July 29, 2023
Childhood obesity has emerged as a major health problem of epidemic proportions worldwide. The rise in the prevalence of childhood obesity has been associated with emergence of several comorbidities, including type 2 diabetes mellitus and cardiovascular disease risk factors at an early age. In January 2023, the American Academy of Pediatrics (AAP) released updated guidelines on evaluation and treatment of children with obesity and related health consequences.
These guidelines highlight the fact that obesity is a chronic disease, which is the consequence of a complex interaction among genetic, physiological, environmental and socioeconomic factors. Social determinants of health and disparities in access to healthy nutrition, physical activity and healthcare play important roles in racial and ethnic differences in prevalence of obesity. The AAP guidelines recommend that children with overweight and obesity be treated following the principles of the medical home and the chronic care model and recommend against watchful waiting, as children are unlikely to outgrow obesity.
The new guidelines emphasize the need for a multipronged approach to management of obesity, with support for healthy nutrition and physical activity as well as family-based behavioral therapy to support the establishment of recommended health habits, pharmacological therapy, and metabolic and bariatric surgery. The guidelines cite evidence that intensive health behavior and lifestyle treatment delivered by trained health care professionals with active parent or caregiver involvement is effective. The guidelines also state that:
- Intensive health behavior and lifestyle treatment should ideally include 26 or more hours of face-to-face, family-based, multicomponent treatment over a 3 to 12-month period.
- Evidence-based structured and supervised treatment delivered by trained personnel do not cause any harm and instead decrease current and future eating disorder symptoms.
Seema Kumar, M.D., chair of Pediatric Endocrinology and Metabolism at Mayo Clinic in Rochester, Minnesota, says: "The guidelines recommend that health care providers consider weight loss medications as an adjunct to health behavior and lifestyle intervention in adolescents 12 years of age and older. The guidelines also suggest that health care providers refer adolescents 13 years and older with severe obesity for evaluation for metabolic and bariatric surgery at regional comprehensive multidisciplinary pediatric metabolic and bariatric surgical centers."
Bridget K. Biggs, Ph.D., L.P., a psychologist at Mayo Clinic in Rochester, Minnesota, says, "The science on lifestyle interventions for children with obesity has demonstrated the importance of going beyond providing education on nutrition and physical activity. Behavioral interventions provide skills and strategies for putting recommended habits into sustained practice.
"The observed effectiveness of interventions using motivational interviewing approaches drives home the importance of taking a respectful, collaborative approach when discussing health and behavior goals with families."
"Families we work with have commented that they often know what to do and look to their medical team to collaborate with them to create and follow a plan to put recommendations into place."
Todd A. Kellogg, M.D., a general surgeon at Mayo Clinic in Rochester, Minnesota, says, "Unfortunately, in the past, obesity and its effects on the pediatric population have been inadequately confronted, although obesity is arguably one of the most important health care crises currently affecting this portion of the population. The new AAP guidelines are a start to realizing the importance of this medical issue and to addressing the short- and long-term health of our children with obesity."
For more information
Hampl SE, et al. Executive summary: Clinical practice guideline for the evaluation and treatment of children and adolescents with obesity. Pediatrics. 2023;151:e2022060641.
Refer a patient to Mayo Clinic.