Childhood obesity has become a major public health crisis, not just here in the United States but worldwide. Only one in 10 countries has even a 50% chance of meeting the World Health Organization (WHO) target of no rise in child obesity from 2010 to 2025.
In the U.S., over the last 50 years, there’s been a steady increase in childhood obesity, and now 1 in 5 children between ages 2 and 19 are obese. If this trend continues, more than half of children currently ages 2 to 19 will have obesity into adulthood.
“Obese children become obese adults, which may put them at greater risk for major life-threatening diseases, like diabetes, high blood pressure, high cholesterol and fatty liver disease,” said Gina Montion, MD, a pediatrician with Banner Children's.
For these reasons and more, the American Academy of Pediatrics recently updated its clinical practice guidelines – the first in 15 years – aiming to move away from “watchful waiting” or delayed treatment.
“The traditional approaches of watching and waiting for children to improve their weight or waiting for children to outgrow obesity wasn’t working,” Dr. Montion said. “The AAP has put out new guidelines which aim to provide evidence-based approaches that work better than what we’re currently doing.”
Understanding the new AAP child obesity guidelines
As a parent, you want to do everything to protect your child. There is a lot of information out there swirling on this topic. Dr. Montion helps cut through the clutter and shares four important takeaways for parents and guardians.
Obesity is a chronic disease
“The overlying guideline changes are framed around obesity being a chronic disease, not a behavior, with multiple contributing risk factors, like poor access to healthy foods and safe places for physical activity,” Dr. Montion said.
No one is immune to the risk of growing up at an unhealthy weight. Childhood obesity affects all communities and all categories of race, ethnicity and family income. However, the underlying cause is not as simple as one believes.
Obesity is not just a condition controlled by choices or environmental factors. It also involves multiple biological systems that are in a constant fight to protect us from losing body weight. That’s why diet and exercise don’t work for many.
“Recommendations include treating in a manner that considers one’s socioeconomic and cultural factors that may contribute as well as genetic and biological factors,” Dr. Montion said. “These guidelines take a more ‘whole child’ approach in treating obesity.”
Family-centered advice and support
Health care providers and pediatricians should build partnerships with families in their care and serve as care coordinators, working with a team that includes dietitians, psychologists, exercise specialists and others.
“I liked that the guidelines emphasized that conversations about weight should be appropriate and non-stigmatizing,” Dr. Montion said. “The AAP advises asking permission to discuss the patient’s weight at a visit and motivational interviewing to help promote healthful behaviors. This will likely impact how we speak about obesity at well-checks.”
Emphasized immediate, intensive treatment
The best evidence-based treatment is intensive health behavior lifestyle treatment (IHBLT). The AAP recommends IHBLT when feasible for children ages 6 and older. This involves face-to-face counseling and coaching on nutrition, physical activity and changes in behavior for the whole family system.
Unfortunately, this treatment program isn’t available everywhere, and for many families, the time and financial demands put it out of reach.
The consideration of weight loss medication and surgery
After intensive therapy, weight loss drugs should be considered for adolescents and teens with severe obesity should be evaluated for weight loss surgery.
“The guidelines are controversial for various reasons but primarily because they advocate consideration to start weight loss medications and refer to weight loss surgery,” Dr. Montion said. “All medications and surgeries have risks, and long-term risks may not yet be certain. I think this makes so many of us hesitant to jump right in and follow the guidelines. However, we must consider the risk of having lifelong obesity.”
Only a handful of medications are currently approved to treat obesity in adolescents. Benefits are modest for all of them and work best when it includes lifestyle and nutritional changes.
Bariatric and metabolic surgery may offer the most significant long-term benefits, especially for children or teens who have severe obesity (BMI in the 120th percentile for age). Surgery also includes intensive lifestyle and nutritional changes.
[Also read, “What Does My Body Mass Index Say About My Health?”]
What you can do as a parent or guardian
Though there is no one solution to address obesity, there are things you can do to help your child have a healthy weight and set lifelong healthy habits.
“I always emphasize that the number isn’t important, but the healthy lifestyle habits are what we must focus on,” Dr. Montion said.
The Centers for Disease Control and Prevention (CDC) share these four actions you can take:
- Try to model healthy eating patterns
- Find ways to move more together
- Help children and teens get enough sleep
- Limit screen time and use
The overlying AAP guideline changes reframe obesity as a chronic disease, not a behavior. In addition, recommendations consider one’s socioeconomic and cultural factors, a ‘whole child’ approach to care, earlier and more intense treatment, and considerations for using weight loss medication or bariatric surgery.
Is your child struggling with weight-related concerns or obesity?
Schedule an appointment with a pediatrician near you.