Childhood obesity has become a global public health crisis, and the United States is not immune to this problem. In fact, there has been a steady increase in childhood obesity in the U.S. over the past 50 years, with 1 in 5 children between the ages of 2 and 19 being obese. If this trend continues, more than half of children currently aged 2 to 19 will have obesity into adulthood. Obese children are at a greater risk for major life-threatening diseases, such as diabetes, high blood pressure, high cholesterol, and fatty liver disease. To address this problem, the American Academy of Pediatrics (AAP) has updated its clinical practice guidelines, the first in 15 years, with a new whole child approach to care.
Understanding the new AAP child obesity guidelines can help parents and guardians make informed decisions to protect their children. Here are four important takeaways:
1. Obesity is a chronic disease: The new guidelines frame obesity as a chronic disease, not just a behavior with multiple contributing risk factors, such as poor access to healthy foods and safe places for physical activity. Obesity is not a simple condition controlled by choices or environmental factors, but also involves multiple biological systems that are in a constant fight to protect us from losing body weight. The guidelines take a more whole child approach to treating obesity, including addressing socioeconomic and cultural factors, as well as genetic and biological factors.
2. Family-centered advice and support: Health care providers and pediatricians should build partnerships with families in their care and serve as care coordinators, working with a team that includes dietitians, psychologists, exercise specialists, and others. The guidelines emphasize that conversations about weight should be appropriate and non-stigmatizing. The AAP advises asking permission to discuss the patient’s weight at a visit and motivational interviewing to help promote healthful behaviors.
3. Emphasized immediate, intensive treatment: The best evidence-based treatment is intensive health behavior lifestyle treatment (IHBLT). The AAP recommends IHBLT when feasible for children ages 6 and older. This involves face-to-face counseling and coaching on nutrition, physical activity, and changes in behavior for the whole family system. Unfortunately, this treatment program isn’t available everywhere, and for many families, the time and financial demands put it out of reach.
4. Consideration of weight loss medication and surgery: After intensive therapy, weight loss drugs should be considered for adolescents and teens with severe obesity should be evaluated for weight loss surgery. Only a handful of medications are currently approved to treat obesity in adolescents, and benefits are modest for all of them and work best when it includes lifestyle and nutritional changes. Bariatric and metabolic surgery may offer the most significant long-term benefits, especially for children or teens who have severe obesity (BMI in the 120th percentile for age). Surgery also includes intensive lifestyle and nutritional changes.
While there is no one solution to address obesity, parents and guardians can take steps to help their children have a healthy weight and set lifelong healthy habits. The Centers for Disease Control and Prevention (CDC) recommend modeling healthy eating patterns, finding ways to move more together, helping children and teens get enough sleep, and limiting screen time and use.
Childhood obesity is a serious problem that requires a whole child approach to care. By understanding the new AAP child obesity guidelines, parents and guardians can work with their health care providers to protect their children’s health and future well-being.
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