Obesity in kids: American Academy of Pediatrics pushes for more aggressive treatments up to drugs and surgery – cleveland.com

The expanding waistlines of American children is a growing problem – one that requires immediate attention, according to the American Academy of Pediatrics. PN
CLEVELAND, Ohio— The expanding waistline of American children is a growing problem – one that requires immediate attention, according to the American Academy of Pediatrics.
The largest professional association of pediatricians in the United States earlier this month released the first comprehensive guidelines in 15 years for evaluating and treating children with obesity.
And, in contrast to advice given by many physicians over the last decade and a half, it makes clear that there is no benefit to the “wait and see” approach when it comes to obesity in children.
Instead, the organization calls for addressing the problem of obesity in children age 2 and up head-on, and outlines strategies for behavioral and lifestyle interventions, as well as treatments with drugs and surgery.
“There is no evidence that ‘watchful waiting’ or delayed treatment is appropriate for children with obesity,” Dr. Sandra Hassink, an author of the guidelines and vice chair of the Clinical Practice Guideline Subcommittee on Obesity, said in a statement released by the AAP.
“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.”
The report highlights evidence that obesity treatments are safe and effective for the more than 14.4 million U.S. children and teens who live with the chronic disease, and proactive treatment is essential to preventing the serious short- and long-term health concerns it is associated with, including cardiovascular diseases and diabetes.
The report coincides with research that those diseases in young people are expected to surge.
A study published at the end of December in the academic journal Diabetes Care predicted that the number of people under age 20 with type II diabetes could increase as much as 700% over the next four decades. Type I diabetes in children could see an increase of as much as 65% over the same time period.
Type II diabetes has substantially increased among young people over the last two decades, says the CDC. If the upward trend continues, more than half a million young people may have diabetes (type I and type II) by 2060, more than double the number of young people with diabetes in 2017.
One explanation for the rise in type II diabetes, say researchers, is the increase in childhood obesity, but the presence of diabetes in women of childbearing age might be another important factor. Maternal diabetes increases risk of diabetes in children.
“Increases in diabetes — especially among young people — are always worrisome, but these numbers are alarming,” Christopher Holliday, director of CDC’s Division of Diabetes Translation, said in a press release from the CDC about the research findings.
“This new research should serve as a wake-up call for all of us. It’s vital that we focus our efforts to ensure all Americans, especially our young people, are the healthiest they can be,” said Debra Houry, acting principal deputy director for the CDC.
“The COVID-19 pandemic underscored how critically important it is to address chronic diseases, like diabetes. This study further highlights the importance of continuing efforts to prevent and manage chronic diseases, not only for our current population but also for generations to come.”
The new guidelines take aim at the diabetes and cardiovascular disease by addressing the root cause: obesity.
The guidelines redefined comprehensive obesity treatment to include nutrition support, physical activity treatment, behavioral therapy, as well as medication, and metabolic and bariatric surgery for older children above a certain Body Mass Index, or BMI.
According to the report, the most effective treatments include intensive health behavior and lifestyle treatments with at least 26 hours of face-to-face time with the family and trained health practitioners over three to 12 months.
When these treatments are delivered by trained health care professionals and a parent or caregiver is actively involved, they can result in less disordered eating with no risk of harm the AAP said.
The new guidelines also said physicians should offer adolescents ages 12 years and older with obesity weight loss medication options together with the health behavior and lifestyle treatments. Furthermore, especially obese teenagers should be evaluated for metabolic and bariatric surgery starting at age 13.
Ryan Farrell, a pediatric endocrinologist at University Hospitals said the report is a big deal because it marks the first time that the organization has recommended treatment with either medications or bariatric surgery in to treat obesity in children.
“It’s been recommended by other governing bodies and institutions, but the American Academy of Pediatrics is very well recognized. And to have them put their backing behind it is I think very meaningful,” Farrell said.
He said that the weight loss drugs that may be prescribed in children primarily are well-studied drugs that have a history of use in patients with diabetes. These include Orlistat, metformin, and a class of medications called GLP1 receptor agonists that are injected daily or weekly to decrease appetite and slow how fast food moves through the gut.
These medications, Farrell said, tend to really work very well. But he said the question he expected people to ask long term is how long children will need to stay on them, because research in adults has shown that stopping these medications tends to result in the patient regaining a significant amount of weight.
“The answer I think still remains to be seen,” said Farrell, adding that one possibility may include prescribing a higher dose to start followed by a lower, but permanent maintenance dose.
However, the rebound weight gain that has been seen after these medications are stopped contradicts the common stigma that the problem of obesity is merely an issue of self-control.
“It’s very clear that there’s a biological process going on here that is either environmentally influenced or programmed through a combination of environment and genetics,” Farrell said.
the AAP also encourages payment and public health policies that cover comprehensive obesity prevention, evaluation, and treatment, and policy changes that address structural racism that drives alarming and persistent disparities in childhood obesity.
“The medical costs of obesity on children, families and our society as a whole are well-documented and require urgent action,” said Dr. Sarah Hampl a lead author of the guidelines.
“This is a complex issue, but there are multiple ways we can take steps to intervene now and help children and teens build the foundation for a long, healthy life.”
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