The American Academy of Pediatricians is recommending a new approach to childhood obesity that addresses the condition as a complex disease and recommends intense behavioral treatment.
Twenty-one of the nation’s top experts in childhood health developed new guidelines after reviewing the body of evidence on childhood obesity; this is the first time in 15 years the group has addressed the topic.
Approximately one in five youth in the U.S. — more than 14 million total — are considered obese according to guidelines from the U.S. Centers for Disease Control and Prevention. While there is some evidence that kids can be healthy at any weight if they are active enough, obesity in children increases their risk of developing Type 2 diabetes, high cholesterol, and high blood pressure. And it increases the risk they will experience chronic disease in adulthood.
The guidelines classify obesity as a disease of complicated factors, including genetics, not just a problem of poor eating and lack of exercise. They urge pediatricians to test youth who are obese for complications including high blood pressure and abnormalities in lipids, glucose metabolism, and liver function. It also encourages them to treat the complications and address obesity specifically.
For youth who are overweight or obese, the guidelines recommend intensive behavioral and lifestyle treatment — kids and their families meet with a range of specialists including nutritionists, exercise physiologists and social workers to develop new habits. The guidelines recommend at least 26 hours of face-to-face counseling for this type of treatment. This support must be non-judgmental and recognize the structural and environmental factors that contribute to childhood obesity.
The guidelines also acknowledge there are barriers to youth enrolling in behavioral treatment. First, there are not many programs like this available in the U.S. Many of them are not covered by insurance and require a substantial time commitment to participate. If this type of program is not available, the report encourages primary pediatricians to provide more support and counseling to youth who are overweight or obese.
For youth who are experiencing serious health conditions related to obesity, the guidelines recommend weight-loss medications and even bariatric surgery for teenagers.
“Obesity in children and adolescents is a complex, multifactorial, and treatable disease,” the report says. “Evidence for successful treatment, despite stated gaps and complexities, gives hope to patients and families that pediatricians and primary health care providers can successfully assess and address the disease of obesity with an individualized and compassionate approach.”
The report is careful to point out that pediatricians should examine their attitudes and biases toward people who are obese. It is important that children not feel that they are being targeted or treated unfairly for being overweight. The report suggests a technique called motivational interviewing, a proven and effective method for discussing sensitive topics and encouraging behavior change.
The take-home message: A sweeping, evidence-based report recommends that pediatricians treat childhood obesity as a complex disease and offer treatment with health behavior programs and, in some cases, weight-loss medicine or bariatric surgery.
