From the Guidelines
Children with a Body Mass Index (BMI) at or above the 95th percentile should undergo a specific assessment for comorbidities and be enrolled in a family-based weight-gain prevention program with a registered dietitian (RD) counseling for an energy-balanced diet, moderate-to-vigorous physical activity (MVPA) prescription, and limited sedentary screen time, with a 3-month follow-up. According to the US pediatric guidelines for obesity management, as outlined in the expert panel on integrated guidelines for cardiovascular health and risk reduction in children and adolescents 1, the approach to managing obesity in children and adolescents involves a comprehensive evaluation and tailored interventions. For those with a BMI at or above the 95th percentile, the guidelines strongly recommend a family-centered program focusing on behavior modification, energy-balanced diet, and increased physical activity, with regular follow-up.
Key components of the management plan include:
- Specific assessment for comorbidities such as hypertension, dyslipidemia, and type 2 diabetes mellitus (T2DM) 1
- Family-based weight-gain prevention with parents or the adolescent as the focus for behavior modification and energy-balanced diet counseling by a registered dietitian (RD) 1
- Prescription for increased moderate-to-vigorous physical activity (MVPA) and decreased sedentary screen time 1
- Regular follow-up, with the frequency depending on the age group and the presence of comorbidities, to monitor progress and adjust the management plan as needed 1
In cases where there is no improvement in BMI percentile or the presence of comorbidities, the guidelines suggest referral to a comprehensive multidisciplinary lifestyle weight-loss program or consideration of additional treatments like medication (e.g., orlistat) under the care of an experienced clinician, or even bariatric surgery for severe cases 1. The management approach is tailored to the child's age, BMI percentile, and the presence of comorbidities, emphasizing the importance of a personalized and multifaceted strategy to address obesity in children and adolescents effectively.
From the Research
US Pediatric Guidelines for Obesity
The US pediatric guidelines for obesity define obesity in adolescents as a Body Mass Index (BMI) at or above the 95th percentile for age and sex 2, 3, 4, 5.
Definition and Prevalence
- Obesity in adolescents is commonly defined as a BMI at the 95th or greater age- and sex-adjusted percentile 2.
- The prevalence of adolescent obesity is approximately 21% in the US 2.
- Over 10% of all children and adolescents are obese, and another 10% are overweight (BMI > 85th percentile) 3.
- More than one quarter of all children and adolescents are either overweight or obese 4.
Treatment Options
- Comprehensive treatment in adolescents includes lifestyle modification therapy, pharmacotherapy, and metabolic and bariatric surgery 2.
- Lifestyle modification therapy, which includes dietary, physical activity, and behavioral counseling, is first-line treatment 2.
- Newer antiobesity medications, such as liraglutide, semaglutide, and phentermine/topiramate, in combination with lifestyle modification therapy, can reduce mean BMI by approximately 5% to 17% at 1 year of treatment 2.
- Surgery (Roux-en-Y gastric bypass and vertical sleeve gastrectomy) for severe adolescent obesity (BMI ≥120% of the 95th percentile) reduces mean BMI by approximately 30% at 1 year 2.
Terminology
- The Centers for Disease Control and Prevention (CDC) 2000 growth charts serve as reference values for BMI in children 5.
- The terminology used for high BMI-for-age in children in the United States has been updated to refer to BMI-for-age from the 85th up to the 95th percentile as "overweight" and to BMI-for-age at or above the 95th percentile as "obesity" 5.