Evidence-based recommendations include intensive health behaviour and lifestyle treatment, pharmacotherapy and bariatric surgery.

Sponsoring organisation: American Academy of Pediatrics.

Background: Obesity is a complexand multifactorial disease that affects the physical and mental health of more than 14 million children and teens in the USA. The American Academy of Pediatrics released its first ever guideline to aid in the evaluation and management of paediatric obesity; guidance about obesity prevention is forthcoming.

Key recommendations

• Any child aged 2 years or older with body mass index (BMI) at or above the 85th percentile should undergo a comprehensive history and physical, including evaluations of mental-behavioural health, social determinants of health, blood pressure and age-appropriate bloodwork (e.g. lipids, alanine transaminase, glycosylated haemoglobin).
• The mainstay of management is intensive health behaviour and lifestyle treatment (IHBLT), an in-person, family-based program requiring at least 26 hours of face-to-face time during three to 12 months.
• Pharmacotherapy can be used as an adjunct to IHBLT for selected teens aged 12 years or older. Medications (e.g. metformin, orlistat, glucagon-like peptide-1 receptor agonists, topiramate) should be chosen based on indications, benefits and risks.
• Evaluation for metabolic and bariatric surgery should be considered for teens aged 13 years or older with severe obesity (BMI, at or above the 120% of the 95th percentile) and clinically significant comorbidities.

Comment: This guideline document is 100 pages long; it reads almost like a textbook on obesity, covering environmental, social and biological factors. The bullets listed above are limited to the concrete diagnostic and therapeutic steps that have received substantial publicity – both supportive and critical.

Providing effective care for the many children with obesity whom I see each day is challenging. The biggest hurdles to initiating treatment are limited resources and long wait lists for time-intensive IHBLT. I am concerned – as are many of my colleagues – about how our healthcare system can broadly implement and pay for IHBLT, pharmacotherapy and surgical intervention in this large patient population. And I worry about liberalising pharmacotherapy when long-term data on efficacy and safety in children are scant.

James A. Feinstein, MD, MPH, Associate Professor of Pediatrics, Children’s Hospital Colorado and University of Colorado School of Medicine, Denver, USA.

Hampl SE, et al. Clinical practice guideline for the evaluation and treatment of children and adolescents with obesity. Pediatrics 2023; 151: e2022060640.

This summary is taken from the following Journal Watch titles: General Medicine, Pediatrics and Adolescent Medicine.