"According to 2017-2020 data from the Centers for Disease Control and Prevention, 19.7% of children and adolescents in the United States are affected by obesity. Those numbers are thought to have only gotten worse during the COVID-19 pandemic, likely due to a combination of factors including reduced physical activity, increased screen time, disrupted schedules, and a reliance on more heavily-processed foods.
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One study shows the rate of childhood obesity increased by 2% during the pandemic, but U.S. childhood obesity numbers have grown rapidly over the past four decades. In response to the data, the American Academy of Pediatrics recently released a set of guidelines aimed at treating overweight and obesity in children. These new childhood obesity guidelines are the first of their kind in nearly 15 years and focus on treatment options beyond the eat less, move more advice often given in the past.
The guidelines address obesity as a chronic disease like diabetes or high blood pressure and work to remove the stigma surrounding obesity and its complicated origins. However, the response to the new childhood obesity guidelines has been mixed at best, with both medical professionals and parents unsure how they will play out in practice. Here, experts what parents should know about the new guidelines.
What do the guidelines say?
Overall, the guidelines recommend early intervention, possibly starting as young as 2 years old, and treating childhood obesity at the highest intensity level that’s appropriate and available to the patient and their family. Risk and recommendations are determined by using the child’s BMI as determined by the appropriate growth chart for age and sex.
Methods of treatment include intensive health behavior and lifestyle treatment (IHBLT) for children aged 6 and older and for children aged 2 to 5 at the pediatrician’s discretion. IHBLT includes nutrition, physical activity, and behavioral change support for children who are overweight (≥ 85th percentile) or obese (≥ 95th percentile).
Adolescents 12 and older may be offered weight loss drugs along with ongoing health behavior and lifestyle treatment, while adolescents 13 and older with severe obesity (≥ 120% of 95th percentile) may be referred for bariatric surgery.
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What are the positives?
While there’s much that is still unknown about how these guidelines will play out and how they will affect children’s healthcare moving forward, there are definitely some positive talking points. To begin, they address the complexity of obesity as well as the weight stigma faced by many children with larger bodies.
“My hope is that the health industry and government accept the challenge of creating all-inclusive programs in the community to help with behavioral modifications for children and their families,” said Sissi Cossio, M.D., pediatric endocrinologist at Pediatrix Endocrinology of Florida. “Available medications and surgical interventions must be accessible to all who qualify for them.”
Additionally, pediatricians are encouraged to talk to patients and their families about the different factors in their lives that may be contributing to their health in both a positive and negative way. This information should be used together with the new guidelines to find the best treatment option for each individual. They also recognize that discussions about weight can bring up strong emotions such as sadness and anger.
Why are these guidelines potentially harmful?
Understandably so, many parents and healthcare providers are feeling a bit uneasy about using weight loss drugs and weight loss surgery for children and adolescents. There are also concerns about the availability and cost of therapy programs and the lack of long-term data on these treatment options, as well as concerns about the impact of childhood dieting on eating disorder development.
“There’s been a large focus on the obesity epidemic, but it’s also important to highlight the eating disorder epidemic,” said Katherine Hill, M.D., pediatrician and VP of Medical Affairs at Equip Health. “We’ve seen a 70% increase in eating disorders since the pandemic, and 25-45% of the young people in inpatient units for eating disorders are in larger bodies. Many people, including some medical providers, don’t realize that eating disorders are common in those with larger body sizes.”
Dr. Hill also explained that the new guidelines fail to adequately acknowledge the risk of eating disorders when recommending weight loss and said there’s even evidence that kids are more likely to struggle with both eating disorders and obesity when kids are prescribed diets and a greater emphasis is placed on their weight.
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So what’s a parent to do? The health professionals I spoke to all echoed the same sentiment, which is that healthcare providers and families need to work together as a team to find the best options for all health needs, including weight management.
“Parents can and should feel empowered to work with their pediatrician on how they discuss topics around their child, including weight,” said Rebekah Diamond, M.D., pediatrician and author of Parent Like a Pediatrician.
“My biggest fear is that [the guidelines] could cause more stress to parents and children and add needless strain to a family’s relationship with the healthcare system,” she continued. “My biggest hope would be that this attention actually leads to policy changes that use a smart, sophisticated understanding of pediatric obesity, not as a simple cause or problem to be addressed but as part of a larger conversation regarding family health, to actually help children.”
My biggest hope would be that this attention actually leads to policy changes that use a smart, sophisticated understanding of pediatric obesity, not as a simple cause or problem to be addressed but as part of a larger conversation regarding family health, to actually help children.
If you feel discussing weight would be difficult for or harmful to your children, you may ask your pediatrician not to talk about it while they are in the room. You may also have your child turn away from the numbers on the scale if weight is a sensitive topic.
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How to promote healthy behaviors that don’t focus on weight
It’s important to note that this set of guidelines solely focus on the treatment of overweight and obesity, not prevention. The AAP says preventative guidelines are coming, but in the meantime there are many ways you can address health in your home that don’t focus on weight.
“Rather than focusing on children dieting to combat obesity, there are certain behaviors that can prevent both eating disorders and obesity—like having more family meals, avoiding diets, and to stop talking about weight,” said Dr. Hill. “Instead of hyper-focusing on a weight number, which can be an overly simplistic and crude way to assess someone’s overall health, I encourage my patients to learn to appreciate the amazing activities our bodies are able to do, like hiking mountains and getting us where we need to go every day.”
Other ideas for promoting health regardless of weight include cooking more at home, trying new fruits and vegetables, and doing physical activity together as a family.
