Childhood Obesity Epidemic: New Treatment Guidelines Urge Early, Strong Intervention

Nearly 20 percent of children and teens in the U.S. have a high BMI (body mass index) that qualifies them as being obese. The new year, however, is ushering in new or updated medical guidelines to help fight the childhood obesity epidemic.

Last month,  the U.S. Preventive Services Task Force (USPSTF) issued first-draft guidelines urging doctors to take extensive steps to help obese children better manage their weight to avoid potentially serious health issues as they get older. Earlier in 2023, the American Academy of Pediatrics (AAP) has updated its guidelines for treating childhood obesity for the first time in 15 years, stressing that there is “more evidence than ever” that early and aggressive treatment of obesity in children and adolescents is “safe and effective.”

The new guidance comes as the number of people under age 20 with type 2 diabetes in the U.S. is likely to surge by nearly 7-fold by the year 2060 – fueled mostly by the ongoing childhood obesity epidemic, according to a modeling study just published that is supported by the U.S. Centers for Disease Control and Prevention (CDC) and the National Institutes of Health.

The Task Force recommends that "clinicians provide or refer children and teens with a high BMI to intensive, comprehensive behavioral interventions."  The recommendation applies to children and adolescents age 6 years and older with a high BMI. A child’s BMI is calculated based on height and weight and is plotted on a growth chart. Obesity is defined as a BMI at or above the 95th percentile for age and sex on the growth chart, states the Task Force. The USPSTF is a widely followed, independent panel of national experts in prevention and evidence-based medicine.

Evidence-based recommendations on medical care for those aged 2 and older are included within a new “Clinical Practice Guideline for the Evaluation and Treatment of Children and Adolescents With Obesity,” published in Pediatrics. The AAP reiterates that Intensive behavioral and lifestyle changes should continue to be the initial approach taken to combat childhood obesity. But, for the first time, the AAP is setting age-based recommendations for providing anti-obesity medications, and possibly surgery, for some patients.

Adolescents, ages 12 years and older, should be evaluated for medications as “an adjunct to health behavior and lifestyle treatment,” the AAP said. Teens, ages 13 and older, with severe obesity (BMI equal to 120 percent of the 95th percentile for age and sex) “should be evaluated for metabolic and bariatric surgery,” the AAP adds.

Nonetheless, lifestyle modifications covering nutrition and regular physical activity remain at the forefront of treatment. “Intensive health behavior and lifestyle treatment, while challenging to deliver and not universally available, is the most effective known behavioral treatment for child obesity,” the AAP states.

Javier A. Hiriart, M.D., a pediatrician and internal medicine physician with Baptist Health Primary Care, Family Medicine Center at West Kendall Baptist Hospital.

“Parents should understand that these guidelines have been updated because more needs to be done to combat obesity in children, which is the biggest contributor to other serious underlying health conditions – diabetes being the most common issue,” said Javier A. Hiriart, M.D., a pediatrician and internal medicine physician with Baptist Health Primary Care, Family Medicine Center at West Kendall Baptist Hospital.. “It always starts with lifestyle modifications. But if weight issues persist, intervention with medication therapy or other treatments may be necessary.”

The AAP describes the role of a pediatrician or primary care physician in overseeing intensive and long-term care strategies, ongoing medical monitoring, and treatment of youth with obesity.

“There is no evidence that ‘watchful waiting’ or delayed treatment is appropriate for children with obesity,” said Sandra Hassink, M.D., an author of the guidelines and vice chair of the Clinical Practice Guideline Subcommittee on Obesity, in a statement. “The goal is to help patients make changes in lifestyle, behaviors or environment in a way that is sustainable and involves families in decision-making at every step of the way.”

According to the most recent update from the CDC on children and adolescents aged 2-19 years, the prevalence of childhood obesity was at about 20 percent, and affected about 15 million children and adolescents. But those statistics are derived before the COVID-19 pandemic began in early 2020. Most indicators point to an increase in childhood obesity since the pandemic. Obesity prevalence was even higher among minorities: 26 percent among Hispanic children and 25 percent among non-Hispanic Black children, the CDC states. 

In a news release, the AAP states that the guidelines also address “increased risks for children with special health care needs, as well as inequities that promote obesity in childhood, such as the marketing of unhealthy food, low socioeconomic status and household food insecurity.”

“Physical fitness has too many benefits to ignore, including helping to increase focus in school, improve sleeping habits and promote overall health,” says Dr. Hiriart. “It starts with decreasing ‘screen time’ on TVs, laptops and smartphones and increasing physical activity.”

U.S. guidelines call for children 6 years and older to get at least 60 minutes a day of physical activity. This can include participating in team sports, going to park, playground or walking/bicycle trails, dog walking, or opting for walking more often as a family to a destination, rather than driving, according to the AAP.