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almost 20% of all children In the United States, some people are considered to have a high body mass index (a measure used by health care professionals to determine whether a person is obese). To help these children stay healthy, new draft guidelines released Tuesday by the U.S. Preventive Services Task Force say doctors should intervene to better help these children manage their weight.
In the draft guidelines, the task force (a group of independent experts whose recommendations guide physicians' decisions and influence insurance coverage) recommends that pediatricians recommend a “moderate” rating for children age 6 and older with obesity. recommends the introduction of comprehensive and intensive behavioral interventions based on what is described. It is certain that such an intervention could have a “moderate net benefit.” The intervention did no harm.
However, the task force's draft recommendations do not include weight loss drugs or surgery, although some studies of those interventions are considered.of American Academy of Pediatricsupdated its own guidelines for managing obese patients earlier this year, recommending both options for some patients.
Additionally, some physicians who treat obese pediatric patients said behavioral interventions alone may be difficult for physicians to provide and difficult for families to access, given the amount of time commitment. .
The definition of high BMI in children is slightly different than in adults. For adults, A BMI of 30 or above is within the obesity range. An obese child is defined as an obese child who: 95th percentile Number of children of the same age and gender based on U.S. Centers for Disease Control and Prevention growth curves. For example, her 10-year-old boy who weighs 102 pounds and is 4 feet 6 inches tall would have a BMI of 22.9. That would place him in the 95th percentile and suggest he is obese.
Based on evidence from 50 randomized controlled trials showing weight loss in children, the task force concluded that intensive behavioral interventions require children and their parents to receive at least 26 hours of medical professional assistance per year. I discovered that I needed to take it.
Interventions include supervised physical activity sessions that teach children and their parents about healthy eating, safe exercise options, how to read food labels, behavior change techniques, goal setting, and how to monitor diet and physical activity; Includes group sessions and individual counseling. .
Studies showed that the more time children spent doing physical activity and contacting professionals, the more they lost weight.
Focusing on intervention rather than simply screening for obesity may represent a shift in thinking for some health care providers.
“Initially there was a feeling that the kids would grow up and outgrow it, but that was proven to be false.” Dr. Irene FennoyAs a professor of pediatrics, I work with children and their parents at Columbia University Medical Center to help them reach a healthier weight. She was not involved in the new draft guidelines.
As your child grows, your weight may fluctuate, especially before birth. growth spurtBut the more severe the level of obesity, the less likely you are to grow out of it, she said.
“If anything, it causes earlier puberty, and earlier puberty causes bones to mature earlier, so they can't grow any further,” she says. “They're already past that.”
Obesity is one of them most common Pediatric chronic diseases and their can lead They are affected by other health issues throughout their lives, including those related to mental health.
Many pediatricians say more children are suffering from obesity-related health problems once associated with adults, such as type 2 diabetes, heart disease and high blood pressure.
Obesity is one of them very common Research reveals why children and teens are bullied at school.
Unlike the guidelines of American Academy of Pediatrics These new draft guidelines, released earlier this year, focus only on obese children and do not encourage interventions for children in the overweight category.
“Of course, we should all do our best to achieve and maintain a normal, healthy weight, but in this case we have particularly strong evidence in the area of these very high BMI categories. '' he said. Dr. john lewis, member of the U.S. Preventive Services Task Force and professor of clinical psychology at the University of Arizona. “The task force's guidelines are evidence-based and we need to respect that and maintain that in our guidelines.”
This guideline also differs from the American Academy of Pediatrics in that it focuses solely on lifestyle interventions. The task force said surgery is considered “outside the scope of primary care” and is not recommended under these guidelines.
The task force also reviewed studies of the weight loss drugs liraglutide, semaglutide, orlistat, phentermine and topiramate, among others. In most trials, the treatments were: Associated with greater BMI reduction than placebo. But there wasn't enough evidence to determine what long-term effects it might have, Lewis said.
“There's really a lack of evidence at this point,” he said. “The task force is therefore requesting further data.”
In fact, Columbia University's Fennoy says very few pediatricians offer intensive 26-hour lifestyle intervention services. “We have demonstrated that our lifestyle interventions are effective, but they are dose dependent,” she says. “Patients don’t often have access to these programs.”
Clinics that focus on weight loss may also have a hard time providing that much help, Dr. Sasma said. Vaidya pediatrician He runs a weight loss clinic at Children's National Hospital in Washington.
“We can’t even provide that kind of intensive care in this region. ideal program “Parents really can't come home every two weeks because there are so many people they want to see,” she said.
Lifestyle changes are the basis of everything the clinic does, but they aren't always enough, she said.
For years, it has been a point of frustration for her patients and her clinic, but she said things are starting to improve with the introduction of weight loss drugs.
Although the new guidelines may not recommend them, she says these drugs are effective and can radically improve some patients' chances of reaching a healthy weight.
“The FDA approval of some of these drugs is just a game-changer,” Vaidya said. “It changes people's lives.”
Her clinic also offers surgery, which is also excluded from the guidelines, but she says it has been effective.
of The guidelines are not final, but only a draft. They will be open for public comment online for four weeks. After considering comments and potential modifications, the task force will vote on whether to adopt them.
The new guidelines replace 2017 recommendations that focused on screening for high BMI rather than emphasizing the importance of physician intervention.
Task Force guidelines typically influence what approaches and drugs are covered by insurance, so not making recommendations for weight loss drugs may be a long way off by the time they are available to all children. This means it may take some time.
Only 16 states offer access to anti-obesity drugs through Medicaid. Dr. Justin Rydera pediatric obesity researcher at the Stanley Mann Children's Research Institute at the Ann & Robert H. Lurie Children's Hospital in Chicago.
Ryder was not involved in the draft guidelines, but He said it's important to continue researching what works to help children maintain a healthy weight.
“Millions of obese children deserve treatments that really work,” he said. “Those treatments could be drug therapy. Those treatments could be behavioral management, and those treatments could be surgery.”
