Primary care providers should treat childhood obesity and adolescents actively – including with drugs When weight loss surgery – rather than relying on ‘wait and see’ and hoping that the problem will resolve itself.that’s the result new guidelines From the American Academy of Pediatrics (AAP).
The guideline authors also encourage primary care physicians to frequently work with other health care professionals to treat comorbidities. lead to obesityrather than tackling all the challenges on your own.
Dr. Ifoma Eneri
“Treatment is impossible. obesity Within the four walls of the clinic. That’s one of the things I’ve learned from him,” said Ihuoma Eneli, M.D., Ph.D., his associate director at the AAP Health Pediatric Weight Institute. Medscape Medical NewsFor example, a primary care physician may partner with a gastroenterologist in treating a non-alcoholic child. fatty liver Enery, a professor of pediatrics at The Ohio State University in Columbus, added that he helped write the recommendation.
This new document updates the AAP’s 2007 recommendations for the treatment of overweight or obese children and adolescents. Earlier statements focused on behavior modification and healthy eating behaviors and paid less attention to weight loss drugs and bariatric surgery in young people. It did not provide specific advice to health care providers on how to do so.
In the 2023 guidelines, pediatricians recommend that all people aged 12 years and older who are overweight (defined as a body mass index (BMI) above the 95th percentile) be on weight-loss medications in addition to ongoing support for lifestyle changes. We recommend that you provide the option to receive Such as exercising more and eating healthier foods.
the same approach works bariatric surgery Once the child reached the age of 13, the AAP stressed that doctors should not stigmatize the child or imply that it was because of their weight.
AAP does not receive industry funding to develop its guidelines.
Once children reach a threshold BMI level, doctors should perform a complete physical examination and order blood tests to get a more complete picture of the patient’s health.
These are the first AAP guidelines aimed at providing pediatricians and other primary care providers with specific guidance for managing overweight and obesity in young patients.
Dr. Sandra Hasink
“Obesity is a complex chronic disease, and it’s a frameshift,” said Sandra S. Hassink, MD, guideline group leader and director of the AAP Institute for Healthy Childhood Weight.
Hassink is obese asthma, another chronic disease that deserves prompt attention and continued treatment. Physicians would never leave a child with asthma untreated until his breathing problems turned blue, Hassink said. Similarly, they need to treat youth obesity quickly and over time.
Although some aspects of treating overweight and obesity are the same for children and adults, Hassink noted distinct differences. “Every child is embedded in a family and an extended support structure,” Hasink said.
Comprehensive approach
The AAP’s new advice reflects the current understanding that overweight or obesity in children is a result of biological and social factors such as the living environment. food dessert or experiencing the effects of structural racism.
The guidelines are a compilation of hundreds of studies on how best to treat excess weight in young people. If multiple studies were of good quality and all reached similar conclusions, they received an ‘A’. Informative studies, although not robust, were rated ‘B’. Overall, the guidelines for weight loss drugs are based on “B” evidence and may change with further research.
The authors recommend that clinicians calculate a child’s BMI starting at 2 years of age. Particular attention should be paid to age and gender above the 85th percentile (defined as overweight) and above the 95th percentile (obesity). or above the 120th percentile (severe obesity). Clinicians should also monitor blood pressure and cholesterol in overweight or obese patients, especially once they reach the age of 10.
From age 6, providers should interview patients and their families about what motivates weight loss and tailor interventions to those factors, rather than outright declaring the need for weight loss. there is. This step should be combined with focused support for effective exercise and eating habits that lead to weight loss.
An intensive support model should be maintained throughout childhood and adolescence, and should be combined with referral for weight loss drugs or bariatric surgery as needed once the child reaches 12 or 13 years of age. If drugs or surgery become effective and new evidence shows that, it could move to a younger age, Hassink said.
“Intensive health behavior and lifestyle treatment is the cornerstone of all other therapeutic extensions,” said Eneri.
Dr. Aaron Kelly
Aaron S. Kelly, Ph.D., assistant chairman of the Minnesota American Corps and Children’s Health at the University of Minnesota in Minneapolis, said younger patients who needed weight loss drugs used to have fewer options.
more than this.
Kelly was not involved in the drafting of the guidelines, liraglutide (Saxenda) was approved by the U.S. Food and Drug Administration (FDA) in 2020 for the treatment of adolescent obesity. In 2022, agency approved Phentermine When topiramate Extended-release capsules (Qsymia) for long-term weight management in patients aged 12 years and older, plus weekly injections semaglutide (Wegovy) patients in this age group. According to Kelly, there are no weight-loss pills for children under 12.
“Obesity is not a lifestyle issue. A lot of it is caused by underlying biology,” Kelly said. is to help make the right lifestyle choices.”
For example, drugs can make you feel fuller for longer or interfere with the chemical pathways that trigger cravings for certain foods. Kelly emphasized that these drugs do not give people permission to eat as much as they want.
As for bariatric surgery, the new guidelines closely follow those of bariatric surgery. 2019 AAP Statement Bariatric surgery is safe and effective in the pediatric setting. This pleases Kirk W. Reichard, MD, MBA, lead author of the 2019 article and director of the Bariatric Surgery Program at Nemours Children’s Health.
Reichard said even if the information is not new as of 2023, the AAP’s sanction may cause eligible families to consider bariatric surgery even if they have never had bariatric surgery before.
Eneli, Hassink, and Reichard report no relevant financial conflicts of interest. Kelly is related to Boehringer Ingelheim, Eli Lilly, Novo Nordisk and Vivus.
Pediatrics. Published online on January 9, 2023. full text
Marcus A. Banks, Massachusetts is a New York City-based journalist who covers health news with a focus on new cancer research. His work has been published in Medscape, Cancer Today, The Scientist, Gastroenterology & Endoscopy News, Slate, TCTMD and Spectrum.
Follow Medscape for more information. Facebook, twitter, InstagramWhen Youtube.
