Children with obesity should get proactive treatment: American Academy of Pediatrics guidelines

The AAP said it's a disease with genetic, social and environmental factors

January 9, 2023, 12:01 AM

Children and adolescents should be proactively evaluated and treated for obesity, according to new guidelines from the American Academy of Pediatrics around childhood obesity.

The guidelines note that treatments, including medications and weight loss surgery, can be effective and can help reduce the risk of developing other health conditions.

The AAP also said childhood obesity is a disease with genetic, social and environmental factors — not something caused by individual choices — and that it shouldn't be stigmatized by health care providers.

"Weight is a sensitive topic for most of us, and children and teens are especially aware of the harsh and unfair stigma that comes with being affected by it," Dr. Sarah Hampl, a lead author of the guidelines and pediatrician and weight management specialist at Children's Mercy of Kansas City, said in a statement. "Our kids need the medical support, understanding and resources we can provide within a treatment plan that involves the whole family."

One in 5 U.S. children and teens are living with obesity, according to the Centers for Disease Control and Prevention. Obesity is a serious condition that, if left untreated, can lead to long-term health problems.

Overweight and obesity are diagnosed after a doctor uses height and weight to calculate body mass index, or BMI. The tool compares a child's weight and height to other children of the same age and sex. Overweight means having BMI 85% greater than others their age and gender, while obese children are at or above 95%. BMI is an imperfect tool, but can still help doctors identify concerns for patients, experts said.

Children with obesity are at a higher risk for diseases such as type 2 diabetes, heart disease, obstructive sleep apnea, and depression.

Doctor examining an overweight boy
Elena Bessonova/Getty Images/iStockphoto, FILE

Pediatricians should screen children with obesity for those and other conditions at routine checkups, the AAP said in the new guidelines.

Reducing BMI with treatment can help prevent those other health problems, according to the AAP.

Previous AAP guidelines, released in 2007, recommended a "watchful waiting" approach to childhood obesity. But evidence collected over the past decade showed that there's no benefit to delays, and that weight loss treatments are effective for children and adolescents. The new guidelines recommend they be used for all children over the age of 2 with overweight and obesity.

Children 6 years and older can receive monthly behavioral therapy to help them make long-lasting health changes, according to the new guidelines. Teens may be eligible for weight loss medications, along with continued diet and exercise. And for teens with severe obesity, weight loss surgery is a safe and effective option.

The AAP recommends treating overweight and obesity like a chronic condition. For effective treatment, parents and children may need to see their doctor on a regular basis.

All services for children and teens should also be carried out in a way that is mindful of patients' culture and language preference, the guidelines say. By working with families to identify personal beliefs, risk factors, and challenges, pediatricians can provide a personalized plan for treatment.

Parents should talk to their child's pediatrician to make any additional health and lifestyle changes, but can model and encourage healthy eating and physical activity for their children, the AAP said.

Cooking with children can make them excited about healthy eating. Preparing meals with vegetables, fruits, and grains can provide a balanced diet. Children should be encouraged to stay active daily or get involved in sports.

While childhood obesity is common, the AAP said many children, teens and parents face weight-based stigma — even though many factors contributing to obesity, like genetics and structural racism, are outside of individual control. The new AAP guidelines call on pediatricians and other health care providers to avoid stigmatizing language when discussing weight with patients.

The organization is also calling for policy changes that could help reduce racial disparities in childhood obesity, including improving access to healthy foods and treatments for groups at greatest risk.

Karra Maniér, MD is a member of the ABC News Medical Unit and a resident physician at Los Angeles County + University of Southern California Medical Center.

Nicole McLean MD, MPH, is a member of the ABC News Medical Unit and a resident physician in pediatrics at Columbia University/New York-Presbyterian.

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