LOUISVILLE, Ky. — In the first update in 15 years, the American Academy of Pediatrics issued new guidance on childhood obesity. It moves away from the watchful, waiting approach. Instead, pediatricians are advised to “offer treatment options early and at the highest available intensity.”

How prevalent is childhood obesity?

The report says obesity is a “complex and often persistent chronic disease” that affects the health of over 14.4 million children and adolescents in America. According to the CDC, about one in five kids are obese.

An annual report from the Trust for America’s Health found 23.8% of Kentuckians between the ages of 10 to 17 are obese. That’s the worst rate in the nation for that age category.

What recommendations are included in the new guidelines?

The previous guidance for providers was to delay treatment to see if a child or teen can outgrow their obesity. The new guidance moves away from what is being called “watchful waiting.”

The new recommendation instead says children 6 and older should first be offered intensive lifestyle treatment, which involves at least 26 hours of face-to-face counseling and training (focused on nutrition, exercise, sleep, etc.) over about one year.

Dr. Mark Brockman Jr., a pediatrician at Norton Children’s Hospital, explains how he would approach that with his patients.

“Typically, I will follow up with these patients, who are willing and ready number one within a month. We set certain goals they think they can attain, or the parent thinks is reasonable for their household,” said Dr. Brockman.

He said it’s important to recognize that change does not come overnight.

“It took a while to get to that point, and it will take a while to get where you want to go. It’s not something like an infection that I can get you over with in a couple days. It will take years and it has to be a whole family change,” said Dr. Brockman.

The AAP suggests after intensive therapy, weight loss drugs should be considered for adolescents as young as 12, while teens 13 and older with severe obesity should be evaluated for weight loss surgery.

Dr. Brockman said weight loss medication and surgery would not be the first approach, but an option if lifestyle adjustments are not working.

“Once you’ve really exhausted those interventions, then that is when medication becomes involved or if you are experiencing a lot of comorbid conditions, such as metabolic disease or what most people know as pre-diabetes. That’s when a lot of these medications come into play,” said Dr. Brockman. “Then, if those aren’t working, then yes, you have a discussion about possible surgery, which we have been using those in adults for a good while, but now we are starting to see it can be beneficial in children as well.”

Reaction to the new guidelines

The new guidelines have received mixed reviews. Dr. Brockman, for example, said obesity can lead to serious health complications like high blood pressure and developing Type 2 diabetes just to name a few.

He said this proactive approach in children will address those concerns while change is more attainable.

“The biggest reason why we are paying attention to this is because we know the older you get, the harder it will be to make those lifestyle changes and reverse the effects obesity can cause,” said Dr. Mark Brockman Jr., a pediatrician at Norton Children’s Hospital.

In a release from the AAP, the authors of the guidance acknowledge obesity has complex causes outside a person’s control, including genetic, environmental and socioeconomic factors.

“If both parents are considered obese or overweight, the child has an 80% chance of also having obesity,” said Dr. Brockman. “It does need to be a whole family lifestyle change to really tackle this problem. Everybody should be on board and want to improve their health, not just for themselves but for the rest of their family including their children.”

Others feel the recommendations go too far and will cause more harm than good.

Dr. Cheri Levinson is the clinical director at the Louisville Center for Eating Disorders. She said the new guidelines promote weight stigmatization, implying a smaller body is an inherently healthier body.

“It’s already estimated that there will be 2.9 million new cases of eating disorders in kids and adolescents in the next year alone. I can guarantee these new guidelines will double, triple that number that we see,” said Dr. Levinson.

She worries the new guidelines will perpetuate bias and promote diet culture. 

“We know that a major precipitant for an eating disorder are critical comments about weight and shape, and any form of restriction offsets any genetic vulnerability for the eating disorder. A lot of times, critical comments lead to restriction, which then sets off the eating disorder. We know that, especially when these comments come from authority figures, like medical professionals,” said Dr. Levinson. “Eating disorders will start and then kids end up with a chronic life-threatening illness.”

Dr. Levinson suggests families seek health care professionals who take a weight neutral approach to treatment.

“Because of weight stigma in the medical communities and because many health providers are not educated on the fact that weight is not equal to health and with these new guidelines reinforcing that idea, it now becomes on the parents to really be advocates for their kids,” said Dr. Levinson.

The Kentucky Eating Disorder Council said it would like to see these guidelines include more references to eating disorder screenings and treatment referral recommendations.