The American Academy of Pediatrics (AAP) has published a document containing the first guidelines for the treatment of childhood obesity. The text highlights that medical intervention against chronic diseases in children becomes broader and more complex than the simple recommendation of changes in diet and physical exercise.
In an unprecedented way, the authors suggest the use of medication as part of the treatment. They also suggest referring obese adolescents older than 13 years for bariatric surgery in cases considered serious.
The document is published on the AAP website and is based on an exhaustive review of studies, technical reports and recommendations on the subject, recognizing that obesity is a disease. Prior to this, the last text published in 2007 predominated, which was more general and all treatment was based solely on behavior change, with emphasis on diet and physical exercise.
“It is the first time that we have a document addressed to paediatricians. Provides updates and instructions for the management of pediatric obesity. Everything that has been there so far has been based solely on lifestyle change, as if obesity were a choice. From now on, obesity is recognized in children as a chronic disease and must be treated as such, with all the tools available, including medications,” explained Daniel Cervigia Domingos, an endocrinologist at the Israelta Albert Einstein Hospital.
The guidelines continue to recommend behavioral measures, but acknowledge that by themselves they may not be sufficient and therefore suggest medical follow-up and medication use. The endocrinologist explained: “We have changed our vision of what obesity is. Today we know that it is a chronic and multifactorial disease that includes genetic, social, behavioral, metabolic and environmental factors. Every little part contributes to the problem.”
For a long time, children and adolescents did not have any treatment to treat obesity, but in recent years several safe drugs have been launched on the market with good results. According to Domingos, in Brazil, the drug liraglutide is approved for use in children older than 12 who are obese. Other medications, such as sibutramine, metformin, and orlistat, may still be used off-label, depending on the situation.
For the expert, the guideline is a great advance because a large part of obese children will be obese adults in the future, if they do not receive treatment for the disease. Being overweight or obese can lead to the onset of high blood pressure, dyslipidemia, diabetes, and other health complications at an earlier time.
The doctor points out that it is necessary to end the myth that a fat child is a healthy child, and also that an obese child will grow and lose weight on its own. “Recent studies suggest that pharmacological treatment of obesity associated with lifestyle changes achieves better results than measures based solely on diet and behavior changes,” he said.
As for bariatric surgery, the guide recognizes that patients over 13 years of age with morbid obesity can be referred to a service specialized in bariatric and metabolic surgery. “It’s not that the guidelines make a recommendation for surgery, but it does suggest that the patient be evaluated by a service that has that experience,” Domingos said.
In both Brazil and the United States, the recommendation for children under 12 years of age remains intensive family-focused lifestyle and behavior change therapy, which plays a critical role in patient success.
“In these cases, multidisciplinary follow-up is necessary with a dietician, physical educator, pediatrician, child endocrinologist and psychologist. The guidelines recommend close contact with the patient, with more frequent returns, follow-up in face-to-face consultations and contact with a limit of 26 hours plus drop in a year.
The Ministry of Health issued the guide
According to the Ministry of Health, in 2020, among all children monitored in the SUS (Unified Health System), 15.9% of children under 5 years of age and 31.8% of those from 5 to 9 years of age had overweight. Of these, 7.5% of children under five years of age and 15.8% of those from 5 to 9 years of age were obese. Regarding adolescents, 31.9% are overweight and 12% obese.
The increasing incidence of obesity is a public health problem. In August 2022, the Brazilian government released the first guide on the subject, which summarizes guidelines on how to promote healthy eating and recommendations to reduce sedentary lifestyles. In addition, it provides an overview of the magnitude and implications of obesity. This article is part of a government campaign called “Let’s Prevent Childhood Obesity: 1, 2, 3 and Now!”.
Domingos points out that the new US guidelines have a significant impact on the management of obesity treatments in children, with key information for clinicians.
“Healthy obesity does not exist. Without a doubt, this document will make professionals feel more confident to be able to prescribe medications to their patients from childhood, whenever there is an indication. If it is treated from childhood, the risk is reduced.” of comorbidities and reduce the risk of morbid obesity.