New AAP guidelines recommend intensive therapy for children with obesity

The American Academy of Pediatrics (AAP) recently published their first edition of clinical practice guidelines for evaluating and treating children and adolescents with overweight and obesity.

The guidelines, published in the journal, Pediatrics, were developed by an AAP subcommittee comprised of a variety of experts representing both public and private institutions. Included in the guidelines are key action statements on evaluating and treating childhood obesity. Among them are motivational interviewing, behavior and lifestyle interventions, weight loss medications, and surgery. 

Authors defined overweight as a body mass index (BMI) at or above the 85^th percentile and below the 95^th percentile for children and teens at the same age and sex. Children and teens above the 95^th percentile, according to experts, are considered obese.

The AAP’s new guidelines for treating obesity in children and teens included:

• Nutritional support and physical activity treatment.
• Intensive health behavior and lifestyle treatment (IHPLT), with the most effective therapies requiring 26 or more hours of face-to-face, family-based, multicomponent treatment over a three-to-12-month period.
• For adolescents over the age of 12 with obesity, an offering of weight loss medication.
• For teens over the age of 13 with obesity, an evaluation for metabolic and bariatric surgery.

Factors that contribute to childhood obesity such as special healthcare needs, the marketing of unhealthy and processed foods, low socioeconomic status, food insecurity, and structural racism were also discussed in the guidelines. The AAP encouraged consideration of a child’s health status, family system, community context, and resources when treating obesity.

The guidelines also called for supportive payment and public health policies that cover obesity prevention, evaluation, and treatment. In addition, the authors urged for policy changes beyond the health sector that address problems such as structural racism to improve the health and wellbeing of children.

Suggestions for how to prevent obesity were not included in the guidelines. However, separate guidelines for obesity prevention are expected to be included in future AAP policy statements.

“There is no evidence that ‘watchful waiting’ or delayed treatment is appropriate for children with obesity,” said Sandra Hassink, MD, an author of the guideline and vice chair of the Clinical Practice Guideline Subcommittee on Obesity. “The goal is to help patients make changes in lifestyle, behaviors or environment in a way that is sustainable and involves families in decision-making at every step of the way.”