New Pediatrics Guidelines on Obesity in Children and Adolescents

Obesity is a complex health problem affecting a surprising percentage of American children and adolescents. Hovering around 5% in 1963 to 1965, obesity rates more than tripled from 2017 to 2019, to 19%. Preliminary data suggests that childhood obesity rates continued to climb during the pandemic. If this trend continues, 57% of children aged 2 to 19 currently will be obese as adults in 2050.

In short, it puts more than half of the children now alive in America at greater risk for high blood pressure, heart disease, diabetes, liver disease and other health complications of obesity. Stress, depression, and poor self-esteem are often associated with the stigma associated with obesity. For these reasons and more, the American Academy of Pediatrics (AAP) recently updated clinical practice guidelines for the evaluation and treatment of children and adolescents with obesity.

A complex interplay contributes to childhood obesity

Obesity has long been stigmatized as merely a problem of personal choice: If people ate less and exercised more, they wouldn’t be obese, experts once believed. But medical evidence is more complex than that. Genetic, physical, socioeconomic and environmental factors contribute to obesity in children.

  • Calories and Food. It is true that eating excess calories and unhealthy foods play a significant role in the development of obesity. But many families do not have easy access to healthy food such as fresh food and vegetables. For many kids, the only foods available to them are heavily processed foods, fast food, and other unhealthy foods that are all their families can afford or can find — and not all schools offer healthy meals either. Even when families have the resources, they are often stressed in ways that make it difficult to spend time and energy eating healthy.
  • exercise. While it’s also true that regular exercise helps keep kids at a healthy weight, many kids live in places that don’t have safe places to play outside, and their parents either don’t sign them up for activities. can or they don’t have time. To get them into those activities—or both.
  • Other factors affecting obesity. Prenatal factors, such as maternal weight gain or gestational diabetes, increase the risk even before the baby is born. We are just beginning to understand genetic factors, many of which may be more influenced by a child’s environment. There are ways in which systemic racism and deeply ingrained socioeconomic factors play a role. Simply put, obesity is complicated.

Work with your child’s doctor on a plan for better health

The new guidelines recommend that your doctor should:

  • screen regularly for obesity, Using body mass index (BMI) as a measurement. This calculation uses a child’s height and weight and is given as a percentage based on age (unlike adults, where numbers alone are used). It’s not an exact measurement, but it’s the best we have. A BMI greater than the 95th percentile for age is considered obese.
  • view full picture When a child’s weight is increasing too much according to his age or he is underweight. where does your family live? What is your socioeconomic status? What can you share about beliefs, daily life, school, ethnic background, and community ties? Willingness and ability to make lifestyle changes? All of this, along with family medical history, matters when it comes to understanding and developing a good plan.
  • Explain treatment options. The best evidence-based treatment is called Intensive Health Behavioral Lifestyle Therapy, or IHBLT. This includes face-to-face, family-based, multidisciplinary counseling on nutrition and physical activity, preferably based in your community and linked to community resources. To make a difference, this must include at least 26 hours over at least three to 12 months. Unfortunately, these programs are not readily available to most families.

What if the comprehensive program called IHBLT is not available?

When a comprehensive program isn’t available, the new guidelines recommend pediatricians:

  • try to see obese children regularlyDo your best to understand and manage all contributing circumstances, and encourage strategies supported by professional organizations, including:
    • drinking less sugar-sweetened beverages
    • Using the recommendations and recipes on myplate.gov
    • engaging children in 60 minutes of moderate to vigorous physical activity per day
    • Usually finding ways to avoid inactivity (sedentary behaviour), such as limiting screen time and encouraging active games.
  • Consider drugs. Several weight loss medications are approved for children. The benefits are modest for all of them and do not take the place of lifestyle changes.
  • Consider surgery.Bariatric surgery may provide the greatest long-term benefit, especially for children or adolescents who are severely obese (BMI in the 120th percentile for age). We tend to think of this more as an option for adults, but growing evidence suggests that surgery should be considered first.

What can families do together?

The Centers for Disease Control and Prevention suggest that families can do four things:

  • Find ways to help kids move more, such as athletics, dance, sports, and active work.
  • Help children and teens get enough sleep.
  • Consider ways to replace Screen Time.

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