New American Academy of Pediatrics guidelines recommend medication, bariatric surgery for children with obesity

DELMARVA- A new practice guideline recommendation from the American Academy of Pediatrics outlines treatment methods for obese children between ages 6-12  including hormone-regulating treatment and bariatric surgery.

The measures come as new evidence shows that chronically obese children are more likely to become obese adults, and carry severe health problems for the rest of their lives without interventional treatment, but local health departments and healthcare providers are stressing that these measures are designed to help kids meet their diet and exercise goals, not replace them.

“This is not fat shaming, this is not blaming, this is recognition of a chronic disease and needs to be treated like a chronic disease,” said the Medical Director for Perioperative Services and the Surgical Director of the Bariatric Surgery Program at Nemours Children’s Health Dr. Kirk W. Reichard.

Dr. Reichard also serves as the  President of the Delaware Chapter of the American Academy of Pediatrics and published best practices for pediatric metabolic and bariatric surgery in 2019, many of which are included in the guidelines about to be released and will be used by physicians across the country.

He says since the last time the American Academy updated its national guidance, his practice has seen double the amount of patients coming in what he describes as Stage 2 obesity or the level at which they would qualify for the treatments outlined in the updated guidance.

“What I think it does is bring out the need to deal with this problem and to deal with it before the kids get sicker and become sick adults,” Dr. Reichard said.

Dr. Reichard stresses that in many cases these children are having these challenges through no fault of their own.

“The social determinants of health is a huge factor, kids who have obesity are doubly likely to come from food insecure homes, and to have a shortage of healthy food options available in their area,” he said adding that Nemours hospital has been conducting its own research to see which factors are driving these conditions in hopes of isolating them and preventing future cases.

“I would love to eventually put ourselves out of business,” he said, adding that his patients experience  comorbidities such as “abnormal lipids high blood pressure, pre-diabetes, diabetes, sleep apnea and we know these will get worse and lead to shorter life expectancy.”

He believes the treatments, that work to help regulate hormone imbalances that can cause irregular hunger and satiety cues in patients can help them better adhere to better eating habits and exercise regimens.

“These measures are to enhance and by no means supplant [Diet and exercise],” he said.

Education and programming for those topics however aren’t limited to Nemours, as THRIVE in Cambridge seeks to give local kids a fun program to learn about nutrition and participate in training at the local Heirloom Athletics gym.

The program is run in partnership with the local health department, and currently just enrolled its second class of 14 students in mid-January.

” We provide two days a week of exercise and nutrition as well as mental health group sessions to help kids gain confidence and normalize healthy habits,” said Thrive Co-Founder Dr. Casey Scott.

Dr. Scott is also a certified Obesity Medicine provider, and tells 47ABC she is glad to be able to help break the stigma around childhood obesity while teaching kids a healthier relationship with food, training, and their bodies.

“We don’t track the weight of the kids that’s not the goal of the program, but we have to get away from this idea of obesity being a choice, where kids are simply eating too many sweets, its a multifaceted issue, and that includes food deserts, economic factors and more, so what this does is teach kids fitness can be fun, and it should be fun so that they stick with it their whole lives, and that diets are not a one-off but something to hold to for the rest of your life,” Dr. Scott said.

She says there is a heritable as well as environmental quality to obesity, and fixing the obesity epidemic means requires action on the part of kids, parents, and communities, and views the new recommendation as another tool in the toolbox for patients, even though many would likely need to travel to Nemours or other centers off of Delmarva to receive them.

“We have to go above and beyond telling people to eat whole foods and provide them with tools and resources so that we can figure out how to make small changes that snowball into bigger changes,” she said.

Dr. Scott tells us locally, parents can get referrals from their PCPs for those treatments.

Dr. Reichard tells 47ABC a second recommendation for clinical practices is expected from the American Academy of Pediatrics later this year, detailing the causes of obesity, and community-level changes that can be done to help prevent these cases, as well as the best way to support kids on their weight-loss journey.