What are the causes and consequences of pediatric obesity?

From the Guidelines

Pediatric obesity should be managed through a comprehensive approach involving lifestyle modifications, including healthy eating patterns and increased physical activity, rather than relying on medications or surgical interventions, as recommended by the American Heart Association 1.

Key Recommendations

• Establish healthy eating patterns with increased fruits, vegetables, and whole grains while reducing processed foods, sugary beverages, and excessive portion sizes.
• Encourage children to engage in at least 60 minutes of physical activity daily, combining aerobic exercise, strength training, and play.
• Limit screen time to less than 2 hours per day for children over 2 years old.
• Family involvement is crucial, with parents modeling healthy behaviors and creating a supportive home environment.
• Regular monitoring of growth parameters by healthcare providers helps track progress.

Rationale

The American Heart Association recommends that severe pediatric obesity be defined as having a BMI ≥120% of the 95th percentile or an absolute BMI ≥35 kg/m2, whichever is lower based on age and sex 1. Accumulating evidence suggests that severe obesity in childhood is associated with an adverse cardiovascular and metabolic profile, even compared with obesity and overweight. Current treatment approaches using lifestyle modification and medications to reduce BMI and improve chronic disease risk factors are insufficient for most patients, and significant residual risk remains 1.

Additional Considerations

• For severe cases, multidisciplinary programs involving dietitians, exercise specialists, and behavioral health professionals may be necessary.
• Medication and surgical interventions are rarely indicated for children except in extreme cases under specialist supervision.
• Innovative approaches to fill the gap between lifestyle/medication and surgery are urgently needed, including intensive programs for families and characterization of the origin of severe obesity to inform the design of novel treatment approaches 1.

Supporting Evidence

Studies have shown that lifestyle modifications, such as healthy eating patterns and increased physical activity, can improve metabolic health and establish sustainable habits in children with obesity 1. Additionally, family involvement and regular monitoring of growth parameters are crucial in managing pediatric obesity. While medication and surgical interventions may be necessary in extreme cases, they should be used with caution and under specialist supervision.

From the Research

Treatment Options for Pediatric Obesity

• The treatment of pediatric obesity involves a multidisciplinary approach, including physical activity, nutrition, and behavioral strategies 2
• Programs that combine decreased sedentary behaviors and nutritional modifications have the most significant results in changes in body mass index (BMI) and weight gain or weight loss 2
• Pharmacological interventions, such as orlistat, metformin, and glucagon-like peptide-1 agonists, may be considered for pediatric patients with obesity, but their use is limited by potential side effects and lack of long-term safety data 3, 4
• Surgical interventions, such as bariatric surgery, may be considered for adolescents with severe obesity who meet specific criteria 5, 6

Lifestyle Interventions

• Lifestyle interventions, including nutrition counseling, increased physical activity, and readiness for behavioral change, are the primary approach for managing pediatric obesity 5
• Combined interventions consisting of dietary modification, physical activity, behavioral therapy, and education have been shown to significantly reduce systolic and diastolic blood pressure, BMI, and triglycerides 6
• Parent-child interventions and parent-only interventions have similar effects on BMI, highlighting the importance of family involvement in pediatric obesity treatment 6

Pharmacological Interventions

• Orlistat is the only FDA-approved medication for pediatric obesity, but its use is limited by gastrointestinal side effects 3, 4
• Metformin and glucagon-like peptide-1 agonists have been shown to reduce BMI in pediatric patients with obesity, but their long-term safety and efficacy are not well established 4
• Other medications, such as phentermine and topiramate, have been studied for pediatric obesity, but their use is not widely recommended due to limited safety and efficacy data 5, 4

Surgical Interventions

• Bariatric surgery may be considered for adolescents with severe obesity who meet specific criteria, including a BMI of 40 or higher or a BMI of 35 or higher with significant comorbidities 5, 6
• Surgical interventions have been shown to result in significant reductions in BMI and improvements in metabolic outcomes, but their use is typically reserved for patients who have failed other treatments 6