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Pesquisa
Clinical Practice Guideline for the Evaluation and Treatment of Children and Adolescents With Obesity
Sarah E. Hampl, Sandra G. Hassink, Asheley C. Skinner, Sarah C. Armstrong, Sarah E. Barlow, Christopher F. Bolling, Kimberly C. Avila Edwards, Ihuoma Eneli, Robin Hamre, Madeline M. Joseph, Doug Lunsford, Eneida Mendonca, Marc P. Michalsky, Nazrat Mirza, Eduardo R. Ochoa, Mona Sharifi, Amanda E. Staiano, Ashley E. Weedn, Susan K. Flinn, Jeanne Lindros, Kymika Okechukwu; Clinical Practice Guideline for the Evaluation and Treatment of Children and Adolescents With Obesity. Pediatrics February 2023; 151 (2): e2022060640. 10.1542/peds.2022-060640
Introduction
The current and long-term health of 14.4 million children and adolescents is affected by obesity,1,2 making it one of the most common pediatric chronic diseases.3–5 Long stigmatized as a reversible consequence of personal choices, obesity has complex genetic, physiologic, socioeconomic, and environmental contributors. As the environment has become increasingly obesogenic, access to evidence-based treatment has become even more crucial.
A significant milestone in the fight to counter misperceptions about obesity and its causes occurred in 1998, when the National Institutes of Health (NIH) designated obesity as a chronic disease. The NIH made a further commitment to necessary research in the “Strategic Plan for NIH Obesity Research,” released by the NIH Obesity Task Force in 2011.6 In 2013, on the basis of accumulating evidence, the American Medical Association recognized obesity as a complex, chronic disease that requires medical attention.7
The scientific and medical community’s understanding of obesity is constantly evolving. Increased understanding of the impact of social determinants of health (SDoHs, see Definition of Terms section) on the chronic disease of obesity—along with heightened appreciation of the impact of the chronicity and severity of obesity comorbidities—has enabled broader and deeper understanding of the complexity of both obesity risk and treatment.8,9 Multiple randomized controlled trials and comparative effectiveness studies have yielded effective treatment strategies, demonstrating that, despite the complex nature of this disease, obesity treatment can be successful.10,11
The knowledge and skills to treat childhood obesity have become necessities for clinical teams in pediatric primary and subspecialty care. For more than 2 decades, the American Academy of Pediatrics (AAP) and its members have had the opportunity to collaborate with multiple scientific and professional organizations to improve the clinical care of children with overweight and obesity. Notable milestones include the 1998 “Expert Committee Recommendations,”12 the 2007 “Expert Committee Recommendations,”13–15 the creation of the AAP Section on Obesity and founding of the Institute for Healthy Childhood Weight, both in 2013; and the Institute’s “Algorithm for the Assessment and Management of Childhood Obesity” in 2016.16
This is the AAP’s first clinical practice guideline (CPG) outlining evidence-based evaluation and treatment of children and adolescents with overweight and obesity.
This guideline does not cover the prevention of obesity, which will be addressed in a forthcoming AAP policy statement.
The CPG also does not include guidance for overweight and obesity evaluation and treatment of children younger than 2 years. Children under the age of 2 were not part of the inclusion criteria for the evidence review, because it is difficult to practically define and measure excess adiposity in this age group. The CPG also does not discuss primary obesity prevention, as no studies reporting results of obesity prevention interventions met the inclusion criteria for the evidence review.
Nonetheless, the topics of obesity prevention and evaluation and treatment of children younger than 2 years are very important to reduce this threat to children’s current and future health. Future CPGs may include these topics; in the meantime, information that may assist pediatricians and other pediatric health care providers (PHCPs) is included on the AAP Institution for Healthy Childhood Weight’s Web site (aap.org/obesitycpg). Further information on the CPG’s methodology and the writing committee’s approach is covered in subsequent sections.
The CPG contains Key Action Statements (KASs), recommendations based on evidence from randomized controlled and comparative effectiveness trials as well as high-quality longitudinal and epidemiologic studies. The CPG writing Subcommittee uses the term “pediatricians and other pediatric health care providers” to include both pediatric primary and specialty care physicians and other medical providers as well as allied health care professionals, since all will encounter and can intervene with children with overweight, obesity, and obesity-related comorbidities. An algorithm with these KASs is provided in Appendix 1.
The KASs are supplemented by Consensus Recommendations that are based on expert opinion and address issues that were not part of the supporting technical reports (TRs). These consensus recommendations are supported by AAP-endorsed guidelines, clinical guidelines, and/or position statements from professional societies in the field and an extensive literature review.
This CPG stands on the shoulders of the pediatricians, other PHCPs, clinical researchers, and other stakeholders who collaborated to create the previous Expert Recommendations, which have been valued sources of guidance for health care professionals, clinical systems, parents, and other key stakeholders. It is our hope that this CPG will further advance the equitable care of children and adolescents with this chronic disease.
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