'We have to tailor the treatment' for obesity in children and adolescents

Key takeaways:

• A speaker reviewed how to follow the AAP’s guidelines for treating obesity while individualizing care.
• Factors like limited data, potential risks and insurance coverage should all be considered.

DENVER — Individualized care is critical for treating childhood obesity, according to a presenter at the Obesity Medicine Association’s annual conference.

Children who have overweight and obesity can develop negative body image, low self-esteem and have a lower quality of life — comparable to their peers who have been diagnosed with cancer, Marisa Censani, MD, FOMA, DABOM, associate professor of clinical pediatrics at Weill Cornell Medicine and an attending physician at New York Presbyterian Hospital, said in her presentation.

“Weight bias damages our health,” she said. “Bullying, in particular. At least one-third of adolescents with obesity report stigma from their parents ... Teachers will also have lower expectations [about] physical abilities and reasoning and report more negative stereotypes. Keeping all of this in mind is really key.”

When treating obesity, the primary goal is to improve health outcomes and any risk for obesity-related sequelae, Censani said.

“We know that a modest weight loss of 5% to 10% does lead to an improvement in complications,” she said.

In early 2023, the American Academy of Pediatrics released its first clinical guidance on treating obesity in 15 years. The guidance recommended “urgent action” and included more advanced treatments like pharmacotherapy and bariatric surgery.

“What they found was that there was no room for watchful waiting. It encouraged really aggressive therapy,” Censani said.

The AAP recommends intensive lifestyle and healthy behavior therapy as first-line treatment and considering anti-obesity medications as an adjunct therapy for those aged 12 years or older based on benefits, risks and medical indications. The organization additionally recommends considering metabolic and bariatric surgery as an adjunct therapy for children who are aged 13 years or older if they meet the criteria.

Censani said intensive health behavior and lifestyle treatment “remains the foundational approach.”

“It's the cornerstone of what we do, diet and lifestyle modification,” she said. “This is the foundational approach to decrease weight gain.”

At least 26 hours of family-based counseling over a period of 3 to 12 months is recommended. When this is unavailable, Censani said, the recommendation is to “deliver the best available intensive treatment to all children with overweight and obesity” and “build these collaborations with other specialists in the community.”

However, Censani noted some limitations to more advanced therapies. For example, she noted that “there are very few FDA-approved medications” for obesity treatment in children and adolescents. Additionally, there is a lack of availability in pharmacies, lack of insurance coverage, risk for adverse events and limited data on the drugs’ safety and efficacy in children and adolescents.

“We have to take all that into consideration,” she said. “When I'm meeting with a family, assessing pharmacotherapy options, I do discuss with them that certain medications work for different indications or certain individuals and that we have to tailor the treatment to you.”