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  • The Review Course in Family Medicine

GUIDELINE ALERT: Obesity in Children & Adolescents (First Ever)





Childhood obesity is multifactorial with complex socioecological, environmental, and genetic influences. Be alert to health disparities and avoid stigmatizing children with obesity.

Here are the Top 15 take aways from the new guidelines!


  1. Despite some discomfort, early weight-related discussions improve care.

  2. Use annual visits to screen for obesity with BMI percentiles and growth curves.

  3. Watch for high-risk groups as obesity disproportionally affects children with (i) low Socioeconomic status, (ii) adverse childhood experiences, (iii) low social support (iv) families struggling with poverty, (v) racism, (vi) and immigration status.

  4. Encourage nutrient dense foods with reduction of sugar sweetened beverages.

  5. Screen time over 2hrs/day and sleep duration shorter than 10hrs/night increases risk of obesity.

  6. Aim for moderate intensity activity 60mins per day.

  7. Support familial lifestyle changes as parental BMI, weight and lifestyle are strong predictors of obesity.

  8. Evaluate for dyslipidemia in children with obesity as young as 5 years.

  9. Type II diabetes is increasingly diagnosed in the pediatric population. Use HbA1c or 2hr OGTT to assess children with obesity for altered glucose metabolism.

  10. Assess for NAFLD and use biomarkers like ALT which correlate with disease progression.

  11. Assess children with BMI >85th for hypertension as early as 3years old.

  12. Evaluate for menstrual irregularities and signs of hyperandrogenism among female adolescents with obesity to assess for PCOS.

  13. Focus management on non-stigmatizing health behaviors and lifestyle treatments, which incorporate families and encourages self-management.

  14. For children with obesity, diets like CHILD-1, DASH and low glycemic diets can improve weight stabilization and reduction.

  15. Children above 8 years can be considered for adjunctive weight-loss pharmacotherapy.




References:

Hampl SE, Hassink SG, Skinner AC, et al. Clinical Practice Guideline for the Evaluation and Treatment of Children and Adolescents With Obesity. Pediatrics. 2023;151(2): e2022060640


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