AAP Childhood Obesity Guidelines Updated to Include Meds


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New Treatment Guidelines for Childhood Obesity Include Medication, Surgery

As the body positivity movement continues to trend, the American Academy of Pediatrics announced Monday new treatment guidelines for childhood obesity that includes early use of medications and weight loss surgery.

In recent years, body positivity has become popular. Plus-size models grace the covers of major fashion magazines and shopping sites. Artists write songs about defying the stereotypical “model” body. And strangers argue on social media about what “fat” means. But the new AAP guidelines seem to serve as a reminder that obesity can be—in fact—very dangerous.

This is the first comprehensive update of the AAP’s obesity treatment guidelines in 15 years. Published in the journal, pediatrics, a major highlight includes medical care recommendations for children as young as 2 and teenage years who struggle with obesity.

“The goal is to help patients make changes in lifestyle, behavior or environment in a way that is sustainable and includes families in the decision every step of the way,” Sandra Hassink, MD, an author of guidance and vice chair of the Clinical Practice Guideline Subcommittee on Obesity, said.

While treatment includes extreme measures such as pharmaceuticals and bariatric surgery, it does not eliminate the need to focus on good nutrition and exercise as well. In fact, most guidelines discuss treatment that includes nutritional support, physical activity therapy and behavioral therapy.

According to the AAP, intensive health behavior and lifestyle treatment (IHBLT) is the most effective known behavioral treatment for childhood obesity. It requires 26 or more hours of face-to-face, multicomponent family-based treatment over a 3- to 12-month period.

“Lifestyle changes are hard – very hard. Patients, families and children need more in the way of support than ‘don’t drink soda’ or ‘don’t eat fast food.’ The recommended lifestyle treatment in the guidelines is a comprehensive, family-based intensive treatment,” explains Sarah Armstrong, MD, FAAP, chair of the obesity section of the AAP, and professor of pediatrics at Duke University. .

Medicine and surgery—done in addition to lifestyle treatment—are an option for some older children and adolescents who have developed severe degrees of obesity.

“We are very fortunate to have some additional options, including drugs and surgery where there is evidence that they are safe and effective,” Armstrong said. “This does not mean that everyone should undergo treatment or surgery. This means that parents, children and doctors have options. “

Emphasized throughout the guide is the need for early intervention.

“There is no evidence that ‘watchful waiting’ or delayed treatment is appropriate for children with obesity,” Hassink said.

The new guidelines do not address obesity prevention. According to AAP, this will be addressed in another upcoming AAP policy statement.

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Treatment Guidelines for Childhood Obesity

Weight and obesity can be controversial topics. But one thing that is clear to many is the increased health risks associated with obesity. The AAP refers to obesity as a disease that can lead to short- and long-term health concerns if left untreated, including cardiovascular disease and diabetes. The headlines and research throughout the COVID-19 pandemic show that many of those who die from the virus are obese.

One thing to note is that the instructions are aimed at doctors, not necessarily parents. According to the AAP, doctors should offer teens age 12 and older weight-loss medications to treat their obesity. The fancy phrase for this is “pharmacotherapy for weight loss,” and it should be done in conjunction with behavioral health and lifestyle treatments.

Adolescents ages 13 and older with severe childhood obesity should be evaluated for metabolic and bariatric surgery, the AAP adds.

More than 14.4 million children in the US live with obesity. And it’s not easy—mentally or physically. The AAP notes that obesity is a disease that has been stigmatized for years, and it can be successfully treated with the recognition that complex genetic, physiologic, socioeconomic and environmental factors are at play.

“Weight is a sensitive topic for many of us, and children and adolescents are especially aware of the harsh and unfair stigma that comes with being affected by it,” said Sarah Hampl, MD, a leading author of the guide, created by a multidisciplinary group of experts in various fields, together with primary care providers and a representative of the family.

Diet and Exercise: Do They Still Matter?

Yes. None of these new treatment guidelines for childhood obesity eliminate the need for proper diet and exercise. These are healthy habits that are important for all people, regardless of their weight. Dr. Bridget Cole Williams, board-certified family physician and CEO of Green Harvest Health, says that offering weight-loss surgery and drugs to obese children serves as a big “red flag” about how serious the problem is. issue.

“We were very careful with our children at first. We don’t even want our kids on any medication, let alone obesity medication and surgery,” Williams said. “However, I think this is a humongous red flag for how bad the obesity epidemic is in our country.”

Williams emphasized the need to start treating obesity in children.

“We need to start earlier, and we need to start younger,” he said. “Inevitably, if we don’t do something, our children’s rates of sleep apnea, asthma, bone and joint issues, as well as heart disease and diabetes, will continue to grow astronomically.”

Overweight is defined as a body mass index (BMI) at or above the 85th percentile and below the 95th percentile for children and adolescents of the same age and sex. Obesity is defined as a BMI at or above the 95th percentile for children and adolescents of both age and sex.

Access to Nutritious Food and Opportunities for Physical Activity

As noted in the guidelines, it is important to consider a family’s access to nutritious food and other essentials that help maintain people’s health. The guidelines address the increased risks for children with special health care needs, as well as the inequities that promote childhood obesity, such as the marketing of unhealthy food, under socioeconomic status and food insecurity at home.

“Research tells us that we need to look closely at families—where they live, their access to nutritious food, health care and opportunities for physical activity—as well as other factors related to health, quality of life outcomes. and risks,” explainedd Hampl. “OhYour children need the medical support, understanding and resources we can provide within a treatment plan that involves the whole family,” Hampl said.

More Information on Childhood Obesity

Williams added a cultural and societal change must occur to reverse the childhood obesity epidemic.

“There are foods that are in the American diet that are not allowed in other countries because of how fatty or toxic some of them are,” he said. “We need to change what our grocery stores look like and have better access to nutritious food in low-income neighborhoods.”

Making these changes may seem like a huge accomplishment, but Williams says it starts with the individual making simple changes. Parents may ask for half of their families’ meals in a takeout box when they eat out at restaurants, spend more time shopping around grocery stores where fresh foods are stored and put less fatty foods on dinner plates.

Abrie McCoy, a certified lactation consultant at SimpliFed, a maternal and child feeding health platform, recommends making nutrition a priority during pregnancy as well.

Your baby’s nutrition begins during pregnancy. During pregnancy, your body provides nutrients through the placenta and amniotic fluid, which is derived from the foods you consume in your body, explained McCoy.

Preventing overfeeding in toddler age is also important.

“Using methods like responsive feeding, infant led feeding, or rapid feeding can help keep babies on one feed,” says McCoy. “This supports them in learning to eat when hungry or thirsty and stop when they are full. Instead, avoid overfeeding at an early age.

To learn more about childhood obesity, visit the AAP website or the Centers for Disease Control and Prevention.



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