In January 2023, the American Academy of Pediatrics (AAP) issued its first comprehensive clinical practice guideline on the evaluation and treatment of obesity in children over 2 years of age and adolescents (Hampl et al., 2023). The 354-page guideline is accompanied by an executive summary published along with two companion articles that further review the research on comorbidities of and interventions for obesity in children and adolescents.
The guideline is prefaced by a discussion of recognition of complexity of issues about this pervasive and common chronic illness experienced by more than 14.4 million American children and adolescents (Hampl et al., 2023). As per the lead author, "Weight is a sensitive topic for most of us, and children and teens are especially aware of the harsh and unfair stigma that comes from being affected by it" (AAP, 2023, p. 2). The committee reviewed evidence that included family dynamics, socioeconomics, neighborhoods, access to nutritious food, health care, and opportunities for physical activity. Multiple factors associated with health, quality of life outcomes, and risks were considered. It is from this lens that the committee presented their guidelines, an evidence-based review of the multifactorial set of socioecological, environmental, and genetic influences that predispose children and teens to obesity (Hampl et al., 2023).
The committee recognized that overweight and obesity is more prevalent in children who have experienced racism, poverty, discrimination, and stigma and who have immigrated or live in underresourced communities. The American Academy of Pediatrics is committed to reducing health disparities and increasing health equity of all children and adolescents. Although the guideline does not include a focus on prevention of obesity, which will be discussed in a forthcoming document, it stresses the chronic nature of childhood obesity and its long-lasting negative health outcomes (Hampl et al., 2023).
Based on the evidence reviewed, 13 key action statements for pediatric providers are presented within the categories of risk factors, evaluation, comorbidities, and treatment (Hampl et al., 2023). These key actions include "comprehensive obesity treatment including nutritional support, physical activity, behavioral therapy, pharmacotherapy, and metabolic and bariatric surgery" (AAP, 2023, p. 4). Specifically, they recommend intensive health behavior and lifestyle treatment; ideally 26 or more hours of face-to-face, family-centered intervention; treatment delivered by trained health care professionals with active parent involvement; offering teens over the age of 12 weight loss pharmacotherapy in combination with health behavior and lifestyle interventions; and for teens 13 years and older with severe obesity an evaluation of metabolic and bariatric surgery (Hampl et al., 2023).
Key action statements are accompanied by a set of consensus recommendations that focus on the promotion of public health policies to support the payment for obesity prevention and treatment and changes to address the persistent health care disparities in childhood obesity, as well as enhanced education related to childhood obesity in all health professions schools (Hampl et al., 2023). The committee noted the costs of obesity on children, families, and society and recommended taking swift action for treatment and support. "There is no evidence that watchful waiting or delayed treatment is appropriate for children with obesity" (AAP, 2023, p. 3). There is strong evidence to support the safety and effectiveness of obesity treatment in children and teens and the role of all providers who care for the millions of children and teens who are overweight or obese (AAP, 2023; Hampl et al., 2023). Nurses have an important role in caring for children and adolescents who are overweight or obese. Sensitive, compassionate, supportive, and informative care is required for this vulnerable population.
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