How should we manage excess weight in children?
Following the lead of other organizations, the American Academy of Pediatrics has issued guidelines for treating excessive body weight in children and adolescents using a chronic disease model. They stress the need for early identification of comorbidities and interventions aimed at changing eating and activity habits through intensive behavior and lifestyle modification. They suggest considering medication or bariatric surgery in adolescents. They offer ways of talking about weight that will not stigmatize the children, though I'm skeptical that the focus on weight instead of health will prevent shaming. The focus on individual behavior instead of structural solutions may set up patients, parents, and clinicians for failure.
Plan de l'etude:
Self-funded or unfunded
These guidelines were based on 2 systematic reviews of the literature of the effect of weight on the morbidity of children and the effectiveness of treatment. The guidelines represent policy statements, as much as specific recommendations; emphasize the societal, community, family, and individual contributions that promote unhealthy weight in children; and suggest addressing those contributions when possible. Here is a brief overview of their consensus recommendations.
- Use body mass index to annually track the weight of children two years or older and to identify and monitor children who are overweight or obese.
- Try to avoid stigmatizing children by using careful language: ask if you can discuss weight; avoid the use of “obese child,” instead say “the child with obesity”; and avoid words known to be offensive, such as obese, morbidly obese, large, fat, overweight, and chubby. Instead, focus on the effects of weight on health by saying "unhealthy weight" or "gaining too much weight for their age, height, or health."
- Consider lipid testing in children younger than 10 years with obesity.
- Check blood pressure at every visit in children with unhealthy weight.
- Check fasting lipids, hemoglobin A1c for diabetes or prediabetes, and alanine transaminase for nonalcoholic fatty liver in children 10 years or older with obesity.
- Treatment recommendations are less prescriptive and emphasize a comprehensive approach that includes nonstigmatizing activities, including motivational interviews and the offer of intensive (at least 26 hours) health behavior and lifestyle treatment, which is a formal, longitudinal, multimodal approach to promote healthy behaviors. The authors suggest, for children at least 12 years of age, the consideration of pharmacologic therapy with or without the intensive health behavior and lifestyle treatment. They also suggest bariatric surgery for adolescents 13 years or older.
Allen F. Shaughnessy, PharmD, MMedEd
Professor of Family Medicine