Childhood obesity has been considered “one of the most serious public health challenges of the 21st century.” From 1990 to 2010, there was a 60% increase in preschool children (under age 5) globally who were overweight or obese. Today, in the U.S., 20% of children and 42% of adults are affected by obesity. It is an issue that only continues to rise, yet, until recently, the common discipline has been to delay treatment in favor of “watchful waiting.”
However, for the first time in 15 years, new guidelines have been published in the American Academy of Pediatrics addressing childhood obesity treatment which focuses on medical treatment options like drugs and surgery. This new guidance is quite clear in its direction, with co-author Dr. Ihuoma Eneli stating, “waiting doesn’t work.” In sum, the new guidelines recommend giving adolescents over the age of 12 medical treatment options in addition to behavioral and lifestyle changes, like diet and exercise. With this new line of thinking being proposed, we asked the Figure 1 community for their thoughts on the new guidance and their approach on consulting adolescents with obesity.
Here is what more than 800 healthcare professionals had to say.
What is the Consensus?
We asked the Figure 1 community what they thought about the newly proposed recommendation of making medical treatment options available to adolescents over the age of 12. The consensus remains relatively unclear. While 43% of respondents agreed with the new guidance, 35% did not agree, and 22% were unsure.
With any form of treatment, there is almost never a “one size fits all” approach that can be taken. However, guidance and best practices can often offer a good starting point, but that is only the case when the methodology is generally agreed upon. With 57% of respondents either disagreeing or remaining unsure about the new childhood obesity treatment guidelines, perhaps these guidelines are not the best starting point.
What’s an Acceptable Age to Begin Treatment?
There are obviously mixed views on offering drug or surgery-related treatments to children between ages 12-17 with obesity. But is there agreement on an appropriate age to start offering these treatments?
Well, in general, as age trends upwards, so does agreement in offering medical treatment. Of respondents, 30% said that medical treatment for obesity should start after the age of 18, while only 16% believe medical options should start between ages 10-12. The remaining responses were 24% selecting ages 13-15, 22% selecting 16-18, and 7% remaining unsure.
Again, the answer isn’t clear, but, we can conclude that most HCPs would generally prefer to wait before introducing medical treatment options. This, of course, is a generalization, as care “Needs to be totally individualized with the family. Lifestyle needs to be critically evaluated and genes assessed …”, said one of our respondents.
What Does This Mean?
It is easy to see that there is debate over when to introduce drug or surgical options for adolescents with obesity. So does this mean the “wait and see” method reigns supreme, and no real intervention should take place? Not exactly. When asked for their personal approach to childhood obesity treatment, our respondents had some interesting answers.
“Needs to be individual for each person but mainly psychological therapy … eating disorder is not a cause it’s a symptom of underlying causes”
– Advanced Practice Registered Nurse
“I think a frank conversation early on can go a long way. When things are minimized or chalked up to ‘growth spurts’, it’s easy to miss more serious things that develop. By the time it’s finally taken seriously, the patient is often very overweight and it can be harder to treat.”
– Registered Nurse
“It is frustrating to manage obesity with diet and exercise. Nutritional approach alone is ineffective. Psychiatric and endocrinological intervention are not just desirable but indispensable …”
– Pediatrician
One registered nurse summarized the thoughts of respondents quite neatly, stating, “Childhood weight issues are an epidemic problem. There is not just one answer. However waiting is not an answer either. As early as possible, that will depend on assessment of the child’s capacity to understand, a complete corrective approach can be started addressing family status, activity level, psychological status, dietary habits. Very costly but so is the alternative.”
Published February 20, 2023
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