New guidelines in the treatment of childhood obesity – AAP, US

American Academy of Pediatrics issues its first comprehensive guideline on evaluating, treating children and adolescents with obesity. AAP Issues First Update to Childhood Obesity Guidelines in 15 Years. In the new guidelines, the physician group steps away from “watchful waiting” and encourages earlier, more aggressive interventions with a supportive “whole child” approach in mind.

In an effort to provide a standard for better care for these children, the American Academy of Pediatrics (AAP) recently updated its Childhood Obesity Guidelines for the first time in 15 years. The guidelines—which provide guidance for the treatment of children as young as 2 and through their teen years—have been amended to encourage earlier, more aggressive interventions and ask doctors to focus on the “whole child” approach.

The “whole child” approach represents a perspective shift in how doctors look at obesity. Rather than placing blame on the child or pointing to one cause, the “whole child” approach fosters a supportive atmosphere that tries to give kids and their parents the tools they need to succeed. It also acknowledges that obesity is complex and for many kids, the cause is often tied to factors beyond their sole control like a lack of nutritious food or a safe place to get outside.

Overall the change in guidelines shows a departure from the idea of “watchful waiting” in favor of early intervention. “There is no evidence that ‘watchful waiting’ or delayed treatment is appropriate for children with obesity,” said Sandra Hassink, MD, an author of the guideline in a press release.

Instead, the new AAP guidelines contain several new evidence-based recommendations for evaluating and treating children with obesity-related health concerns. These recommendations include everything from intensive health behavior and lifestyle treatment (IHBLT) to weight loss drugs and surgery.

Key action statements guide physicians on how to evaluate children and teens for obesity. The AAP also recommends:

  • Comprehensive obesity treatment may include include nutrition support, physical activity treatment, behavioral therapy, pharmacotherapy, and metabolic and bariatric surgery.
  • Intensive health behavior and lifestyle treatment (IHBLT), while challenging to deliver and not universally available, is the most effective known behavioral treatment for child obesity. The most effective treatments include 26 or more hours of face-to-face, family-based, multicomponent treatment over a 3- to 12-month period.
  • Evidence-based treatment delivered by trained health care professionals with active parent or caregiver involvement has no evidence of harm and can result in less disordered eating.
  • Physicians should offer adolescents ages 12 years and older with obesity weight loss pharmacotherapy, according to medication indications, risks, and benefits, as an adjunct to health behavior and lifestyle treatment.
  • Teens age 13 and older with severe obesity (BMI ≥120% of the 95th percentile for age and sex) should be evaluated for metabolic and bariatric surgery.

Childhood Obesity:

Childhood obesity is a medical condition in which excess body fat negatively affects a child’s health or well-being. According to the World Health Organization, childhood obesity is one of the most serious public health challenges of the 21st century. It is defined as a body mass index (BMI) at or above the 95th percentile for children and teens of the same age and sex. Children who are obese are more likely to have risk factors for cardiovascular disease, such as high blood pressure and high cholesterol. They are also at increased risk for bone and joint problems, sleep apnea, and social and psychological problems such as stigmatization and poor self-esteem. The causes of childhood obesity are multifactorial and includes genetic, behavioral, environmental and socioeconomic factors.

There are several guidelines and recommendations for treating childhood obesity. These include:

Promoting healthy eating habits: Children should be encouraged to eat a variety of nutrient-dense foods, such as fruits, vegetables, whole grains, lean proteins, and low-fat dairy products. They should also be encouraged to eat smaller portions and to limit their intake of added sugars, saturated fats, and sodium.

Encouraging physical activity: Children should be physically active for at least 60 minutes each day, and preferably more. They should participate in a variety of activities, such as sports, dancing, swimming, and biking.

Providing support and education for families: Families play a critical role in helping children maintain a healthy weight. They should be provided with information and resources to help them make healthier food choices and encourage physical activity.

Monitoring and managing weight: Children’s weight and other health indicators, such as blood pressure and cholesterol levels, should be monitored regularly. Medications and surgery may be considered for children who have a BMI greater than 35 with comorbidities and have not responded to lifestyle interventions for 6 months.

Addressing related emotional and psychological issues: Children who are overweight or obese may face emotional and psychological challenges, such as low self-esteem, depression, and bullying. Mental health support, such as counseling or therapy, can be beneficial.

Coordinated care: Treatment should be multidisciplinary, with all the stakeholders such as primary care, dietitians, physical therapists, and mental health professionals, working together to support the child and the family.

It’s important to note that treating childhood obesity is a gradual and long-term process, and it’s important to set realistic goals and to be patient.

Source: American Academy of Pediatrics, USA.

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