New Guidelines For Childhood Obesity Include Early Medical And Surgical Intervention
Obesity is a complex chronic disease and should be treated as such — without the stigma.
Children with obesity should be offered more intensive treatment options, including medications for kids as young as 12 and surgery for those 13 and older, according to the American Academy of Pediatrics (AAP).
On Jan. 9, the U.S. medical group put out new guidance on childhood obesity for the first time in 15 years, urging both doctors and policy makers to take action in combating childhood obesity, which affects 14.4 million children — roughly 20% of kids — in the U.S. Untreated, childhood obesity can lead to both short- and long-term medical issues, including diabetes, heart disease, and depression.
“Obesity is a complex chronic disease, obesity itself,” Dr. Sandra Hassink, MD, an author of the guideline and vice chair of the Clinical Practice Guideline Subcommittee on Obesity, tells Scary Mommy. “And that's a big message, because it's a reframe on what many people think about obesity.”
Previously, parents of children with obesity, along with their pediatricians, were advised to use “watchful waiting,” or closely monitoring a patient's condition but not going forward with treatment unless symptoms change or appear. Now, the AAP recommends safe and evidence-based treatments for childhood obesity.
“There is intense health and behavior, lifestyle treatment, which is evidence-based and effective, as pharmacotherapy evidence-based and effective, and there's metabolic bariatric surgery, evidence-based and effective,” Dr. Hassink explains of the newly recommended treatment guidelines.
The AAP’s new guidelines promote a much more holistic approach to combating childhood obesity, which includes “motivational interviewing, intensive health behavior and lifestyle treatment, pharmacotherapy and metabolic and bariatric surgery,” and “considers the child’s health status, family system, community context, and resources.”
“This really takes a whole child approach,” says Dr. Hassink. “This is way beyond weight — way, way, way beyond weight, or BMI. So we're looking at the whole child with an intense interest here in how the whole child is doing, how their baseline health is, what effects obesity has had on their body systems.
“What are the psychological effects from being bullied or teased? Or weight stigma? What are the mood affects? How this is going to affect how they're functioning in their daily life? What context do they live in? And how easy or hard is it to grapple with this, depending on their social determinants of health? Are your investment community? And how can we help your family?” Dr. Hassink explains.
According to the guidelines, the most effective treatment includes up to 26 hours of intensive lifestyle interventions between a 3- to 12-month period. This approach is recommended to children 6 and older, but can be recommended to children as young as 2.
Medical intervention is deemed appropriate to children 12 and older who have undergone this treatment or whose case requires immediate and intense intervention. On Dec. 23, 2022, the FDA approved Wegovy (semaglutide), a drug used to treat diabetes, as a weight loss treatment for children 12 and over. It is the first once-weekly weight loss drug, taken via injection, approved for adolescents. It was previously approved for use in adults in June 2021.
For those 13 and older, the AAP recommends weight loss surgery, including pharmacotherapy and metabolic and bariatric surgery. Like with Wegovy, the AAP recommends children with obesity to undergo lifestyle intervention treatment before considering surgery, unless recommended by health professionals.
Of course, the type of intervention can be costly, and not always covered by insurance. The AAP acknowledges, obesity is a complex issue that “complex genetic, physiologic, socioeconomic, and environmental factors are at play,” and that these guidelines are not only meant to help treat children with obesity, but also help eliminate the stigma associated with obesity, which can lead to its own set of health issues.
“It's a reframe for everybody here,” Dr. Hassink says of not only insurance company and community-based policies, but also of the cultural beliefs and stigmas surrounding obesity. “If I said to you that we have treatments for cancer, nobody would ask if an insurance company is covering cancer treatment. They would cover it because cancer is a complex chronic disease.”
Fortunately, Dr. Hassink notes that a lot can be done in terms of treating childhood obesity in their primary care pediatrician’s office.
“We have to reframe this in the minds of the healthcare system, the insurers, the pediatric health care providers, and the families to demystify and remove blame and guilt and say [obesity] is a complex chronic disease, and there’s help available,” Dr. Hassink explains, adding, “So the question — the real issue — is how do we reframe this in a way that just makes it inherently inherently right and obvious to treat to to fund to pay for treatment of a complex chronic disease?”
Still, the stigma is real, and parents with children who have obesity might find it difficult to discuss the topic. “Pediatricians now have become much more savvy about the social determinants of health, and are often asking about food insecurity, or housing or energy. So a lot can be done in the pediatricians office right out of the gate.”
“I think really, as a parent, you talk to your child about health,” Dr. Hassink says. “The conversation goes something like this: We really want to stay healthy as a family, we want to all be healthy, right? And we're going to make sure we are, we're going to go to the pediatrician and make sure that you know you're healthy. We're going to make changes in the family if we need to, to make sure you stay healthy,” she explains, adding that the conversation shouldn’t be so much about weight but about family health. “The family mobilizes around the child, the talk is not about weight, it's about getting as healthy as we can be.”
And for any parent who feel guilt or shame about having a child with obesity, Dr. Hassink explains that parents should feel empowered to talk to their child’s pediatrician about any potential worries — that’s part of fighting the stigma. “I think that up till now, parents [may] have felt reluctant to have this conversation, because they're afraid of blame, right?” she says, reiterating that obesity is a complex chronic disease.
“I just would like families to feel our care here — just our care — and love and concern for them,” Dr. Hassink says. “We want to help them. We are intensely interested in the health of their children and we care deeply that children get access to the treatment they need.”