13 Key Action Steps on Pediatric Obesity Evaluation and Treatment: An American Academy of Pediatrics Guideline Topline
The American Academy of Pediatrics on January 9 published landmark recommendations on the evaluation and treatment of obesity in children and adolescents that propose proactive assessment by pediatricians and other pediatric health care providerss and "immediate, intensive" treatment as soon as a diganosis is made.
The comprehensive guideline incorporates data collected over more than a decade on health equity, structural racism, social determinants of health, and weight bias and stigma in addition to the leading evidence on the physiology of the disease of obesity and on new and emerging treatments.
The following guideline topline highlights the AAP's Key Action Statements -- recommendations based on evidence from RCTs and comparative effectiveness trials as well as longitudinal and epidemiologic studies.
The CPG writing Subcommittee uses the term “pediatricians and other pediatric health care providers” to include both pediatric primary and specialty care physicians and other medical providers as well as allied health care professionals, since all will encounter and can intervene with children with overweight, obesity, and obesity-related comorbidities.
In the upper right corner of each slide are noted the Grade of Evidence (A, B) assigned to the evidence associated with the statement followed by the strength of the recommendation (Strong, Moderate).
AAP Pediatric Obesity Guideline - Key action statement #1 …measure height and weight, calculate BMI, and assess BMI percentile using age-and sex-specific CDC growth charts or growth charts for children with severe obesity at least annually for all children aged 2 –18 yrs to screen for overweight, obesity, and severe obesity.
AAP Pediatric Obesity Guideline - Key action statement #2 ... evaluate children aged 2 – 18 yrs with overweight and obesity for obesity-related comorbidities using patient history, mental/behavoral health screening, SDoH eval, PE, diagnostic studies.
AAP Pediatric Obesity Guideline - Key action statement #3 ... …in children aged ≥10 yrs, evaluate for lipid abnormalities, abnormal glucose metabolism, and abnormal liver function in children and adolescents with obesity and for lipid abnormalities in those with overweight.
AAP Pediatric Obesity Guideline - Key action statement #3.1 ... In children aged ≥10 yrs with overweight, clinicians may evaluate for abnormal glucose metabolism and liver function in the presence of risk factors for T2DM or NAFLD.
AAP Pediatric Obesity Guideline - Key action statement #4 ...treat children and adolescents for overweight or obesity and any comorbidities concurrently.
AAP Pediatric Obesity Guideline - Key action statement #5 ...evaluate for dyslipidemia by obtaining a fasting lipid panel in children aged ≥10 yrs with overweight and obesity.
AAP Pediatric Obesity Guideline - Key action statement #6 ...evaluate for prediabetes and/or diabetes mellitus with: Fasting plasma glucose or 2-h plasma glucose after 75-g OGTT or glycosylated hemoglobin (HbA1c).
AAP Pediatric Obesity Guideline - Key action statement #7 ...evaluate for NAFLD by obtaining an alanine transaminase (ALT) test.
AAP Pediatric Obesity Guideline - Key action statement #8 ...evaluate for hypertension by measuring blood pressure at every visit starting at age 3 yrs in children and adolescents with overweight and obesity.
AAP Pediatric Obesity Guideline - Key action statement #9 ...treat overweight and obesity in children and adolescents, following the principles of the medical home and the chronic care model, using a family-centered and nonstigmatizing approach that acknowledges obesity’s biologic, social, and structural drivers.
AAP Pediatric Obesity Guideline - Key action statement #10 ... use motivational interviewing to engage patients and families in treating overweight and obesity.
AAP Pediatric Obesity Guideline - Key action statement #11 ... provide or refer children aged ≥6 yrs (Grade B) and may provide or refer children aged 2 to 5 yrs (Grade C) with overweight and obesity to intensive health behavior and lifestyle treatment. Health behavior and lifestyle treatment is more effective
with greater contact hours.
AAP Pediatric Obesity Guideline - Key action statement #12 ...offer adolescents aged ≥12 yrs with obesity weight loss pharmacotherapy, according to medication indications, risks, and benefits, as an adjunct to health behavior and lifestyle treatment.
AAP Pediatric Obesity Guideline - Key action statement #13 ...offer referral for adolescents aged ≥13 yrs with severe obesity for evaluation for metabolic and bariatric surgery to local or regional comprehensive multidisciplinary pediatric metabolic and bariatric surgery centers.
