More Support and Critique of AAP Guideline for Childhood Obesity

The American Academy of Pediatrics (AAP) updated guideline on obesity evaluation and treatment in children and teens has been hotly debated since it was released in early January 2023. Groups such as The Obesity Society and Obesity Action Coalition support the recommendations while others such as the Collaborative of Eating Disorders Organizations (CEDO) and the Eating Recovery Center say the recommendations on bariatric surgery and antiobesity medications put children at risk for developing eating disorders, disordered eating, and other mental and physical health issues.

The updated AAP guideline, the latest in 15 years, includes new recommendations that emphasize an intensive and comprehensive approach to care of children affected by obesity such as assessing risk factors, evaluating for comorbidities, and offering treatment options using shared decision-making with the child and family. The AAP has moved away from a watchful waiting approach to see if children outgrow obesity to now recommending that treatment options be offered early and at the highest intensity available. The guidelines recommend 4 treatment options:

• Motivational interviewing
• Intensive health behavior and lifestyle intervention
• Antiobesity medications
• Metabolic and bariatric surgery used alone or in combination with other treatment modalities

“Obesity is a chronic disease that requires treatment across the lifespan, including for children. As with other chronic diseases like asthma, hypertension, and diabetes, we need a range of treatment options depending on the patient, and for obesity, that includes lifestyle modifications, medications, and surgery,” said Daniel S. Hsia, MD, a member of The Obesity Society’s Pediatric Obesity Treatment Task Force and associate professor, Pennington Biomedical Research Center in Baton Rouge, La.