A new guideline issued by the Endocrine Society offers evidence-based recommendations that clinicians can use to combat the growing problem of childhood obesity in the United States.
The guideline is currently available online at http://jcem.endojournals.org
This is the first time the Endocrine Society has issued a clinical practice guideline for pediatric obesity, Dr. A. Jay Cohen, medical director of the Endocrine Clinic, P.C., in Memphis, Tenn., said in an interview.
The guideline will make it easier for clinicians to treat pediatric patients who are at risk for obesity, explained Dr. Cohen. “It will give direction to pediatricians, family practice physicians, and endocrinologists as to what to evaluate, how, and when. It will also give direction to insurance companies as to standards of care.” The guideline recommends that clinicians define overweight as a body mass index greater than the 85th percentile and obesity as a BMI greater than the 95th percentile.
The most important elements of the guideline that clinicians can use immediately are the recommendations for changes in daily exercise patterns and dramatic adjustments in food behaviors, Dr. Cohen said.
The guideline recommends breastfeeding of infants for at least 6 months as part of a strategy to prevent obesity. And as a first-line treatment for obesity in children and adolescents, the guideline emphasizes intensive lifestyle changes in diet, exercise, and behavior. To help with lifestyle modification, the guideline encourages clinicians to advocate for 60 minutes of moderate to vigorous exercise each day for all school-aged children in all grades.
While pharmacotherapy is included in the guideline, it should be considered for children only after lifestyle modification has failed, or if severe comorbidities such as nonalcoholic fatty liver disease persist despite lifestyle modification. And medication should be given only by clinicians who have experience in using antiobesity drugs and who understand the possible side effects and adverse reactions.
In addition, the guideline recommends evaluating children with a BMI above the 85th percentile for comorbidities and complications associated with obesity. This process would help identify children who might benefit from specialized treatment such as bariatric surgery.
Bariatric surgery may be an option for some children, but the guideline states that it should be considered only for adolescents with a BMI greater than 50, or in those with a BMI greater than 40 who have severe comorbidities or who have failed to manage weight with intensive lifestyle modification, pharmacotherapy, or both.
Implementation of this guideline into clinical practice poses many challenges, including the amount of time needed on a consistent basis to educate, support, and give follow-up care to young patients at risk for obesity, Dr. Cohen said, adding that reimbursement for care remains an issue. “Insurance companies must start covering for nutritionists and counseling.”
Additional research is needed to continue to support the guidelines or revise them if necessary, noted Dr. Cohen.
“Data will be needed to show the evolution of these patients into adulthood and the risks of diabetes, cardiac problems, and accelerated complications. The roles of medication and bariatric surgery are important issues to address in the near future,” he said.