JW

Obesity AAP Clinical Guidelines

Overview of the 2023 AAP Clinical Practice Guidelines

  • Topic: Evaluation and Treatment of Children and Adolescents with Obesity

  • Presented by: Ihuoma Eneli MD, MS, FAAP

  • Event Dates: March 10-13 Virtual, May 15-July 31

  • Organization: National Association of Pediatric Nurse Practitioners

Learning Objectives

  • Objective 1: Summarize the 2023 Clinical Practice Guideline (CPG) for pediatric obesity.

  • Objective 2: Review the translation of CPG recommendations into a resource change package and two Quality Improvement projects.

  • Objective 3: Identify clinical decision supports and resources that aid in the implementation of CPG recommendations in primary care.

CPG Development

  • Comprehensive Process:

    • Evidence Review & Technical Reports (TRs) generated by a subcommittee.

    • Internal and external review of 2017-2023 guidelines.

    • Aimed to evaluate pediatric obesity better.

Prevalence of Pediatric Obesity

  • Approximately 14.1 million children and adolescents in the U.S. are affected.

  • 4.5 million have severe obesity (BMI ≥120% of the 95th percentile or BMI ≥35).

AAP Guidelines Audience

  • Primary audience includes Pediatric Health Care Clinicians, focusing on the prevention and treatment of obesity.

CPG Summary

  • Key Actions:

    • Contains 13 Key Action Statements.

    • Includes 11 Consensus Recommendations with a focus on assessment, comorbidities, and multiple treatment options.

Evidence Grading

  • Strength of Recommendations:

    • Based on quality of evidence regarding benefits or harms and the levels of obligation to follow these recommendations.

Use of Language in KAS

  • The terms "should" and "may" in KAS reflect the level of required action based on evidence.

  • "Should" indicates an intermediate level of obligation—suggesting recommendations while allowing for variations depending on circumstances.

Understanding Obesity

  • Obesity is complex and can indicate systemic issues:

    • Structural inequities (food systems, health inequities)

    • Genetic and environmental factors contribute to obesity.

  • Emphasis on understanding social determinants impacting health and obesity treatment.

New Recommendations

  • Immediate Treatment:

    • No benefit to watchful waiting; treat early and continue concurrently for obesity and comorbid conditions.

    • Utilize a variety of evidence-based strategies for effective treatment.

  • Recognize the harmful impact of weight stigma and bias on treatment.

Patient-Centered Care

  • Non-Stigmatizing Communication:

    • Avoid blame; focus on systemic factors.

    • Use person-first language when discussing weight.

    • Favor neutral language regarding weight.

    • Treatment focuses on developing healthy relationships with food, avoiding restrictive eating.

Evaluation and Treatment Recommendations

Key Action Statements (KAS)

  1. KAS 1: Regularly measure height, weight, and BMI for children 2-18 annually.

  2. KAS 2: Evaluate children with overweight or obesity for comorbidities through a comprehensive history and physical examination.

Physical Assessment and Evaluation

  • Evaluation tools include blood pressure checks, fasting lipid panels, and glucose metabolism evaluation, particularly for obesity-related comorbidities.

Treatment Guidelines

  • Concurrent Treatment: Treat obesity and comorbidities together, emphasizing immediate and intensive interventions.

  • Use of Motivational Interviewing (MI) to enhance patient engagement.

  • Introduce intensive health behavior and lifestyle treatment for ages 6 and older.

Behavioral Strategies

  • Recommendations include reduction of sugar-sweetened beverages, daily physical activity, and promoting a balanced diet.

Pharmacotherapy Considerations

  • Pediatricians prescribing weight loss medications must understand efficacy, side effects, and necessary follow-up.

  • Medications like Orlistat and Liraglutide are suggested under specific conditions while recognizing the importance of behavioral interventions alongside these treatments.

Community Connection and Implementation

  • Strategies for implementing guidelines include education, training, and community healthcare resource identification.

  • Set realistic expectations for change and adjustments in practice; use decision support tools for better adherence to guidelines.

Concluding Remarks

  • Continuous evaluation of adherence to CPG recommendations is essential.

  • Resources such as CME modules, educational materials, and patient engagement strategies are readily available through the AAP to support practitioners.