AAP guidance: Consider medication, surgery for children with obesity

The AAP on Monday released its first clinical guidance on obesity in 15 years, suggesting that physicians offer adolescents as young as age 12 years weight loss medication and evaluate teens for metabolic and bariatric surgery.

The AAP estimates that more than 14.4 million U.S. children, adolescents and teens live with obesity.

Sarah E. Hampl, MD, FAAP, chair of the academy’s clinical practice guideline subcommittee on obesity, said that the medical costs of obesity on children, families and society as a whole required “urgent action.”

“Weight is a sensitive topic for most of us, and children and teens are especially aware of the harsh and unfair stigma that comes with being affected by it,” Hampl said in a news release summarizing the guidance, which was published along with an executive summary and two technical reports.

“Research tells us that we need to take a close look at families — where they live, their access to nutritious food, health care and opportunities for physical activity — as well as other factors that are associated with health, quality-of- life outcomes and risks,” Hampl said. “Our kids need the medical support, understanding and resources we can provide within a treatment plan that involves the whole family.”

According to the guidance, the use of intensive health behavior and lifestyle treatment is the most effective behavioral treatment for child obesity and most often works “when it occurs face-to-face, engages the whole family, and delivers at least 26 hours of nutrition, physical activity, and behavior change lessons over 3 to 12 months.”

The guidance also encourages physicians to offer weight loss pharmacotherapy as an adjunct to health behavior and lifestyle treatment for adolescents aged 12 years or older with obesity. Teens aged 13 years or older with severe obesity should be evaluated for metabolic and bariatric surgery, it says.

The guidance also notes that patient-centered care and nonstigmatizing nutrition and activity counseling are important for all children because “there is no evidence to support either watchful waiting or unnecessary delay of appropriate treatment of children who have already developed obesity,” and “many children are only referred to treatment programs when their obesity has become more severe.”

“The goal is to help patients make changes in lifestyle, behaviors or environment in a way that is sustainable and involves families in decision-making at every step of the way,” Sandra G. Hassink, MD, FAAP, vice chair of the subcommittee, said in the release.

“This is a complex issue, but there are multiple ways we can take steps to intervene now and help children and teens build the foundation for a long, healthy life,” Hampl said.

References:

• American Academy of Pediatrics issues its first comprehensive guideline on evaluating, treating obesity in children and adolescents. https://www.aap.org/en/news-room/news-releases/aap/2022/american-academy-of-pediatrics-issues-its-first-comprehensive-guideline-on-evaluating-treating-children-and-adolescents-with-obesity/. Published Jan. 9, 2023. Accessed Jan. 9, 2023.
• Hampl SE, et al. Pediatrics. 2023;doi:10.1542/peds.2022-060641.
• Hampl SE, et al. Pediatrics. 2023;doi:10.1542/peds.2022-060642.
• Hampl SE, et al. Pediatrics. 2023;doi:10.1542/peds.2022-060643.