In its first comprehensive guide to treating childhood obesity in more than 15 years, the (AAP) recommends doctors offer adolescents more intensive interventions sooner, including weight loss medications and even surgery. But it is unclear whether the recommendations will adequately address paediatric obesity.
Childhood obesity rates in the US have nearly quadrupled since the 1960s and current estimates suggest more than in the US have obesity. Previously, doctors waited to see if children outgrew the condition before initiating treatment. But now, the AAP recommends intervening as soon as possible, sometimes as early as 2 years old.
They recommend counselling on nutrition and physical activity for children and their families. In a technical report, at Children’s Mercy Kansas City Hospital in Missouri and her colleagues reviewed more than 200 studies of childhood obesity treatments and found that interventions with at least 26 hours of counselling were the most effective for lowering a child’s body mass index (BMI) – a score based on a person’s weight and height . On average, these programs reduced a child’s BMI by . Depending on a child’s BMI, that may not change their obesity diagnosis.
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A from 2017 similarly found these programs are effective for lowering BMI, though the absolute amount of weight loss varied widely. Still, many of the children who didn’t have counselling continued gaining weight, so they may prevent additional weight gain. “A lot of families expect their child to lose 10 pounds, but even flattening the body mass index curve is important for their health,” says at Harvard University.
Obesity is defined as an excess accumulation of fat that increases the risk of other chronic health conditions – such as heart disease, type 2 diabetes and depression – which suggests successful treatment must decrease body fat. The AAP guidelines suggest pairing these interventions with weight loss drugs for children as young as 12. The technical report accompanying the guidelines found that medications are about as effective as intensive lifestyle counselling for lowering BMI.
That brings up a real concern: if the medications are not outperforming counselling, are we rushing to use them? These drugs may need to be used indefinitely, as people who stop them tend to regain weight. And it is unclear what the long-term health effects are, as most trials on the medications only lasted six months or less.
The AAP also recommends children 13 years and older with severe obesity – having a BMI greater than 35 – be evaluated for weight loss surgery. One study of 242 adolescents found that , weight decreased by more than 25 per cent, on average. Remission of type 2 diabetes also occurred in 95 per cent of those with the condition.
While the guidelines are a much-needed update from the previous recommendations, they underscore just how little we know about childhood obesity. For instance, the AAP still recommends using BMI to diagnose obesity despite the metric’s well-known limitations – for example, it doesn’t differentiate between muscle and fat mass, and it fails to account for the influences of race on body composition. Weight change alone also isn’t a perfect measure, because healthy children are expected to gain weight as they grow.
The guidelines reveal a bigger issue in Western culture, which is the assumption that all excess fat is bad. “It’s very possible to have a BMI that is high [and] have a higher percentage of fat tissue and still be at a healthy functioning state,” says at the American Occupational Therapy Association. We need to know more about when excess body fat increases the risk of health conditions and when it doesn’t. Otherwise, we risk prescribing treatments like weight loss medications to children who don’t need them.
Still, the guidelines mark an important shift. For instance, they stress that obesity is not a consequence of personal lifestyle choices, but a combination of genetic, socioeconomic and environmental factors. They emphasise the need for significant policy changes that tackle food insecurity, pollution and healthcare inequities, which all contribute to childhood obesity. They also offer healthcare providers clear guidance on how to discuss childhood obesity in a way that doesn’t stigmatise the condition. That is a step in the right direction.
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