Clinical Guidelines for Pediatric Obesity Encourage Early Intervention

On January 9, 2023, the American Academy of Pediatrics (AAP) released its clinical practice guidelines for evaluating and treating pediatric obesity. These updated practices encourage comprehensive obesity treatment (COT) for pediatric populations, considering factors that contribute to health equity — or inequity — such as racism, access to care, weight bias, stigma, and adverse childhood experiences.

The new guidelines clarify that COT should include longitudinal treatment, evaluations and long-term monitoring of comorbidities, identifying and addressing social determinants of health, a non-stigmatized approach tailored to the patient and their family, motivational nutrition discussions, integrative approaches to weight management — which may incorporate pharmacotherapy or surgical interventions, and collaborative treatment goals that extend beyond BMI reduction.

Of the many guidelines proposed, one focused on individualized approaches for evaluating and assessing patients based on individual, structural, and contextual risk factors. Recognizing the potential benefits of using BMI while acknowledging its concurrent harms, providers are encouraged to take a more comprehensive approach and be mindful of their rhetoric when discussing body weight.

The AAP notes that the evaluation of obese or overweight patients should include a complete medical history with a chief complaint, a history of present illness, a family history, and a medication history. Providers should also gather information on social history, nutrition, physical activity history, and behavioral health or disordered eating concerns. Combined with a physical assessment, these factors may allow providers to determine the most effective treatment strategies.

Part of developing these guidelines required an in-depth analysis of risk factors and other components that contribute to the development of diabetes. The AAP compiled data on the genetic component of obesity, including medical conditions and family history. Additional research focused on biological, environmental, and social factors. Researchers even analyzed how policy can impact obesity trends.

The AAP notes in the guidelines that “Understanding the underlying genetic, biological, environmental, and social determinants that pose risk for obesity is the bedrock of all evaluation and intervention. Allowing the family to have a safe space to understand and process the complexity of obesity and its chronicity requires tact, empathy, and humility. Achieving this goal enables the patient and family to gain the knowledge and understanding needed to recognize risk factors in their environment and behaviors, to honor cultural preferences, and to institute changes independently as well as under the guidance of a trusted and well-trained advocate.”