Q&A: AAP’s guidance on treating childhood obesity provides an ‘on-ramp to implementation’

Key takeaways:

• Earlier this year, the AAP issued guidance on obesity treatment for youth.
• Providers can use a checklist and other available resources to implement the guidance one step at a time.

WASHINGTON —Pediatric obesity and guidelines on how to manage it were the focus of several symposiums at the AAP National Conference & Exhibition.

In January, the AAP released its first comprehensive clinical guidelines on evaluating and treating childhood obesity. According to the guidance, intensive health behavior and lifestyle treatment is the most effective behavioral strategy for treating childhood obesity. It also recommends that physicians offer pharmacotherapy to youth aged 12 years and older as an adjunct to health behavior and lifestyle treatment, and to evaluate adolescents aged 13 years and older with severe obesity for metabolic and bariatric surgery.

Speaking to Healio, Sandra Hassink, MD, MS, FAAP, director of the AAP Institute for Health Childhood Weight, discussed how providers should implement the guidance in clinical settings, the feasibility of implementation and more.

Healio: How should providers implement the AAP's guidance on treating pediatric obesity in clinical practice — both in pediatricians' offices and in family practices?

Hassink: I think the guidelines are out there to reflect the current evidence we have about effective obesity treatment, and we know that practitioners are in many different stages of being able to implement this guidance. We're looking at it as, “here's the evidence,” and then there’s an on-ramp to implementation.

Some practices out there have templates for taking care of children with obesity that reflect certain reviews of systems that they want to check, and some practitioners haven't done that yet. Some practitioners have a good system in place for following these patients over multiple visits.

We designed what we call a “capacity checklist,” which allows practitioners to survey their practices point by point and identify areas where they may have something already in place, or they may have gaps and then go from there. It’s an on-ramp, and there’s a tool there that people can use to ask, “Where am I in my implementation plan?”

Healio: Is AAP asking providers to make significant changes to their practices? Do you see this guidance being implemented easily, or will it take time?

Hassink: I think in medicine today, nothing is easy to implement, if you want to know the truth. Everybody is working hard to get in everything that they need and want to do.

I think pediatricians have shown that they can implement new paradigms in, for example, mental health. So, if you use that as a paradigm condition years ago, pediatricians weren't prescribing medicine for depression or anxiety and weren't doing as extensive an evaluation. They realized that the children out there needed help, and they incorporated that. So, I think pediatricians can do this. I think it's a matter of identifying what needs to be done and working at a pace where they aren’t overwhelmed and think, “I have to do all these implementations steps at once.” No, you do them one at a time and incorporate them.

In that capacity checklist is also a place where you can evaluate how your system may be supporting you. Do you have good IT support? Do you have buy-in from your clinic? So, there are many areas for them to work in. I think it's evidence based with a plan.

Healio: How did the meeting speak to these issues? What were the most useful presentations/talks at AAP 2023 regarding the implementation of the guidance at the point of care?

Hassink: Yeah, we had a lot. We had a forum before the [National Counselor Examination (NCE)] called the Innovations Forum, and that whole forum included presentations about how people were implementing the guidelines. We had talks about language, about testing guideline implementation, about quality improvements and about people who were using already established programs to help meet the guidelines.

We had a program within the body of the NCE on eating disorders, obesity, food, insecurity and obesity-related type 2 diabetes. We had what we call the Section H program, which is the obesity section, where we had an entire day of programming around medication use and eating disorder screening. So, we had a lot this time for people to access, and the sessions were full.

Healio: Do you have anything else to add?

Hassink: I think it’s good for people to know that from the beginning — and this guideline took 5 years to develop — and ongoing through the development, we were working on implementation materials. If you go to the Institute for Healthy Childhood Weight at the AAP website, we have a huge amount of implementation material. We have CME courses and MOC courses. We have quality improvement plans and quality improvement projects you can enroll in. We have webinars on obesity pathophysiology. We have podcasts.

So, we have a huge amount of implementation material, including that capacity checklist I talked about, and I would like pediatricians to know that because you don't have to reinvent the wheel. We have lectures if people want to go out and speak about the guidelines.

I think that a first stop for pediatricians would be to look at the guidelines, which are also on the website, and then look at the implementation materials. Don't reinvent the wheel if you don't have to; there's plenty of support material there for you.

Reference:

• American Academy of Pediatrics issues its first comprehensive guideline on evaluating, treating children and adolescents with obesity. https://www.aap.org/en/news-room/news-releases/aap/2023/american-academy-of-pediatrics-issues-its-first-comprehensive-guideline-on-evaluating-treating-children-and-adolescents-with-obesity/. Published Jan. 9, 2023. Accessed Nov. 2, 2023.