The Endocrine Society released an updated evidence-based clinical practice guideline on the prevention and treatment of childhood obesity with lifestyle changes.
The guideline contains recommendations on how to evaluate affected children for clinical or psychological complications, when to evaluate children for rare genetic causes of obesity, and when to consider pharmacologic treatment or surgery for the most severely affected older adolescents.
Children and adolescents are diagnosed as being overweight if the body mass index (BMI) is between the 85th and 95th percentile for their age and gender. If BMI is ≥95th percentile for age and gender, the child or teen can be diagnosed as being obese. An extreme obesity diagnosis would be considered when BMI is ≥120% of the 95th percentile.
Dennis M. Styne, MD, Chair of the task force that developed the guidelines, stated that intensive, family-centered lifestyle modifications are needed to encourage healthy diet and activity. This “remain[s] the central approach to preventing and treating obesity in children and teenagers.”
Since the 2008 pediatric obesity guideline, there have been new data on genetic causes of obesity, psychological complications, surgical techniques, and new medication options. The updated recommendations include:
- Children or teens with a BMI ≥85th percentile should be evaluated for related conditions such as metabolic syndrome and diabetes.
- Youth being evaluated for obesity do not need to have their fasting insulin values measured because it has no diagnostic value.
- Children or teens affected by obesity do not need routine laboratory evaluations for endocrine disorders that can cause obesity unless their height or growth rate is less than expected based on age and pubertal stage.
- About 7% of children with extreme obesity may have rare chromosomal abnormalities or genetic mutations. The guideline suggests specific genetic testing when there is early onset obesity (<5 years old), an increased drive to consume food known as extreme hyperphagia, other clinical findings of genetic obesity syndromes, or a family history of extreme obesity.
Areas for future research include understanding causes of pediatric obesity and its complications, prevention, and treatment. The guidelines also highlighted the need to investigate how environmental and economic factors can impact diet and activity across the world.
The full guideline, titled, “Pediatric Obesity — Assessment, Treatment, and Prevention: An Endocrine Society Clinical Practice Guideline” has been published in The Journal of Clinical Endocrinology & Metabolism.
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