New guidelines for childhood obesity address treatment and prevention

The Endocrine Society has issued new clinical practice guidelines for the prevention and treatment of childhood obesity.

“Pediatric Obesity—Assessment, Treatment, and Prevention: An Endocrine Society Clinical Practice Guideline,” was published online and will appear in the March 2017 print issue of The Journal of Clinical Endocrinology & Metabolism (JCEM). They are co-sponsored by the European Society of Endocrinology and the Pediatric Endocrine Society.

The guidelines discuss lifestyle changes and provide recommendations on how and when to evaluate children for medical or psychological complications, and when to evaluate for rare genetic causes of obesity. Medications and surgical options for more severely affected older adolescents are also discussed.

Children and teenagers are diagnosed as overweight when BMI is between the 85th and 95th percentile for their age and sex. Obesity is categorized as a BMI greater than or equal to the 95th percentile for their age and sex. Extreme obesity is identified as a BMI greater than or equal to 120% of the 95th percentile.

“Intensive, family-centered lifestyle modifications to encourage healthy diet and activity remain the central approach to preventing and treating obesity in children and teenagers,” said Dennis M. Styne, MD, chair of the task force that developed the guideline. “Since the Society last issued a pediatric obesity guideline in 2008, physicians have access to new information on genetic causes of obesity, psychological complications associated with obesity, surgical techniques and medications that are now available for the most severely affected older teenagers. The guideline offers information on incorporating these developments into patient care.”

Recommendations include:

• Children or teens with a BMI greater than or equal to the 85th percentile should be evaluated for related conditions, such as metabolic syndrome and diabetes.
• Youth evaluated for obesity do not require measurement of fasting insulin values, as these values have no diagnostic value.
• Obese children and teens do not require 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.
• Specific genetic testing is indicated in early onset obesity (before 5 years of age), cases of hyperphagia, other clinical findings of genetic obesity syndromes, or a family history of extreme obesity. Approximately 7% of children with extreme obesity may have rare chromosomal abnormalities or genetic mutations.

The guidelines also identify unmet needs for future research, such as the causes of pediatric obesity and its complications.

Seventeen percent of American children and teenagers between the ages of 2 and 19 were affected by obesity between 2011 and 2014, according to the CDC. Obesity in this age group was associated with an estimated $14.1 billion in additional prescription drug, emergency room, and outpatient medical visit costs each year.