New Guideline: Treat Childhood Obesity Early and Aggressively

New guidelines released by the American Academy of Pediatrics on Monday recommend testing and actively treating children with obesity early and aggressively. This includes administering drugs to children as young as 12 and surgery to children as young as 13.

The first guidance study in 15 years by the American Academy of Pediatrics (AAP) highlighted more evidence than ever that when it comes to childhood obesity, “waiting doesn’t work.”

“There is no evidence that ‘watchful waiting’ or delayed treatment is appropriate for children with obesity,” said Dr.Sandra Hassink, co-author of the guideline and vice chair of the Clinical Practice Guideline Subcommittee on Obesity.

Watchful waiting, or putting off treatment to see if children and teens will grow out of obesity, has been proven to actually increase a child’s risk of obesity in adulthood.

In fact, according to the study, rapid weight gain in the first two years of life has been linked to a nearly four times greater chance of adulthood obesity.

According to the Centers for Disease Control and Prevention, childhood and teen obesity affects about 20 percent (14.4 million) of people in the United States. Adult obesity affects around 42 percent of people. Left untreated, obesity can lead to lifelong health issues, including diabetes, depression, and high blood pressure.

If a child or teen's BMI is at or above the 85th percentile for their age and gender, they are considered overweight. Obesity occurs when a child or teen's BMI is above 95% for their age and gender.

The AAP, including co-author Sarah Hampl, Professor of Pediatrics at the University of MO-Kansas City School of Medicine, has set age guidelines for treatment for the first time. The AAP recommendations include set ages at which kids and teens should be offered medical treatments like drugs and surgery, as well as intensive diet, exercise, and other behavior and lifestyle interventions.

The guidelines also include a few specific action statements for doctors treating children and teens with obesity, as well as some recommendations, including the following:

A complete treatment plan for obesity might include help with diet and exercise, behavioral therapy, pharmacotherapy, and metabolic and bariatric surgery.

  1. Intensive health behavior and lifestyle treatment (IHBLT) is the most effective behavioral treatment for childhood obesity.
  2. Evidence-based treatment given by trained healthcare professionals with active participation from the parent or caretaker has not been shown to cause harm and can lead to less disordered eating.
  3. Physicians should offer preteens and teens ages 12 years and older obesity weight loss pharmacotherapy based on the medication's indications, risks, and benefits. This should be done in addition to health behavior and lifestyle treatment.
  4. Metabolic and bariatric surgery should be considered for teens ages 13 and older with severe obesity (BMI ≥120% of the 95th percentile for age and sex).
  5. Metabolic and bariatric surgery should be considered for teens ages 13 and older with severe obesity (BMI ≥120% of the 95th percentile for age and sex).

The AAP also discussed some risk factors for childhood obesity, like children with special health care needs, as well as inequities in society, like the marketing of unhealthy food, low socioeconomic status, and insufficient food at home. The researchers also noted that systemic racism contributes to childhood obesity.

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

The AAP guidelines call for policy changes that address structural racism and promote comprehensive obesity prevention, evaluation, and treatment for all children regardless of socioeconomic status.

“The medical costs of obesity on children, families, and society as a whole are well-documented and require urgent action,” Dr. Hampl said. “This is a complex issue, but there are multiple ways we can take steps to intervene now and help children and teens build the foundation for a long, healthy life.”


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