For the first time in 15 years, the American Academy of Pediatrics updated its recommendations regarding childhood obesity.
The American Academy of Pediatrics on Monday released new guidelines for treating childhood obesity, emphasizing the need for early and intensive treatment for the first time in 15 years.

According to data from the Centers for Disease Control and Prevention, rates of childhood obesity have continued to rise over the past decade and a half, rising from 17% to 20%. Obesity rates among children have tripled and adolescents have quadrupled since the 1980s.

Dr. Joan Han, a professor and chief of the Division of Pediatric Endocrinology and Diabetes at Mount Sinai Kravis Children’s Hospital who was not involved in the new report, stated that the pandemic had a negative impact. In comparison to pre-pandemic years, the rate of weight gain nearly doubled in 2020, according to a CDC report.

According to data from the CDC, obesity affects nearly 15 million children and teens in the United States. In addition to having negative effects on physical health like Type 2 diabetes and high blood pressure, excess weight also has a negative impact on mental health.
The new guidelines emphasize that obesity is a complicated, long-term condition for which there is no easy solution. The AAP includes recommendations for the first time for anti-obesity medications and surgery in addition to intensive behavioral and lifestyle changes as the first-line approach. The flurry of recent drug approvals and research has prompted these novel recommendations.

We now have proof that obesity therapy works. The medical director of the AAP Institute for Healthy Childhood Weight and co-author of the new guidelines, Dr. Sandra Hassink, stated, “There is treatment, and now is the time to recognize that obesity is a chronic disease and should be addressed as we address other chronic diseases.”

Getting involved as soon as possible is a part of that. According to the guidelines, there is no evidence that so-called watching, waiting, or delaying appropriate treatment is advantageous.

According to the new guidelines, working with pediatricians and other health care providers on changes to behavior and lifestyle should be the first step for children who are obese and are between the ages of 2 and 5 in some cases. Experts acknowledge that this can be challenging for families, but it is most effective when it includes at least 26 hours of face-to-face counseling over the course of about a year.

One of the most significant changes to the recommendations for children aged 12 and up is the inclusion of weight-loss surgery and anti-obesity medications alongside lifestyle changes.

In recent years, more and more studies have shown that a person’s weight is not just determined by their diet and amount of physical activity; The way a person uses and stores energy can also be affected by genes and hormones. New drugs have been developed on the basis of this new understanding.

“People started to realize that there are hormones made in the gut that have multiple roles related to obesity. This was the breakthrough that happened in the last few years. Han stated, “Medications can help people feel fuller more quickly and help stabilize insulin levels by targeting these.”

According to the guidelines, pediatricians should prescribe medications to help obese children over the age of 12 lose weight.

Orlistat, Saxenda, Qsymia, and Wegovy are the four medications that have been approved for the treatment of obesity in adolescents beginning at the age of 12; phentermine is the only medication that has been approved for use in adults over the age of 16. Another medication, called setmelanotide (brand name Imcivree), has been supported for youngsters age 6 and more seasoned who have Barde-Biedl disorder, a hereditary sickness that causes heftiness.

The FDA approved Wegovy in late December for adults over the age of 12 after it gained popularity as a weight-loss medication last year. The results of a clinical trial that were published in the New England Journal of Medicine showed that kids over the age of 12 could reduce their body mass index by about 16% with a weekly injection of the drug and healthy eating and exercise habits, as opposed to just over 0.5 percent in a group that took a placebo.

However, not everyone has access to the new drugs.

Han stated, “The problem with these medications is that they are very expensive and insurance often does not cover them.” He further stated that a supply of Wegovy for one month can cost as much as $1,500, which is beyond the means of the majority of families.
The guidelines also suggest that teens with severe obesity over the age of 13 talk about weight loss surgery, which has been shown to be a safe, effective, and long-lasting treatment.

Han advised, “For many things, the sooner the better.” Bariatric surgery has been shown to be effective in reversing health problems like Type 2 diabetes and high blood pressure in children, so it should be considered for them.

The AAP’s holistic approach emphasized that medications and surgery should only be considered in exceptional circumstances when lifestyle changes prove ineffective for individual patients.

She also acknowledged that these lifestyle adjustments can be extremely challenging to implement, particularly for overworked parents with low incomes.

Hassink stated, “There is work being done, but we can safely say that we are all living in an environment that tends to promote obesity across the board.”

The guidelines emphasize treating obesity holistically. This entails taking a child’s entire life into account, taking into account not only their diet and activity levels but also their mental health, their environment, and the social injustices they face.

There are a great number of environmental factors that contribute to obesity. According to Hassink, it is more difficult to maintain a healthy lifestyle in a negative environment.

Change that is observable will necessitate significant changes that are frequently beyond a family’s control.

We can recommend eating more vegetables and engaging in more enjoyable physical activity. Dr. Roy Kim, a pediatric endocrinologist at Cleveland Clinic Children’s in Ohio, stated, “These recommendations are not realistic if a person’s neighborhood does not have sidewalks or parks to walk in.”

Although obesity prevention will be addressed in future guidance, the new guidelines emphasize the importance of investing in obesity prevention-focused public health policies. This includes making neighborhoods that are walkable and safe, equipping schools with the resources they need to encourage healthy habits in children, and making sure everyone has equal access to affordable healthy food, which is currently not the case.

We must make walking areas comfortable, easy, and safe. Han stated, “We need to figure out ways to leverage existing opportunities for people to exercise and access cheap and convenient healthy food.”

She also emphasizes the significance of health care facilities that serve as “one-stop shops,” bringing together psychological, nutritional, and other specialties under one roof to make it simpler for families to obtain the assistance they require for their children.

Nonetheless, she stated, “it will take a whole society to make this possible.”

Surgery and medications cost a lot of money, and expecting overworked parents to make lifestyle changes is not always possible. “The best, most effective, safest, and most economical approach will always be prevention,” Kim stated, despite the significant recent drug breakthroughs in the treatment of obesity.