In clinical practice, all clinicians are seeing a rising number of kids with obesity. This article provides information about the newly published key action statements & consensus recommendations by the American Academy of Paediatrics for evaluating & treating overweight & obese children.

Obesity is a widespread, intricate, and often persistent chronic condition that, if left untreated, has negative effects on both one's health and society. But despite the intricacy of the illness, obesity may be successfully treated. Obesity is one of the most prevalent pediatric chronic disorders, having an impact on the short- and long-term health of 14.4 million children and adolescents.

The AAP's first clinical practice guideline, which was just published in Paediatrics, outlines evidence-based evaluation and treatment for kids and teens who are overweight or obese (defined as having a body mass index [BMI] at or above the 85th percentile but below the 95th percentile).

The purpose of this clinical practice guideline (CPG) is to educate paediatricians and other pediatric health care professionals (PHCPs) on the accepted practices for diagnosing and treating overweight, obesity, and associated comorbidities in children. The CPG encourages a strategy that develops the optimal evidence-based treatment plan by taking into account the child's health state, family system, community setting, and treatment resources.

The CPG includes Key Action Statements (KASs), which are evidence-based suggestions from randomised controlled and comparative efficacy studies, based on this data.

Important action statements and consensus recommendations for the assessment and treatment of overweight and obese children and adolescents

1. Paediatricians and other PHCPs should screen all children 2 to 18 years old for overweight (BMI 85th percentile to 95th percentile), obesity (BMI >95th percentile), and severe obesity (BMI >120% of the 95th percentile for age and sex). They should measure height and weight, calculate BMI, and assess BMI percentile using age- and sex-specific CDC growth charts or growth charts for children with severe obesity.
2. Using a thorough patient history, mental and behavioural health screening, SDoH evaluation, physical examination, and diagnostic studies, paediatricians and other PHCPs should evaluate children 2 to 18 years of age who are overweight (BMI 85th percentile to 95th percentile) and obese (BMI 95th percentile) for obesity-related comorbidities.
3. Paediatricians and other PHCPs should check children and adolescents with obesity (BMI 95th percentile) and children and adolescents with overweight (BMI 85th percentile to 95th percentile) for lipid abnormalities, abnormal glucose metabolism, and abnormal liver function. Paediatricians and other PHCPs may assess for impaired glucose metabolism and liver function in children 10 years of age and older with overweight (BMI 85th percentile to 95th percentile) in the presence of risk factors for T2DM or NAFLD. Paediatricians and other PHCPs may check for lipid abnormalities in obese children 2 to 9 years old (BMI 95th percentile).
4. Paediatricians and other PHCPs should simultaneously treat children and adolescents who are overweight (BMI between the 85th and 95th percentile) or obese (BMI more than the 95th percentile).
5. Children 10 years of age and older who are overweight (BMI 85th percentile to 95th percentile) or obese (BMI 95th percentile) should have a fasting lipid panel done to check for dyslipidemia. Children 2 to 9 years of age who are obese can also have this test done.
6. Using fasting plasma glucose, 2-hour plasma glucose following a 75-gram oral glucose tolerance test (OGTT), or glycosylated haemoglobin (HbA1c), paediatricians and other PHCPs should screen for prediabetes and/or diabetes mellitus.
7. Alanine transaminase (ALT) testing should be used by paediatricians and other PHCPs to assess for NAFLD.
8. From the age of three, paediatricians and other PHCPs should check the blood pressure of children and adolescents who are overweight (BMI between the 85th and 95th percentile) or obese (BMI more than the 95th percentile) for hypertension by taking their measurements at each visit.
9. Following the principles of the medical home and the chronic care model, paediatricians and other PHCPs should treat overweight (BMI 85th percentile to 95th percentile) and obesity (BMI 95th percentile) in children and adolescents, using a family-centred and non-stigmatising approach that acknowledges obesity's biologic, social, and structural drivers.
10. To include patients and families in treating overweight (BMI 85th percentile to 95th percentile) and obesity (BMI 95th percentile), paediatricians and other PHCPs should employ motivational interviewing (MI).
11. Paediatricians and other PHCPs should offer intensive health behaviour and lifestyle treatment to children aged 6 years and older (Grade B) and may do so for children aged 2 to 5 years (Grade C) who are overweight or obese (BMI 85th percentile to 95th percentile). Greater contact hours increase the effectiveness of health behaviour and lifestyle treatments; the most successful treatment involves 26 or more hours of in-person, family-based, multi-component therapy over a three to twelve-month period.
12. In addition to health behaviour and lifestyle treatment, paediatricians and other PHCPs should provide weight reduction pharmacotherapy to adolescents 12 years of age and older with obesity (BMI >95th percentile).
13. Paediatricians and other PHCPs should refer adolescents 13 years of age and older with severe obesity (BMI >120% of the 95th percentile for age and sex) to local or regional comprehensive multidisciplinary pediatric metabolic and bariatric surgery centres for evaluation for metabolic and bariatric surgery.

Recommendations reached by consensus

1. Perform early and longitudinal assessments of individual, structural, and contextual risk factors to offer personalised and tailored therapy for the child or teenager with overweight/obesity, according to the CPG authors' advice to doctors and other pediatric health care professionals.
2. To test for OSA, get a sleep history from children and teenagers who are obese. Included in this information should be snoring, daytime sleepiness, nocturnal enuresis, morning headaches, and inattentiveness.
3. Children and teenagers with obesity and at least one sign of respiratory issue should have a polysomnogram.
4. Examine hirsutism and other symptoms of hyperandrogenism in female adolescents with obesity to determine their risk of PCOS.
5. Children and adolescents with obesity should be watched for signs of depression, and teenagers 12 years of age and older should have an annual examination for depression using a standardised self-report instrument.
6. As part of the assessment for obesity, do a musculoskeletal review of systems and physical examination (e.g., internal hip rotation in growing children, gait).
7. If SCFE (Slipped Capital Femoral Epiphysis) is suspected, encourage total and immediate activity restriction, no weight bearing while using crutches, and referral to an orthopaedic specialist for an urgent examination. If an orthopaedic surgeon is not available, PHCPs may think about taking the kid to an emergency room.
8. Maintain a high index of suspicion for IIH (Idiopathic Intracranial Hypertension) in women in the presence of new-onset or increasing headaches and considerable weight gain.
9. Deliver the finest intensive care accessible to all overweight and obese children.
10. Create partnerships with programs and other experts in local areas.
11. To treat children with obesity and weight loss who are 8 to 11 years old, pharmacotherapy may be given in accordance with the drug's indications, risks, and benefits.

Disclaimer- The views and opinions expressed in this article are those of the author and do not necessarily reflect the official policy or position of M3 India.

About the author of this article: Dr Monish Raut is a practising super specialist from New Delhi.