A growing issue: How to prevent and treat pediatric obesity

Pediatric obesity is a complex and serious public threat that continues to grow in prevalence. According to the CDC, childhood obesity affects 12.7 million infants, children and adolescents aged 2 to 19 years.

Childhood obesity occurs when a child is well above the normal or healthy weight for their age and height. It can lead to immediate and future health risks, such as high blood pressure, high cholesterol, breathing problems, anxiety and depression. Children who have obesity are also more likely to become adults with obesity, and their disease risk factors in adulthood are more likely to be increasingly severe.

Unfortunately, the multidisciplinary clinics that address obesity are filled to capacity. As health care providers, we cannot rely on a few specialized physicians to start the conversation and initiate interventions when it comes to addressing pediatric obesity. All providers, especially primary care physicians, have an obligation to initiate discussions about healthy weight and lifestyle during visits. As front-line providers who can detect the problem first, PCPs have the potential to play a pivotal role in decreasing the development of related chronic diseases in children with obesity, such as type 2 diabetes, hypertension, cardiovascular disease and sleep disturbances.

It is imperative that health care providers stay updated on treatment developments and talk to patients and their family members about childhood obesity. By addressing it directly, we can potentially slow the progression of metabolic disease and subsequently lower the development of comorbidities.

How pediatric obesity differs from adult obesity

Obesity in adults is often associated with metabolic and chronic medical conditions, including cardiovascular disease, diabetes and cancer. While children do not have high rates of these obesity-related conditions, these numbers are increasing as the prevalence of childhood obesity grows. Obesity negatively affects quality of life for children and can lead to anxiety and depression. Many also suffer from social stigmatization. A key differentiator between treating children with obesity and adults with obesity is that weight loss is not as critical. Instead, the primary focuses of pediatric obesity treatment are promoting healthy habits and improving body composition.

Updates in pediatric obesity treatment

Several recent changes have impacted how we approach pediatric obesity, further differentiating treatment in comparison to adult obesity, including the creation and promotion of weight management centers in many institutions and in private practices. Multidisciplinary weight loss clinics focus on the entire child and family and address the psychological, social, nutritional, hormonal, medical, genetic, activity, neurological and sleep issues that may contribute to excess weight gain. Advances in genetic testing today help clinicians identify more abnormalities that contribute to weight gain. And there is active research and development of medications that are therapeutic targets for these abnormalities.

While anti-obesity medications are becoming more available for weight management in children, there are still far fewer options compared with adults, and there may be usage restrictions based on state laws. At this time, medications like orlistat, metformin, phentermine, naltrexone HCL/bupropion HCL, setmelanotide, and some GLP-1 agonists are FDA approved for children if they fit the treatment criteria. Other medicines, such as the combo pill phentermine/topiramate, exenatide, bupropion, lisdexamfetamine dimesylate and topiramate are not FDA approved, but many obesity medicine specialists use these medicines off label.

Bariatric surgery is another recent option in pediatric obesity treatment. Research demonstrates that adolescents with multiple severe comorbidities who don’t see improvement through diet, lifestyle, medications and/or multidisciplinary interventions benefit from bariatric surgery. Many years ago, surgical intervention was not an option for patients aged younger than 18 years, but it is now a treatment option that has shown good results.

Focusing on prevention

How can we all work together to lessen obesity prevalence in children and teens in the future? Prevention is essential. There is so much we can do to make a difference in our communities. From a nutrition standpoint, providing education and improving access to fresh foods, fruits and vegetables can make a real difference. School districts can hire dieticians to guide and design healthy school meals. As a community, creating safe opportunities for age-appropriate exercise and activity can help children with their body composition and cardiovascular health. In addition, we can educate parents about the pitfalls of too much screen time (TV, phone, video games, etc.) for both activity level and sleep. Finally, the mental health of both children and their parents can often be overlooked. We need to provide better access to mental health professionals to help children and their families who have developed unhealthy relationships with food. These changes are possible to achieve and can make a big impact in preventing pediatric obesity.

Leveraging available tools for treatment

Many health care providers have not received focused pediatric obesity medicine education as part of their medical training. Although some programs provide fellowships, education about obesity management is still mainly self-studied outside of formal medical training. The Obesity Medicine Association (OMA) has a spectrum of tools and resources to help providers treat pediatric obesity.

The OMA’s Self-Assessment Program (SAP) Volume II — Pediatrics is an excellent tool that aims to enhance your understanding of pediatric obesity medicine and improve patient care. Designed for pediatric obesity medicine clinicians by pediatric obesity medicine clinicians, the SAP contains case-based scenarios and questions intended to prompt self-study and offers an opportunity to highlight gaps in your understanding of pediatric obesity while advancing your treatment strategies.

OMA’s Pediatric Obesity Algorithm is another clinical tool to help health care professionals make informed decisions when treating obesity in children. This resource provides age-specific recommendations and a staged treatment approach that clinicians can leverage when making treatment decisions or when referring patients to childhood obesity specialists.

Our knowledge of pediatric obesity continues to evolve. Reference more of OMA’s pediatric resources to utilize in your daily medical practice here.

References:

CDC. Prevalence of childhood obesity in the United States. https://www.cdc.gov/obesity/data/childhood.html. Accessed Oct. 28, 2021.

Cuda S, et al. Pediatric obesity algorithm, presented by the Obesity Medicine Association. 2020-2022. www.obesitymedicine.org/childhood-obesity. Accessed Oct. 25, 2021.

Christensen S, Alexander L, Karjoo S, Cox M, Cuda S, Ferdous C, Hardy A, Lindquist R, Mcllven P, Munoz-Mantilla D, Sabharwal A, Shetye B, Tondt J, Ziltzer R. Press Media Tool Kit, presented by the Obesity Medicine Association. 2021. https://obesitymedicine.org. Accessed Nov. 8, 2021.