Story at a glance
- The guidelines state providers can consider medication interventions for youth as young as 12 and surgery for those as young as 13.
- The new recommendations mark the first comprehensive guidance on the subject issued in 15 years.
- Authors highlight the confluence of genetic, environmental and socioeconomic factors that contribute to youth obesity risk.
The American Academy of Pediatrics (AAP) has issued new guidelines for treating children and adolescents with obesity in an effort to address the growing toll of the disease on the nation’s youth.
The update, which marks the first comprehensive guidance from the AAP in 15 years on the subject, includes recommendations for different medications, along with metabolic and bariatric surgery. It also touts a holistic approach to treating the disease by recognizing the complex genetic, physiologic, socioeconomic and environmental factors that contribute to the increased risk of obesity.
Obesity is defined as a body mass index (BMI) at or above the 95th percentile, while overweight is classified as a BMI over the 85th percentile for children and teens of the same age and sex.
According to the new guidelines, only those with a BMI equal to or greater than 120 percent of the 95th percentile should be evaluated for metabolic and bariatric surgery. This recommendation is also limited to youth aged 13 or older.
Medications are only recommended as an adjunct to health behavior and lifestyle treatment in those aged 12 and older.
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Obesity affects around 20 percent of children between the ages of 2 and 19 in the United States, while rates have tripled in the last 30 years.
When left untreated, obesity can lead to cardiovascular diseases, diabetes, depression and other chronic conditions.
“Weight is a sensitive topic for most of us, and children and teens are especially aware of the harsh and unfair stigma that comes with being affected by it,” said Sarah Hampl, a lead author of the guideline, in a statement.
“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 that are 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.”
Along with medication and surgery, the guidelines recommend strategies like motivational interviewing and intensive health behavior and lifestyle treatment, which take the child’s health status, family system, community and resources into account.
Providers had previously often employed a “watch and wait” strategy to address childhood obesity or delayed treatment altogether to see if children outgrew or overcame obesity. The new recommendations reject this practice.
“The goal is to help patients make changes in lifestyle, behaviors or environment in a way that is sustainable and involves families in decision-making at every step of the way,” said Sandra Hassink, another author of the guideline.
Genetics and biological factors play a role in obesity, though environmental factors also contribute to an increased risk. These can include the availability of affordable healthy food, marketing of unhealthy food, household food insecurity and low socioeconomic status.
Childhood obesity is especially prevalent among communities of color and is driven in part by structural racism. This factor “drives disparities and inequities in childhood obesity and obesity-related comorbidities,” authors wrote in their executive summary of the recommendations.
Previous research has linked systemic racism with obesity, as BIPOC can suffer chronic stress from experiencing racism. These individuals also can face barriers when trying to access health care, and once they do, may face systemic racism within the system.
In addition to addressing the factors that contribute to an increased risk of obesity, the authors emphasize the need for supportive payment and public health policies to cover the costs of obesity prevention, evaluation and treatment.
“The medical costs of obesity on children, families and our society as a whole are well-documented and require urgent action,” said Hampl.
“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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