New AAP Guideline on Childhood Obesity Raises Concerns

Mar 14, 2023 - By Lucy Li, University of Washington Information School Capstone Student   The recent Clinical Practice Guideline for the Evaluation and Treatment of Children and Adolescents with Obesity published by the American Academy of Pediatrics (AAP) illuminates the importance of the interdisciplinary diagnosis and management of childhood obesity. School nurses, nutrition and dietary practitioners, mental health counselors, behavior interventionists and other social workers ion addition to pediatricians and primary care providers all play a role in treating children with obesity.   The clinical practice guideline (CPG) is the first evidence-based practice (EBP) recommendation from the AAP to treat and manage obesity among children and adolescents. A key treatment recommendation is the 3 to 12 month (a minimum of 26 total hours) Intensive Health Behavior and Lifestyle Treatment (IHBLT) for children 2 years and older. IHBLT refers to the face-to-face consultation on nutrition, physical activity, and behaviors lessons for children and adolescents with obesity and their family. This highlights the significance of not only the healthcare facilities but of the communities and institutions and (including such food and activities in schools and school nurses and nutritionists) in the management of childhood obesity.   What raised concerns in the social media and among healthcare experts are the more aggressive treatment recommendations in the guideline. The CPG acknowledged that childhood obesity is “a common, complex, and often persistent chronic disease associated with serious health and social consequences”. It recommends that healthcare practitioners “may offer children ages 8 through 11 years of age with obesity weight loss pharmacotherapy”. For children 13 years and older, referral to “local or regional comprehensive multidisciplinary pediatric metabolic and bariatric surgery centers” was recommended. According to a New York Times (NYT) report, the intensive behavior, pharmacotherapy, and surgery recommendations are “a significant departure from past advice” that “came as a surprise to many parents”.   The new guideline raised discussions on the society’s weight bias and stigmatization of obesity. Critique of the guideline pointed out that the guideline reinforced the wrong premise that “weight loss is the best path to health and happiness”, quotes one NYT Opinion article. The guideline’s use of BMI as the only indicator ignoring other metabolic signs of health was also critiqued by healthcare experts, including specialists on eating disorders. Obesity is defined as having a Body Mass Index (BMI) greater than or equal to the 95th percentile for the age and sex based on the Center for Disease Control (CDC) growth chart. According to an NPR report, specialists on eating disorders worried that the guideline would “perpetuate deep-rooted, damaging stigma on obesity” by putting “an explicit and misguided focus on weight rather than heath”. Specialists are especially concerned with the difficulty for patients to recover from eating disorders under the weight stigma and the potential life dependency and risks on anti-obesity drugs and bariatric surgery.   Supporters of the new guidelines, however, think that by acknowledging obesity as a disease rather than personal choice, it destigmatizes the bias. According to Clinical Advisor a, semaglutide (brand name Wegovy) also recommended in the CPG, was approved by the FDA in December 2022 based on effective clinical trials for adolescents aged 12 years and older as a chronic weight management medication. But obesity stigmatization, the cost, and the long term need often limit access to obesity drugs like this. The unavailability of intervention services and the cost of drugs often pose obstacles to the treatment of obesity. Thus with the CPG, some hoped that the document could guide healthcare providers to actively treat obesity as a chronic disease and to push insurers, including Medicaid and Medicare, to start paying for such treatments.   In conclusion, the guideline tries to recommend a Comprehensive Obesity Treatment (COT) that involves the participation of, on top of healthcare practitioners, families, schools, and communities from the diagnosis stage. The CPG recommends to “perform initial and longitudinal assessment of individual, structural, and contextual risk factors” that encompasses policies, communities, families, and individual factors that could contribute to obesity in order to design tailored treatment. Most think the AAP’s guideline is a proactive effort to raise awareness for the holistic approach for the management and treatment of childhood obesity.   Users of HEALWA can take advantage of the multi-disciplinary resources contained in the databases when doing research on the subject of childhood obesity.   References

• Hampl, S., Hanssink, S., & Skinner, A. (2023). Clinical Practice Guideline for the Evaluation and Treatment of Children and Adolescents with Obesity. Pediatrics, 151(2).
• Kolata, G. (2023, January 27). Why Experts Are Urging Swifter Treatment for Children With Obesity. The New York Times. https://www.nytimes.com/2023/01/27/health/obesity-children-guidelines.html
• Kyle, T., & Golden, A. (2023, February 7). We Have Better Obesity Medications, but Access Is Lagging. Clinical Advisor. https://www.clinicaladvisor.com/home/topics/obesity-information-center/obesity-medications-access-glp-1/
• Pearson, C. (2023, January 20). New Guidelines Underscore How Complicated Childhood Obesity Is for Patients and Providers. The New York Times. https://www.nytimes.com/2023/01/20/well/family/childhood-obesity-guidelines.html
• Radde, K. (2023, February 15). New childhood obesity guidance raises worries over the risk of eating disorders. NPR. https://www.npr.org/2023/02/15/1155521908/eating-disorder-obesity-guidance-risk-weight-loss
• Sole-Smith, V. (2023, January 26). Why the New Obesity Guidelines for Kids Terrify Me. The New York Times. https://www.nytimes.com/2023/01/26/opinion/aap-obesity-guidelines-bmi-wegovy-ozempic.html