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Guidelines for the prevention and treatment of pediatric obesity
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I recently attended a school program put on by my son’s second grade class. I was amazed by how many overweight and obese children there were. Obese children were a rarity when I was in elementary school. I looked around the audience and realized that I should not be surprised. A large number of the children’s parents and grandparents were obese.
It has been estimated that the overall prevalence of childhood obesity is now 17.1%. This prevalence has increased fourfold in 6 to 11 year olds and threefold in 12 to 19 year olds over the past three decades. This is a great concern because childhood obesity strongly predicts adult obesity. It also increases future risk of cardiovascular disease, type 2 diabetes, hypertension, dyslipidemia and other comorbidities.
The Endocrine Society recently released clinical practice guidelines on the prevention and treatment of pediatric obesity. They advised prescribing and supporting intensive lifestyle modification before considering any other treatment. They suggested that pharmacotherapy be considered in obese children only after failure of a formal program of intensive lifestyle modification. Such therapy should be prescribed only by clinicians familiar with the use of these agents and the possibility of adverse reactions.
Per these guidelines, bariatric surgery is a last resort option only after all other interventions have failed. It should be considered only in adolescents with BMI above 50 kg/m2 or above 40 kg/m2 with severe comorbidities.
The authors also recommended several measures to prevent obesity. They advised breastfeeding infants until at least 6 months of age. They advocated that schools provide 60 minutes of moderate to vigorous daily physical activity. They also recommended restricting availability of unhealthy food choices in schools, banning advertising of unhealthy food choices to children and community redesign to maximize opportunities for safe walking, bike riding and other physical activity. Finally, they encouraged parental and community participation and education.
I am an adult endocrinologist who does not see children. I am not so sure about pharmacotherapy in children and am uncomfortable with the idea of bariatric surgery in adolescents. However, I also realize that for some, lifestyle modification will not be effective and other options may need to be considered.
Many of the young adults and adolescents in my practice already have insulin resistance, mixed dyslipidemia and early onset type 2 diabetes. The prevention of these and other cardiovascular risk factors must begin years earlier. Of all the recommendations in the guidelines, I think encouraging parental and community involvement is the most important.
How can we expect our children to succeed in being physically active and eating right when so many others in their family and community are not?
J Clin Endocrinol Metab. 2008;93:4576-4599.