Child obesity intervention recommendations leave out medication and surgery, says draft task force report
In a new draft of recommendations, an independent group of experts, known as the Task Force, advises pediatricians to refer children struggling with obesity to intensive behavioral therapy starting from the age of 6. They believe these interventions could bring modest benefits without causing harm.
However, medications for weight loss and surgeries are not included in these recommendations, despite some studies indicating their effectiveness.
The American Academy of Pediatrics (AAP) updated its guidelines earlier this year, recommending both medication and surgery for some patients, particularly those with a high Body Mass Index (BMI). Some doctors argue that relying exclusively on behavioral therapies could be challenging and time-consuming for both the medical professionals and the families.
The Proposed Guidelines
Obesity is defined differently for children than it is for adults. While an adult with a BMI of 30 or higher is considered obese, children who fall into the 95th percentile for their age and gender based on Centers for Disease Control and Prevention growth charts are considered obese.
The Task Force analyzed data from 50 randomized controlled trials showing weight loss in children who participated in intensive behavioral interventions, requiring at least 26 hours of medical expertise assistance per year. Recommended interventions for children and families can include structured exercise programs, group classes, and individual counseling. These interventions aim to promote healthy eating habits, safe physical activity, and behavior modification techniques.
Research shows that children lose more weight with increased physical activity and direct support from medical professionals.
The emphasis on intensive behavioral interventions has met some resistance from a few healthcare providers. Dr. Erin Fennoy, a pediatrician from Columbia University Medical Center, notes that while children might grow out of obesity, the severity often increases the likelihood of continued struggles with health issues.
Obesity is one of the most common chronic illnesses in children, often leading to other health problems later in life, including heart disease, diabetes, and high blood pressure. Many pediatricians report seeing children and adolescents who suffer from conditions previously associated with adults, including Type 2 diabetes, heart disease, and high blood pressure.
Differing Approaches
The new guidelines differ from those of the AAP, which now recommends medication and surgery for certain patients. The Task Force, however, has based its recommendations on the available evidence and stresses the importance of ongoing research in this field.
Dr. John Ruiz, a member of the U.S. Preventive Services Task Force and a professor of clinical psychology at the University of Arizona, emphasizes the need for more data before fully embracing these treatments. While some medications show promise for weight loss, the long-term effects require further examination.
Many pediatricians struggle to offer 26 hours of intensive support per year, which is necessary for these behavioral interventions to be effective. Columbia University Medical Center has demonstrated the effectiveness of their lifestyle intervention programs, but the time commitment and accessibility remain challenges for many families.
Enrichment Data:
The American Academy of Pediatrics (AAP) and the US Preventive Services Task Force (USPSTF) have different approaches to dealing with childhood obesity, reflecting their distinct roles and guidelines.
American Academy of Pediatrics (AAP)
- Pharmacotherapy and Lifestyle Changes:
- AAP recommends the use of glucagon-like peptide-1 (GLP-1) agonists like liraglutide and semaglutide as an adjunct to lifestyle changes in adolescents 12 years of age and older [1].
- The AAP’s clinical practice guidelines for evaluating and treating children and adolescents with obesity emphasize the importance of early treatment to prevent comorbidities such as liver disease, hypertension, dyslipidemia, and diabetes [1].
- Family-Based Behavioral Treatment (FBT):
- AAP supports family-centered, comprehensive, intensive behavioral programs (Family Healthy Weight Programs, FHWPs) for treating children with obesity. These programs incorporate physical activity, healthy eating habits, and age-appropriate behavioral skills [2][3].
- Medications and Surgery:
- While the AAP recommends medications such as GLP-1 agonists for children aged 12 and older, there is no specific mention of surgery as a primary treatment option [1][4].
US Preventive Services Task Force (USPSTF)
- Screening and Interventions:
- USPSTF recommends screening for obesity in children and adolescents aged 6 to 18 years. They also recommend offering or referring these children to comprehensive behavioral interventions to promote improvement in weight status [3].
- Medications and Surgery:
- USPSTF has not issued specific recommendations on the use of medications or surgeries for treating obesity in children [3].
Summary
- AAP: Emphasizes the use of GLP-1 agonists (liraglutide and semaglutide) for children aged 12 and older, alongside lifestyle changes and family-based behavioral treatments. There is no specific mention of surgery as a primary treatment option.
- USPSTF: Focuses on screening for obesity and referring children to comprehensive behavioral interventions. They do not provide specific recommendations on the use of medications or surgery.
These approaches reflect the clinical practice guidelines of the AAP and the public health recommendations of the USPSTF, both addressing childhood obesity from different perspectives.
