Obesity in children

Expanding the waistline of American children is a growing problem-it requires immediate attention, according to the American Academy of Pediatrics.

The largest professional association of Pediatricians in the United States earlier this month released the first comprehensive guidelines in 15 years for the assessment and treatment of children with obesity.

In contrast to the advice given by many doctors over the past decade and a half, he makes it clear that there is no point in a "wait-and-see" approach when it comes to childhood obesity.

Instead, the organization advocates for addressing the problem of obesity in children aged 2 and older, and outlines strategies for behavioral and lifestyle interventions, as well as treatments with medication and surgery.

"There is no evidence that' watchful waiting ' or delayed treatment is appropriate for children with obesity," Dr. Sandra Hassink, author of the guidelines and vice chair of the subcommittee on clinical practice guidelines on obesity, said in a statement released by the American Pediatric Association.

"The goal is to help patients make lifestyle, behavioral or environmental changes in a sustainable way and involve families in decision-making every step of the way.”

The report highlights evidence that obesity treatments are safe and effective for the more than 14.4 million American children and adolescents living with the chronic disease, and that proactive treatment is necessary to prevent serious short-and long-term health concerns associated with it, including cardiovascular disease and diabetes.

The report coincides with research indicating that these diseases among young people are expected to rise.

Growing concern about diabetes

A study published at the end of December in the academic journal Diabetes Care predicted that the number of people under the age of 20 with Type II diabetes could increase by 700% over the next four decades. Type I diabetes in children can experience an increase of up to 65% over the same period of time.

Type II diabetes has increased significantly among young people over the past two decades, says the CDC. If the upward trend continues, more than half a million young people may develop diabetes (Type I and Type II) by 2060, more than double the number of young people with diabetes in 2017.

One of the explanations for the rise in Type II diabetes is the increase in childhood obesity, but the presence of diabetes in women of childbearing age may be another important factor, the researchers say. Maternal diabetes increases the risk of developing diabetes in children.

"Increases in diabetes — especially among young people — are always alarming, but these numbers are alarming,"said Christopher Holliday, director of the CDC's Department of Diabetes Translation, in a CDC press release on the research results.

"This new research should be a wake-up call for all of us. "It is necessary that we focus our efforts to ensure that all Americans, especially our young people, are the healthiest,"said Debra Houry, acting deputy director of the CDC.

"The covid-19 pandemic has underlined how crucial it is to tackle chronic diseases, such as diabetes. This study highlights the importance of continuing efforts to prevent and manage chronic diseases, not only for our current population but also for future generations.”

New guidelines

The new guidelines are aimed at Diabetes and cardiovascular disease by addressing the root cause: obesity.

The guidelines redefined comprehensive obesity treatment to include nutrition support, physical activity therapy, behavioral therapy, as well as medication, Metabolic Surgery and bariatric surgery for older children above a certain body mass index, or BMI.

According to the report, the most effective treatments include intensive health behavior and lifestyle therapies with at least 26 hours of face-to-face time with family and trained health practitioners over a period of three to 12 months.

When these treatments are provided by trained healthcare professionals and a parent or caregiver is actively involved, they can lead to less disruptive eating with no risk of harm.

The new guidelines also said doctors should offer teens ages 12 and older with obesity weight loss medication options along with healthy behavior and lifestyle treatments. Furthermore, obese adolescents should be particularly evaluated for Metabolic and bariatric surgery starting at the age of 13.

Ryan Farrell, a pediatric endocrinologist at University Hospitals said the report is a big problem because it marks the first time the organization has recommended treatment with either medication or bariatric surgery to treat childhood obesity.

"It has been recommended by other governing bodies and institutions, but the American Academy of Pediatrics is well recognized. And to have them put their support behind that I think is very helpful, " Farrell said.

He said that weight loss drugs that can be prescribed primarily to children are well-studied drugs that have a history of use in people with diabetes. These include orlistat, metformin, and a class of drugs called GLP1 receptor agonists that are injected daily or weekly to reduce appetite and slow down how fast food moves through the gut.

Farrell said that these drugs tend to work very well. But he said that the question he expects people to ask in the long term is how long children will need to stay on them, because research on adults has shown that stopping these drugs leads to the patient regaining a significant amount of weight.

The answer I think remains to be seen, " he said, adding that one possibility might include prescribing a higher starting dose followed by a lower but permanent maintenance dose.

However, the rebound weight gain seen after stopping these drugs contradicts the popular stigma that the obesity problem is just a matter of self-control.

"It is very clear that there is a biological process going on here that is either environmentally influenced or programmed through a combination of Ecology and genetics,"Farrell said.

The association also promotes payment and public health policies that cover comprehensive obesity prevention, assessment and treatment, and policy changes that address the structural racism that leads to alarming and persistent disparities in childhood obesity.

"The medical costs of obesity for children, families and our society as a whole are well documented and require urgent action,"said Dr. Sarah humble, lead author of the guidelines.

"This is a complex issue, but there are multiple ways we can take steps to intervene now and help children and adolescents build the foundation for a long and healthy life.”