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American Academy of Pediatrics Recommends 'Early and Aggressive' Treatment for Childhood Obesity

The medical body's new guidelines recommend medical and surgical intervention

Children considered to be obese could now undergo surgical or medical intervention in compliance with new guidelines released by the American Academy of Pediatrics.

After years of saying parents and guardians should wait until a child goes through puberty to see if his or her body weight normalizes, the medical group is now backing “early and aggressive” treatment. Obese children are now eligible to undergo surgery at age 12 or to be prescribed medicine at age 13 to help them lose weight.

Long stigmatized as a reversible consequence of personal choices, obesity has complex genetic, physiologic, socioeconomic, and environmental contributors,” states the AAP.

“Obesity is long-lasting and has persistent and negative health effects, attributable morbidity and mortality, and social and economic consequences that can impact a child’s quality of life,” the new guidance continued. “Because obesity is a chronic disease with escalating effects over time, a life course approach to identification and treatment should begin as early as possible and continue longitudinally through childhood, adolescence, and young adulthood, with transition into adult care.”

This is the first time in 15 years the AAP has updated its guidance regarding childhood obesity.

“Waiting doesn’t work,” said Dr. Ihuoma Eneli, the co-author of the new guidance, per AP News. “What we see is a continuation of weight gain and the likelihood that they’ll have (obesity) in adulthood.”

Medicine and surgery will be offered in addition to other treatments, including lifestyle interventions, diet, and exercise.

The AAP says 14.4 million American children and teens are considered to be obese. According to its research, “weight loss pharmacotherapy and metabolic bariatric surgery are evidence-based obesity treatment modalities that should be available and offered to patients” because of the “complex nature of obesity management.”

Furthermore, the AAP says children’s referral appointments for these surgeries, as well as the surgery itself, related hospitalization, and pre- or post-operative care should be covered by health insurance.

Metabolic and bariatric surgery can include laparoscopic Roux-en-Y gastric bypass and vertical sleeve gastrectomy.

The organization found that 15% of minors who underwent metabolic and bariatric surgery and experience complications reported issues shortly after surgery. These complications included postoperative nausea and dehydration. About 8% of patients report a major complication within 30 days of the surgery.

The organization said more research must be conducted before it will recommend obese children under the age of 12 be referred for this type of surgical intervention. 

For medical information, the AAP recommends a number of options including the ADHD medication Lisdexamfetamine to treat children with binge-eating disorder, intestinal lipase inhibitor Orlistat, which blocks fat absorption, and a three-month course of the norepinephrine uptake inhibitor Phentermine.

“Although so much has been learned to advance the treatment of children and adolescents with overweight and obesity, there is still so much we have yet to discover,” the authors of the guideline noted.

According to the Centers for Disease Control and Prevention, 12.7% of 2- to 5-year-olds, 20.7% of 6- to 11-year-olds, and 22.2% of 12- to 19-year-olds were obese between 2017 and 2020. Childhood obesity is most common among Hispanic children (26.2%) and Black Children (24.8%). Just less than 17% of non-Hispanic White Children were obese as were 9% of Asian children.

Obesity is linked to high blood pressure, high cholesterol, asthma, sleep apnea, joint problems, and type 2 diabetes.

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