Updated guidelines for treating obesity in children include drugs, surgery for some young people

Updated guidelines for treating obesity in children include drugs, surgery for some young people

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The American Academy of Pediatrics’ updated guidelines for the treatment of obesity call for the immediate use of behavioral therapy and lifestyle changes and say that surgery and medication should be used for some young people.

The guidelines, published Monday in the journal Pediatrics, are the first comprehensive update of the academy’s obesity treatment guidelines in 15 years. They provide treatment guidelines for children ages 2 through teens.

The guidelines recognize that obesity is complex and related to access to nutritious food and health care, among other factors.

Treatment of younger children should focus on behavior and lifestyle for the whole family, including nutritional support and increased physical activity. For children 12 and older, the use of weight-loss drugs is appropriate in addition to health behavior therapy and lifestyle treatments, the academy says. Adolescents 13 years of age and older with severe obesity should be evaluated for surgery, according to the guidelines.

“There is no evidence that ‘watchful waiting’ or delayed treatment is appropriate for obese children,” said Sandra Hassink, MD, guideline author and vice chair of the Clinical Practice Guidelines Subcommittee on Obesity. statement. “The goal is to help patients make lifestyle, behavioral or environmental changes in a way that is sustainable and involves families in decision-making every step of the way.”

For children and teenagers, overweight is defined as a body mass index at or above the 85th percentile and below the 95th percentile; obesity was defined as a BMI at or above the 95th percentile.

Miles Feit, a psychologist at the State University of New York at Buffalo who studies childhood eating behavior and obesity, praised the new report for recognizing that the causes of childhood obesity are complex and that treatment must be a team effort.

“It’s not a one-size-fits-all cause for all kids,” he said. “There hasn’t been this kind of report that says there are more options and that we shouldn’t automatically dismiss the possibility of drugs, that we shouldn’t dismiss the role of surgery.” For some families, that might be something to consider,” said Feit, who was not involved in creating the guidelines.

The new guidelines do not discuss obesity prevention; this will be addressed in another policy statement to come, says the American Academy of Pediatrics.

“These are the most comprehensive, patient-centered guidelines we’ve had that address childhood overweight and obesity,” said Dr. Rebecca Carter, a pediatrician at the University of Maryland Children’s Hospital and an assistant professor in the School of Medicine. of the University of Maryland. email monday.

“New to these recommendations are several new medication management strategies that have been shown to be very successful in the treatment of obesity as a chronic disease in adults and are now being recommended for use in children and adolescents,” Carter wrote. “This is an important step in allowing overweight and obesity to be considered the chronic diseases that they are.”

She added that the recommendations were a “big step forward” in helping parents and medical teams “take ownership” of the long-term health risks to children associated with being overweight and obese.

“They provide a variety of tools to help families feel empowered that there are ways to treat these medical conditions and that there are nuanced causes for these conditions that go beyond easy solutions and certainly take our focus away from outdated or unhealthy dietary strategies ,” Carter wrote.

The new guidelines are intended for health care providers, but Carter said parents should talk to their child’s doctor if there are concerns about weight and discuss strategies to optimize health and monitor changes.

“It’s also appropriate to do this in a child-centered way, being careful not to stigmatize them or make them feel bad about their bodies, while empowering the child to feel they have the tools they need to keep your body healthy over time.”

The new guidelines are a “much-needed advance” in aligning holistic care with modern science, Dr. Jennifer Waugh Baidal, assistant professor of pediatrics and director of the Childhood Obesity Initiative at Columbia University in New York, said in an email Monday.

“Adopting the new guidelines will help reverse the childhood obesity epidemic,” she wrote. “More work will be needed at the policy level to mitigate the policies and practices that perpetuate racial, ethnic, and socioeconomic disparities in obesity, starting at an early age.” While the guidelines support the advocacy efforts of pediatricians, we as a society must voice our support for a healthy environment for the nation’s children.

The American Academy of Pediatrics says more than 14.4 million children and teens are living with obesity. Children who are overweight or obese are at higher risk for asthma, sleep apnea, bone and joint problems, type 2 diabetes and heart disease, according to the US Centers for Disease Control and Prevention.

A separate study published last month in the Journal of the American Diabetes Association Diabetes caresuggests that the number of young people under 20 with type 2 diabetes in the United States could increase by nearly 675% by 2060 if current trends continue.

Last month, the CDC released updated growth charts which can be used to track children and teenagers with severe obesity.

Growth charts are standardized tools used by health care providers to track growth from infancy through adolescence. But as obesity and severe obesity have become more common over the past 40 years – more than 4.5 million children and teenagers were severely obese in 2017-18, the agency said – the rankings have not caught up.

The growth chart used since 2000 is based on data from 1963 to 1980 and does not exceed the 97th percentile, the agency said. The newly expanded percentiles include more up-to-date data and provide a way to monitor and visualize very high BMI values.

Existing growth charts for non-obese children and adolescents will not change, the CDC said, while the expanded growth chart will be useful for health care providers treating patients with severe childhood obesity.

“Prior to today’s release, growth charts did not extend high enough to plot BMI for the growing number of severely obese children. New growth charts combined with high-quality treatment can help optimize care for severely obese children,” said Karen Hacker, MD, director of the CDC’s National Center for Chronic Disease Prevention and Health Promotion. it said in a statement. “Providers can work with families on a comprehensive plan of care to address childhood obesity.”

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