Why experts are urging swifter treatment for children with obesity
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Interventions like nutrition programmes in schools have not been enough to prevent weight gain and obesity in children.
PHOTO: NYTIMES
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NEW YORK – The American Academy of Pediatrics recently issued new guidelines for treating the more than 14 million children and adolescents with obesity in the United States.
The recommendations came as a surprise to many parents, and to some experts, as they encourage vigorous behavioural interventions even for very young children, as well as drug treatment or surgery for adolescents.
The guidelines spring from a scientific understanding of obesity that has been evolving for decades.
The condition is a risk factor for a number of disorders, including Type 2 diabetes, high blood pressure, joint and back pain, and several cancers. Treating the problem as early as possible may help prevent a lot of misery.
Here are answers to some questions about paediatric obesity research and why experts are now advising aggressive treatment.
What do the new guidelines say about the causes of obesity?
The academy’s recommendations stress that obesity is not just a consequence of poor eating habits and a lack of exercise. It is a chronic disease with many intertwined causes, including genetics.
Researchers now know that obesity is one of the most strongly inherited traits. For example, adopted children tend to have the same shapes and weights as their biological parents.
A genetic predisposition sets the stage for some children to gain weight in an environment in which food – often poor-quality food – is everywhere. And weight gain can become a vicious circle.
Children and adolescents with obesity often experience teasing and bullying, which, the academy wrote, contribute to “binge eating, social isolation, avoidance of health care services and decreased physical activity, further complicating the health trajectory”.
How do scientists define overweight and obesity?
They are defined by body mass index, a measure of weight and height. (It is an imperfect measure; many muscular athletes, for example, have high BMIs but are in excellent shape.)
Overweight means a BMI at or above the 85th percentile, but below the 95th percentile for children and teenagers of the same age and sex. Obesity is a BMI at or above the 95th percentile for children and teenagers of the same age and sex.
When did paediatric obesity become such a problem?
For scientists, the alarms went off in the 1980s and 1990s.
Before then, experts took comfort in data from the 1960s indicating that just 5 per cent of children and adolescents had obesity.
But national data in the 1980s showed that the rate had doubled. By 2000, it had tripled and, by 2018, quadrupled.
As the epidemic began, expert opinions about why it was happening circulated widely, often citing favourite villains like Big Food, too little exercise or a lack of fresh fruit and vegetables. But rigorous evidence was scarce and solutions evasive.
What do the guidelines say should be done now?
It is not that lifestyle interventions cannot work for some.
The academy says children and adolescents who are overweight and obese should be offered “intensive behavioural and lifestyle treatment”, which is the most effective intervention short of medications and surgery.
The most effective programmes involve at least 26 hours of in-person treatment over three to 12 months and include the family.
The treatment focuses on nutrition, physical activity and behaviour change. The expected result? A decline of 1 to 3 points in BMI.
But intensive programmes are not always available, and insurers often do not pay for them.
The academy advises that doctors instead should “provide the most intensive programme possible”, referring families to additional programmes to help with food insecurity and to community recreation programmes.
The underlying message is one of urgency.
In a significant departure from past advice, for example, the academy recommends that children aged 12 and older with obesity should be offered treatment with any of the few approved drugs, including newer ones like Wegovy (a brand name for semaglutide) that elicit significant weight loss by suppressing the appetite.
Those 13 and older with severe obesity should be offered bariatric surgery, the academy says.
These are drastic (and expensive) interventions for doctors and parents to contemplate, but the authors of the recommendations note that obesity rarely ends without a concerted effort. NYTIMES
