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.