Monday, September 29, 2008

Pediatric obesity - some guidelines

Photos and all italics were added by me to explain the meaning of certain words and phrases.

The Endocrine Society (read about The Endocrine Society) has issued practice guidelines for the prevention and treatment of pediatric obesity. The online version was released on 9 September.

Recommendations set forth in the guidelines are as follows:

  • Overweight is defined as a body mass index (BMI) in the 85th percentile or greater, but less than the 95th percentile, and obesity as a BMI in the 95th percentile or greater.
    BMI Categories for Kids:
    Underweight - BMI less than the 5th percentile
    Healthy Weight - BMI 5th percentile up to the 85th percentile
    Overweight - BMI 85th to less than the 95th percentile
    Obese - BMI greater than or equal to the 95th percentile.
    Refer to BMI chart for girls
    here, and for boys here

  • If there is evidence of a genetic syndrome (syndrome = a group of symptoms or identifying features of a disorder or disease; genetics syndrome = a syndrome presented by abnormalities in development and/or growth, which is caused by defects in genes and chromosomes) , referral to a geneticist is indicated.
    Children with a BMI in the 85th percentile or greater should be evaluated for obesity-associated comorbidities (other underlying or co-existing illness/health conditions).
  • As the prerequisite for any treatment, intensive lifestyle modification should be prescribed and supported, including dietary, physical activity, and behavioral components.
  • Dietary recommendations include avoiding consumption of calorie-dense, nutrient-poor foods (eg, sweetened beverages, most "fast food," and calorie-dense snacks); controlling energy intake through portion control in accordance with the Guidelines of the American Academy of Pediatrics; reducing saturated dietary fat intake for children older than 2 years; increasing intake of dietary fiber, fruits, and vegetables; eating timely, regular meals, particularly breakfast; and avoiding constant "grazing," especially after school.

Suggestions set forth in the guidelines are as follows:

  • Pharmacotherapy (treatment with drugs), in addition to lifestyle modification, should be considered in obese children only when intensive lifestyle modification has been ineffective and in overweight children only if severe comorbidities persist despite intensive lifestyle modification, especially those children who have a strong family history of type 2 diabetes or premature cardiovascular disease.
    Pharmacotherapy should be prescribed only by clinicians experienced in using antiobesity agents who are cognizant of the risks for adverse reactions.
    Pharmacotherapeutic options may include: i) sibutramine, which is not approved by the US Food and Drug Administration (FDA) for those younger than 16 years; ii) orlistat, which is not FDA approved for those younger than 12 years; iii) metformin, which is not FDA approved for treatment of obesity but which is approved for those who are at least 10 years old with type 2 diabetes mellitus; iv) octreotide, which is not FDA approved for the treatment of obesity; v) leptin, which is not FDA approved; vi)topiramate, which is not FDA approved for the treatment of obesity; - growth hormone, which is not FDA approved for the treatment of obesity.
  • Bariatric surgery, which refers to surgical procedures performed to treat obesity by modification of the gastrointestinal tract to reduce nutrient intake and/or absorption, is suggested for adolescents with a BMI of less than 50 kg/m2, or more than 40 kg/m2 in whom lifestyle modifications and/or pharmacotherapy have been unsuccessful and who have severe comorbidities. (more about bariatric surgery from Wikipedia).

  • Bariatric surgery is not recommended for preadolescent children; for pregnant or breast-feeding adolescents; for those planning to become pregnant within 2 years of surgery; for any patient who has not mastered the principles of healthy dietary and activity habits; or for any patient with an unresolved eating disorder, untreated psychiatric disorder, or Prader-Willi syndrome (read more about Prader-Willi Syndrome here).

  • To help prevent obesity, clinicians should recommend that infants be breast-fed for at least 6 months and that schools offer children in all grades 60 minutes of moderate to vigorous daily exercise.

  • Clinicians should educate children and parents regarding healthy dietary and activity habits; advocate to restrict availability of unhealthy food choices in schools; ban advertising promoting unhealthy food choices to children; and redesign communities in ways that will maximize opportunities for safe walking and bike riding to school, athletic activities, and neighborhood shopping.

"The objective of interventions in overweight and obese children and adolescents is the prevention or amelioration of obesity-related co-morbidities, e.g., glucose intolerance and T2DM [type 2 diabetes mellitus], metabolic syndrome, dyslipidemia, and hypertension," the authors of the guidelines write. "We suggest that pharmacotherapy (in combination with lifestyle modification) be considered if a formal program of intensive lifestyle modification has failed to limit weight gain or to mollify comorbidities in obese children. Overweight children should not be treated with pharmacotherapeutic agents unless significant, severe co-morbidities persist despite intensive lifestyle modification."
-Journal of Clinical Endocrinology & Metabolism-


1 comment:

John Livingston said...

I agree that childhood obesity has to be addressed by educating parents and schools boards as well. The changes in lifestyle towards healthier eating habits, proper exercise are much more easily adapted in childhood then in adulthood. I can't say enough times that prevention is the best medicine, and this is particularly true when it comes to obesity. The abundance of health issues associated with obesity, hypertension, heart problems, type 2 diabetes and even different types of cancer, could be so easily prevented with changes adapted early. While I know that bariatric surgery has been proved to be a successful treatment for morbid obesity, when it it comes to our children, let's try and educate them and guide them as parents, doctors and teachers, so they won't have to appeal to that solution as adults. 75% of obese children end up obese in their adulthood.