For the first time in 15 years, the American Academy of Pediatrics released new guidelines for treatment on Monday childhood obesityunderlines the need for early and intensive treatment.
This guidance was developed in response to the fact that childhood obesity rates have continued to rise over the past decade and a half. 17% To 20%, according to data from the Centers for Disease Control and Prevention. Obesity rates have tripled among children and quadrupled among adolescents since the 1980s.
Dr. Joan Han, professor and chief of the Department of Pediatric Endocrinology and Diabetes at Mount Sinai Kravis Children’s Hospital, who was not involved in the new report, said the pandemic made things worse.one CDC report found that weight gain rates nearly doubled in 2020 compared to pre-pandemic years.
Obesity affects little 15 million US children and adolescents, CDC data show. Excess weight not only affects physical health, such as type 2 diabetes and high blood pressure, mental health.
The new guidelines emphasize that obesity is a complex and chronic condition with no simple solutions. also includes the following recommendations: antiobesity drug and my first surgery. These new recommendations address the past years of drought-flying research and drug approvals.
“There is now evidence that obesity treatments are effective. There are treatments and now is the time to recognize that obesity is a chronic disease and needs to be addressed like any other chronic disease.” It’s time,” said medical director of the AAP Institute for Healthy Childhood Weight and the new guidelines.
Part of that involves intervening sooner or later. According to the guidelines, there is no evidence that so-called wait-and-see or delay in appropriate treatment is beneficial.
For obese children aged 6 years and older (and sometimes 2 to 5 years old), the first approach should be to work with pediatricians and other health care providers to address behavioral and lifestyle changes, according to a new study. The guidelines state: This is most effective when it includes at least 26 hours of face-to-face counseling over a period of about a year.
new treatment
One of the main changes in the recommendations for children 12 years and older is the inclusion of anti-obesity drugs and weight-loss surgery in addition to lifestyle changes.
In recent years, a person’s weight diet and physical activity levels, as well asgenetics and hormones can also play a role in how the human body uses and stores energy.
“A breakthrough that has occurred in the last few years is that people are beginning to realize that hormones with multiple roles related to obesity are made in the gut. It helps you feel full and helps stabilize insulin levels.
According to guidelines, pediatricians should offer weight-loss medications to obese children over the age of 12.
Four drugs have been approved: Orlistat, Saxenda, Qsymia, Wegovy, and phentermine for teenagers over the age of 16. Another drug called setmelanotide (brand name Imcivree) is approved for her children aged 6 and older with Barde-Biedl syndrome, a genetic disease that causes obesity.
Wegoby — which surged in popularity last year as a weight-loss drug for adults — Approved by the Food and Drug Administration Late December for ages 12 and up. clinical trials Results published in the New England Journal of Medicine showed that weekly injections of the drug, along with healthy exercise and eating habits, can reduce BMI by approximately 16% in children aged 12 and older. . group that received a placebo.
However, new drugs are not available to everyone.
“The problem with these drugs is that they are very expensive and Often not covered by insuranceHan added that a month’s supply of Wegovy can cost as much as $1,500, which is not affordable for most households.
The guidelines also recommend that severely obese teens over the age of 13 consider discussing weight loss surgery. evidence It has been shown to be a safe and effective treatment with lasting results.
“Often, the sooner the better,” Han said. “Studies show that having bariatric surgery early can improve health problems such as type 2 diabetes and high blood pressure. This is why surgery should be considered in pediatric patients.”
Holistic approach
AAP’s Hassink emphasized that medications and surgery are not first-line treatments and should only be considered in special circumstances where lifestyle changes have proven ineffective for individual patients. Did.
She also acknowledged that these lifestyle changes are very difficult to adopt, especially for overworked and low-income parents.
“There is research going on, but I would say that all of us in this country live in an environment that tends to contribute to obesity overall,” Hasink said.
The guidelines emphasize a holistic approach to obesity treatment. This includes looking at the child’s entire life, taking into account not only physical habits such as diet and activity levels, but also mental health, environment and social inequalities faced by the child.
“There are many factors that contribute to obesity, which can be attributed to the environment itself.
Concrete changes often require significant changes that are outside the family’s control.
“I recommend eating more vegetables and getting more exercise. says Roy Kim, Ph.D., pediatric endocrinologist at Cleveland Clinic Children in Ohio.
Although the new guidelines do not directly address obesity prevention, they emphasize the importance of funding public health policies aimed at preventing obesity. , equipping schools with the tools they need to support healthy childhood lifestyles, and ensuring everyone has equal access to affordable healthy food. is not yet realistic.
“We need to make walking places safe, easy and comfortable. We need to find ways to take advantage of existing opportunities for people to exercise and access cheap and convenient healthy food,” Han said. increase.
She also stresses the importance of health care facilities, where psychological, nutritional and other specialties are all “one-stop-shops” under one roof, helping families find the support their children need. make it easier to receive
Still, “it takes society as a whole to make this possible,” she said.
Medicines and surgeries are expensive. Also, asking an overworked parent to make lifestyle changes isn’t always practical. Recent breakthroughs in obesity medicines have been huge, says Kim, but “prevention is always the best, most effective, safest and most economical approach.”
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