New guidelines to treat childhood obesity suggest more drastic interventions

Amna Nawaz:

The American Academy of Pediatrics has released new guidelines on treating childhood obesity, the first in 15 years.

It recommended pediatricians should evaluate and treat obesity in kids early on to reduce the risk of developing long-term health conditions. The guidelines also suggest more drastic interventions for the first time, including offering weight loss medications to kids 12 or older and considering bariatric surgery for teens 13 and older with severe obesity.

For a closer look at these recommendations and the implications, I'm joined by one of the authors, Dr. Sandra Hassink. She's the director of the AAP's Institute for Healthy Childhood Weight and the former president of the American Academy of Pediatrics.

Dr. Hassink, welcome, and thank you for joining us.

I just want to set out with a definition here for folks at home. When we talk about obesity, we're not talking about weight or size. For children in particular, it's measured as a percentile within their age and sex, and a child with a BMI in that 95th percentile or higher is considered obese.

Do I have that correct?

Dr. Sandra Hassink, American Academy of Pediatrics: Yes.

BMI greater than 95th percentile is a screening test for obesity. I think it's important to point out at this point that it's a screening test. And when you have a BMI, that triggers further evaluation of the child.

Amna Nawaz:

So, let's talk about these new guidelines now.

Just give me a broad overview here. Why are these new guidelines necessary right now?

Dr. Sandra Hassink:

We're at a point in time where we have a lot of new and encouraging evidence that intense health and behavioral lifestyle treatment is effective. It works.

We have emerging evidence that obesity pharmacotherapy can be an adjunct to this lifestyle therapy in children who meet the indications, as well as research on bariatric — metabolic and bariatric surgery that also showed that this is an important adjunct to the intense health and behavioral lifestyle therapy that we can offer children who meet the indications for that pharmacotherapy or surgery.

Amna Nawaz:

And we should mention as well we're talking about the issue here. Some one in five children or adolescents in America, I believe, is impacted by obesity. According to the CDC, that's over 14 million children.

But some have already expressed some concern. They call these new guidelines drastic or aggressive. One such person is Dr. Robert Lustig. He's the director of the Weight Assessment Program for Teen and Child Health at the University of California, San Francisco.

Here is just a portion of what he had to say.

Dr. Robert H. Lustig, University of California, San Francisco: We were able to help 50 percent of our patients without medicine.

So, the fact that pediatricians are going to be grabbing for the pharmaceuticals right off the bat, I think, is putting the cart before the horse. If we're going to be using these drugs in kids, are we setting them up for problems later on, just because they're not acute problems, but chronic problems? Is that a great idea?

Amna Nawaz:

Dr. Hassink, specifically when it comes to the use of pharmacotherapy, as you mentioned, or medication, what would you say to Dr. Lustig, who has these concerns?

Dr. Sandra Hassink:

Well, I think it's important here to take a step back and realize that the core foundational part of obesity treatment is this intense health and lifestyle behavioral therapy, which helps a large majority of children.

And there is no current evidence that drugs alone are effective. So whenever you're thinking about obesity pharmacotherapy, it's always in the context of using also intense health — health and lifestyle behavioral therapy. So this is in context. And these therapies, the pharmacology — pharmacological therapy is really for children who are at — meet the indications, which really are for children who have severe obesity or comorbidities who need help as an adjunct to the lifestyle therapy.

So, we're not — we're not saying jump to the drugs. We're saying, you use the lifestyle therapy. And if you have children who need this, it's an important adjunct.

Amna Nawaz:

There's also the very real issue of weight bias and stigma in particular.

We did speak with two eating disorder specialists, Shira Rosenbluth and Dr. Kim Dennis, both of whom said that putting this kind of emphasis on weight loss so early in life can have lasting impacts for years to come. Here's what they had to say.

Shira Rosenbluth, Eating Disorder Therapist:

I have so many clients that show up in my office with debilitating eating disorders that started with just going to a pediatrician who mentioned that they might need to lose weight.

And so then they end up in my office, honestly, often close to death because of these recommendations.

Dr. Kim Dennis, CEO, SunCloud Health:

I have had lots of patients, former patients, reach out to me saying, like, here's a picture of me as a kid. I was a little chubby, but I was put on a diet at the age of 8. And that, like, messed me up for the next 30 years.

Amna Nawaz:

And, Dr. Hassink, even the AAP guidelines from 2016 discouraged parents and family and pediatricians from talking specifically about weight and weight loss with children because of potential long-term impacts.

So why the change?

Dr. Sandra Hassink:

This is exactly why we wrote the guidelines.

These guidelines take a whole child approach. We're concerned with the whole — evaluating the whole child. This is about health. This is about obesity comorbidities. We have many, many areas in these guidelines that help pediatricians have a dialogue with parents and families about overall health.

The use of motivational interviewing is very important here. So these guidelines are setting obesity in context. This goes well beyond weight. Obesity is a chronic — a complex chronic disease. And the conversation here centers on the health of the whole child and how the family can best help the child, in partnership with the pediatrician.

So, I think that the concerns expressed are exactly why we're setting obesity in the context of a complex chronic disease and helping pediatricians have those — that approach to the whole child.

Amna Nawaz:

Obesity is indeed complex, as you mentioned, and the contributing factors are so varied and numerous, right? You have everything from the environment and socioeconomic conditions to genetics.

It does seem, though, that the conversation has shifted away from prevention and addressing some of those root causes and more towards treatment. Are you worried about that?

Dr. Sandra Hassink:

We can't really say this is — this shouldn't be an either/or, right? You must prevent and treat to be fair to all the children.

We need obesity prevention. We certainly want to work as hard as we can at that. But for the children who need treatment for this complex chronic disease, we need treatment. And I think it's hard because prevention and treatment shouldn't be set opposite each other. We need to do both of them.

Amna Nawaz:

That is Dr. Sandra Hassink, the director of the AAP's Institute for Healthy Childhood Weight.

Thank you for joining us.

Dr. Sandra Hassink:

Thank you very much.