kelly was not involved in drafting the rules but was the lead investigator for studies of liraglutide (Saxenda), which received FDA approval in 2020 to treat obesity in adolescents. In 2022, the agency approved phentermine and extended-release topiramate capsules (Qsymia) for chronic weight management in patients 12 and older, in addition to a once-weekly injection of semaglutide (Wegovy) in the identical age group. There aren’t any weight-reducing drugs for kids younger than 12, Kelly says.
“Obesity is not a lifestyle problem. It has a lot to do with the underlying biology,” Kelly said. “These drugs make it easier for people to make the right lifestyle choices by addressing the biology.”
For example, a drug could make people feel fuller for longer or disrupt chemical processes that trigger cravings for certain foods. However, Kelly stressed that this doesn’t give people the proper to eat as much as they need.
As far as bariatric surgery is anxious, the brand new guidelines are closely aligned with those of a 2019 statement from the American Academy of PediatricsThis shows that bariatric surgery is protected and effective in children. This is encouraging for Kirk W. Reichard, MD, considered one of the lead authors of the 2019 paper and director of the bariatric surgery program at Nemours Children's Health.
Even though the knowledge isn’t any longer latest in 2023, Reichard said the AAP's statement could cause some eligible families who may not have done so before to contemplate bariatric surgery.