New guidelines recommend surgery, nutrition

Recommending that teenagers undergo surgery to treat obesity may surprise some parents, but the AAP’s guidelines reflect current evolution of medical thinking about treating weight loss. is consistent with

Ah Recent reports It was published in the magazine PediatricsFor example, it calls surgical interventions for weight loss in children “underutilized”, especially among minority groups.

“Metabolic and bariatric surgery should be considered a viable tool for obese adolescents and young adults who are severely obese or with comorbidities. For many patients, surgery is likely to enable patients to achieve their target weight. It’s the only option,” he said. Dr. Mary Alice Younger Rossia doctor at Children’s Hospital New Orleans.

“The human body doesn’t like to lose weight,” Younger Rossi explained to Healthline. The human body has evolved to be very good at retaining extra calories because it isn’t. , also works by helping the body reset its metabolic setpoints.”

Dr. Sissy Empress Cosio, A pediatric endocrinologist at Pediatrix Endocrinology in Florida agreed.

“We recommend metabolic surgery and bariatric surgery for adolescents who meet our criteria,” she told Healthline. “We have had the opportunity to refer eligible patients for bariatric surgery, and the results have been successful. The main issue I found in recommending this treatment is the affordability of the procedure, and I hope the new AAP guidelines will make it easier to access and get health insurance approval. ”

Other AAP recommendations include expanding the use of new anti-obesity drugs and a highly effective approach to treating obesity known as Intensive Health Behavior and Lifestyle Treatment (IHBLT).

“There have been about three new drugs approved by the FDA [Food and Drug Administration] in the last 1-2 years. However, access to pediatric patients remains very limited, and having strong recommendations could certainly improve access.” Dr. Alvaro Floresa pediatric gastroenterologist at the Children’s Hospital & Medical Center in Omaha, Nebraska.

Access to drug therapy and IHBLT may prevent these treatments from reaching as many children as they otherwise could.

“Drugs and treatments are available now, but patients need access to these new prescriptions and surgical procedures,” Cossio explained. is too expensive and, if enrolled, requires a large amount of paperwork to approve the procedure.Like many diseases treated by doctors, the hurdles to approval and payment of insurance can be overwhelming for wealthy communities. is one of the main causes of disparities in quality of care between poor and poor communities.”

Dr. Jessica MaddenHe is a physician specializing in pediatrics, neonatology and lactation, and is the medical director of Aeroflow Breastpumps.

She pointed out that interventions such as IHBLT require at least 26 hours of visitation over a period of 3 to 12 months and require full family consent to be successful.

“One of the major barriers to implementing IHBLT is cost. Who pays for these programs? Are they (or are they) covered by insurance, subsidies, or is the family paying for it?” Are you expected to bear the burden?” Madden told Healthline. “Other barriers include figuring out how to dedicate time to the IHBLT program, transportation-related costs and logistics, and how to keep patients and families motivated to continue and complete the program. included.”

Studies show that children in minority groups with obesity underutilize available treatments, from drugs to counseling to surgery, because of these economic and logistical barriers. It has been.

“Targeted policies are needed to deliberately address systemic racism in our society. Written by AAP authors described in the Executive Report that accompanies the new guidelines.

Perhaps one of the most important changes that the new AAP recommendations will bring is a more nuanced view of childhood obesity and updating the recommendations accordingly.

“[One of the most striking changes is] Basically, how they view obesity: a chronic, intractable, relapsing disease for which a careful wait is no longer appropriate.” Dr. Anilda Setia, a pediatric gastroenterologist at KIDZ Medical Services, Florida. “We have changed our nomenclature to remove stigma, and we understand that children grow and develop differently each year, so there can be no blanket statement.”

Setya cites updates to how body fat and obesity are measured beyond static body mass index (BMI) scores as key signals of this shift.

“The committee used ‘obese’ instead of ‘overweight’ if BMI was above the 95th percentile and ‘at risk of being overweight’ if BMI was between the 85th and 94th percentile. It is recommended to use “overweight”. ’” he told Healthline. “The clinical justification for this change is compelling.”

This nuance is necessary, especially because we still don’t understand a lot about body fat and obesity, Setya said.

“High levels of body fat are associated with increased health risks,” he explained. or disease risk cannot be clearly differentiated. Even if body fat levels can be easily measured, other factors such as fat distribution, genetics and fitness contribute to health assessments.”