Pediatric Obesity Treatment and Prevention Guidelines
Pediatric Obesity Treatment and Prevention Guidelines
The global epidemic of obesity continues to plague us. Somewhat encouraging is that while the national obesity rates in adults have continued to increase, the prevalence in children has stabilized or decreased. Over the last 5 years, the prevalence in children 2-5 years of age has declined to below 10%, while the 6-11 and 12-19 year age groups have been steady at just below 20%.
In March of this year, guidelines for the treatment, diagnosis and prevention of pediatric obesity were published by the Endocrine Society. These guidelines serve to assist the primary care provider in assessing for obesity as well as working to prevent its development. It also discusses treatment strategies for both the primary care provider and the weight management specialist.
Novel recommendations from the guidelines include: consideration of genetic testing in children with obesity onset before the age of 5 years and in those with clinical features of an obesity syndrome; refraining from checking routine labs such as thyroid function tests and cortisol levels unless the child has other clinical features of either endocrinopathy, including poor linear growth; avoidance of obtaining insulin levels as it is not part of the diagnostic criteria for diabetes and that there is no well-defined cutoff point to define insulin resistance.
The guidelines also reiterate the encouragement of healthy eating and activity habits to prevent obesity from developing. This includes avoiding sugary beverages, processed foods and fast foods, as well as increasing fruit and vegetable intake. At least 5 days a week of 20-60 minutes of moderate to vigorous activity is recommended as well. Good sleep hygiene is encouraged, as is limiting non-academic screen time to 1-2 hours daily.
Pharmacotherapy is only recommended for obese children and adolescents after formal lifestyle modification efforts have failed. The only FDA-approved medication for obesity in the pediatric population is Orlistat, but other medications such as Qsymia, Belviq, Contrave and Saxenda, are approved for obese adults ≥ 18 years of age. Bariatric surgery is only recommended for post pubertal females and males with BMI ≥ 40 kg/m2 or ≥ 35 kg/m2 with severe comorbidities, failure to succeed on a lifestyle modification program, a stable psychological evaluation and ability to adhere to the protocol for bariatric surgery.
The Endocrine Society emphasizes that the treatment should be family centered and that mental health issues be identified and treated. The entire article can be found in the March 2017 issue of the Journal of Endocrinology and Metabolism.
Rushika Conroy MD MS
Pediatric Endocrinologist
A little about Rushika:
Rushika Conroy grew up in New Jersey, a few blocks away from Chris! She completed her undergraduate training and a Masters degree in nutrition at Columbia University. She went on to medical school at New York Medical College. She completed her pediatrics residency at Schneider Children’s Hospital and her pediatric endocrine fellowship at Morgan Stanley Children’s Hospital, after which she left the city and moved to Western Massachusetts, where she currently practices at Baystate Medical Center in Springfield. She lives in Massachusetts with her husband Dan and three children.