New treatment tactics for childhood obesity

Nearly 20 percent of U.S. kids ages 2-19 are obese, according to the Centers for Disease Control and Prevention.

WASHINGTON — New medical guidelines from the American Academy of Pediatrics (AAP) call for aggressive treatment of childhood obesity, including, in some cases, prescribing weight-loss drugs and bariatric surgery for children as young as middle school.

The recommendations reflect concerns that, if left unchecked, childhood obesity could lead to major health problems early in life.

“When you're 30 and 40, the process of high blood pressure, heart attacks and strokes starts at 15,” said Dr. Jenny Gourgari, a pediatric endocrinologist and associate professor at Georgetown University.

According to the most recent data from the Centers for Disease Control and Prevention (CDC), 19.7 percent of US children ages 2-19 are obese. In total, there are “nearly 14.7 million children and youth,” the CDC said.

In some cases, doctors should consider prescribing weight-loss pills to patients as young as 12, the AAP's new guidelines say. In some cases, adolescents as young as 13 years old should be evaluated for bariatric surgery.

But Dr. Gourgari said these approaches should only be used in severe cases where other, less invasive treatments have been tried and failed to produce results.

“It's very, very severe obesity that you would consider treating with these drugs,” she said.

Doctors are advised to try other options before reaching the point of considering weight loss medication or weight loss surgery.

According to Dr. Gourgari, the first-line approach is a familiar one: encouraging parents and children to be physically active and eat a healthy diet.

This is what the YMCA of Metropolitan Washington provides to thousands of children every year.

“Prevention and lifestyle are still key,” said Kristy McCarron, vice president of community health and wellness at the YMCA of Metropolitan Washington.

According to her, “Y” coaches work hard to develop healthy habits in all of their programs, whether it's learn-to-swim lessons or after-school basketball lessons.

But socioeconomic factors may pose additional health challenges.

“The tricky question is whether children or families have safe spaces to be physically active, or whether they have access to healthy foods,” McAllen said.

According to a CDC study of children ages 2-19 between 2011 and 2014, “the prevalence of obesity among children and adolescents ages 2-19 was 18.9 percent in the lowest-income group, 19.9 percent in the middle-income group, and 10.9 percent in the highest-income group middle.”

“As the educational attainment of the head of household increases, the prevalence of obesity decreases,” the report continued.

These challenges could complicate one of the other major recommendations of the AAP guidelines: that children with obesity receive “intensive health behavior and lifestyle therapy.”

According to the AAP, “the most effective treatment consists of 26 or more hours of face-to-face, home-based, multicomponent therapy over a three to 12-month period.” A dedicated time program dedicated to improving patients' health habits, attitudes and outcomes.

Such treatments are “the most effective known behavioral treatments for childhood obesity,” according to the AAP.

However, it also acknowledged that the programs were “difficult to deliver and not universally available”.

That's why Dr. Gourgari says it's the pediatrician's job to explain it all to patients and their families in a way they can understand.

She stresses that guidelines are just that: guidelines. They are not mandatory. As with any medical strategy, patients and parents are the ultimate decision makers.

“You can't force anyone to take any action,” Dr. Gulgari said. “As a doctor, as an obesity specialist and as a coach, my role is to help people. Give them the information they need. Help them make their own decisions with the full picture.”

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