New AAP Guidelines Advise Immediate, Intensive Treatment for Children with Obesity

The guideline outlines the steps pediatricians, and other healthcare providers should take to address obesity in children and teens.

The American Academy of Pediatrics has announced new comprehensive guidance on childhood obesity, recommending immediate and intensive treatment for children and teens whose body mass index (BMI) is at or above the 85th percentile for their age and sex.

The document is the first AAP clinical practice guideline addressing evidence-based evaluation and treatment of young people with overweight and obesity. In addition, it is accompanied by two technical reports and an executive summary of the recommendations.

However, it does not offer guidance on obesity prevention. Instead, the AAP will cover those recommendations in a future policy statement.

According to the guideline, obesity is one of the most common childhood chronic diseases, affecting 14.4 million children and teens in the United States.

Childhood obesity increases the risks of several short- and long-term adverse health effects, including cardiovascular disease, nonalcoholic fatty liver disease (NAFLD), and insulin resistance. It is also associated with mental health conditions, increased stress, and low self-esteem.

To address the needs of young people with obesity, the AAP recommends that healthcare professionals consider the child’s family system, health status, community status, and resources to develop a child-centered, evidence-based treatment plan.

The AAP also recommends that pediatricians and other healthcare providers should consider the following:

  • Evaluate children 2 to 18 years of age with BMIs at or greater than the 85th percentile for obesity-related comorbidities by using a comprehensive patient history, mental and behavioral health screening, social determinants of health (SDoH) evaluation, physical examination, and diagnostic studies.
  • Use motivational interviewing (MI) to involve young people and their families in treating overweight and obesity.
  • Provide or refer children 6 years and older with BMIs at or greater than the 85th percentile to intensive lifestyle and health behavior treatment.
  • Offer adolescents 12 years and older with a BMI at or above the 95th percentile weight loss medication, according to the medication indications, risks, and benefits, in addition to health behavior and lifestyle treatment.
  • Offer referrals for metabolic and bariatric surgery evaluation to adolescents 13 years and older with a BMI at or above 120% of the 95th percentile.

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

The guideline supports and encourages the promotion of supportive public health policies to improve the health and wellbeing of children and overcome barriers to quality healthcare services. It also urges healthcare providers, health systems, and policymakers to work together towards equitable and universal evaluation and treatment of children and teens with obesity.

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