In the US, it is recommended to treat obesity in children with pills and even surgery

Updated American Academy of Pediatrics guidelines for treating obesity in children call for immediate use of behavioral therapy and lifestyle changes, and for some adolescents, surgery and medication should be used, reports CNN.

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The guidelines, published Jan. 9 in the journal Pediatrics, are the first comprehensive update of the obesity academy's guidelines in 15 years. They provide treatment recommendations for children ages 2 through adolescence.

The guidelines recognize that obesity is complex and is linked, among other things, to access to nutritious foods and health care.

Treatment of young children should be aimed at changing the behavior and lifestyle of the whole family, including supporting nutrition and increasing physical activity. For children aged 12 and over, the use of weight loss medications in addition to behavioral therapy and lifestyle changes is appropriate, the academy says. According to the guidelines, adolescents 13 years of age and older with severe obesity should be evaluated for surgery.

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“There is no evidence that watchful waiting or delayed treatment is appropriate for children with obesity,” said Dr. Sandra Hassink, author of the guideline and vice chair of the group's clinical guidelines subcommittee on obesity. “The goal is to help patients make lifestyle, behavioral or environmental changes in a way that is sustainable and involves families in the decision-making process every step of the way.”

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

Miles Faith, a psychologist at the State University of New York at Buffalo who studies eating behavior and obesity in children, praised the new report for acknowledging that the causes of childhood obesity are complex and that treating it must be a team effort.

“It’s not one reason for all kids,” he said. “We shouldn’t automatically discount the possibility of drugs, we shouldn’t discount the role of surgery. This may be important for some families.”

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

"These are the most comprehensive, patient-focused guidelines that address childhood overweight and obesity," said Dr. Rebecca Carter, pediatrician at the University of Maryland Children's Hospital and assistant professor at the University of Maryland School of Medicine.

“What's new in these guidelines are several innovative medication management strategies that have been highly successful in treating obesity as a chronic disease in adults and are now recommended for use in children and adolescents,” Carter wrote. “This is an important step towards recognizing overweight and obesity as the chronic diseases that they are.”

She added that the recommendations are a "big step forward" in helping parents and healthcare teams "take responsibility" for the long-term health risks of being overweight and obese in a child.

“They provide a variety of tools to help families feel more confident. They explain that there are treatments for these diseases and that there are nuances to the causes of these conditions that go beyond simple solutions and certainly shift our attention away from outdated or unhealthy diet strategies,” Carter wrote.

The new recommendations are for health care providers, but Carter said parents should speak with their children's doctor if there are weight concerns and discuss strategies to optimize health and track changes.

“It is also appropriate to do this in a child-friendly way, being careful not to stigmatize them or make them feel bad about their bodies, and to enable the child to feel like they have the tools they need to maintain the health of their body over time,” said she.

The new guidelines are a "critical achievement" to align comprehensive care with modern science, Dr. Jennifer Wu Baydal, assistant professor of pediatrics and director of the Pediatric Obesity Initiative at Columbia University in New York, said Jan. 9.

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“Implementing the new guidelines will help reverse the childhood obesity epidemic,” she wrote. “More work will be needed at the policy level to mitigate policies and practices that propagate racial, ethnic, and socioeconomic disparities in obesity, starting early in life.” While the recommendations support pediatricians' efforts to advocate for children, we as a society must voice our support for a healthy environment for the nation's children."

Concerns about obesity

The American Academy of Pediatrics reports that more than 14,4 million children and adolescents are obese. 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 (CDC).

A separate study published last month in the American Diabetes Association's Journal of Diabetes Care suggests that the number of young adults 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 that can be used to track severely obese children and teens.

Growth charts are standardized tools used by health care providers to track growth from infancy to adolescence. But as obesity and severe obesity have become more prevalent over the past 40 years—more than 4,5 million children and adolescents were severely obese in 2017-2018—the charts are not keeping up.

The agency said the growth chart used since 2000 is based on data from 1963 to 1980 and does not go beyond the 97th percentile. New expanded percentiles include more recent data and allow you to track and visualize very high BMI values.

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

“Until today's release, growth charts were not accurate enough to show BMI for the growing number of severely obese children. New growth charts combined with high-quality treatment may help optimize care for children with severe obesity, Dr. Karen Hacker, director of the CDC's National Center for Chronic Disease Prevention and Health Promotion, said in a statement. “Providers can work with families on a comprehensive childhood obesity care plan.”

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