Childhood obesity is a prevalent chronic disease affecting children today, with a complex etiology involving genetic, physiological, environmental, and socioeconomic factors. The increase in childhood obesity rates in the United States has been significant, rising from approximately 5% in the 1960s to over 19% according to recent estimates. This condition greatly increases the risk of both short- and long-term health issues, such as adult obesity, cardiovascular diseases, and type 2 diabetes, while also impacting mental health and quality of life. Failing to effectively address childhood obesity can result in persistent comorbidities that extend into adulthood.
In recognition of National Childhood Obesity Awareness Month 2024, this Guidelines Side-By-Side article offers a comprehensive comparison of current clinical practice guidelines from the American Academy of Pediatrics (AAP) and the Endocrine Society (ES). By exploring these recommendations, this article aims to offer healthcare providers critical insights and best practices for the assessment of pediatric obesity, ensuring an evidence-based approach in evaluating this complex condition and improving health outcomes for affected children and their families.
Titles of Comparison:
| AAP | ES | |
|---|---|---|
| Title | Evaluation and Treatment of Children and Adolescents With Obesity | Pediatric Obesity—Assessment, Treatment, and Prevention: An Endocrine Society Clinical Practice Guideline |
| Society | American Academy of Pediatrics (AAP) | Endocrine Society (ES) |
| Publication Date | January 2023 | January 2017 |
| Objective | This is the AAP’s first clinical practice guideline (CPG) outlining evidence-based evaluation and treatment of children and adolescents with overweight and obesity. This guideline does not cover the prevention of obesity, which will be addressed in a forthcoming AAP policy statement. The CPG does not include guidance for overweight and obesity evaluation and treatment of children younger than 2 years. The CPG also does not discuss primary obesity prevention, as no studies reporting results of obesity prevention interventions met the inclusion criteria for the evidence review. | To formulate clinical practice guidelines for the assessment, treatment, and prevention of pediatric obesity. Cosponsored by the European Society of Endocrinology and the Pediatric Endocrine Society, the guideline was funded by the Endocrine Society. |
| Target Population | Pediatric populations ages 2 to 18 years. Studies could also include young adults up to age 25, if this population was stratified from older adult participants, as long as children younger than 18 years were also included in the study. Children could have other conditions (eg, asthma), as long as these conditions were not known to cause obesity, or be taking medications (eg, steroids) other than those known to be significantly obesogenic. Conditions known to cause obesity, such as Prader-Willi syndrome, obesogenic medication (eg, antipsychotics), or known genetic mutations associated with obesity (eg, melanocortin 4 receptor [MC4R]) were excluded. | Overweight and obese pediatric populations |
| Methodology | The AAP Classifying Recommendations for Clinical Practice Guidelines policy statement, consistent with the grading recommendations advanced by the University of Oxford Centre for Evidence-Based Medicine. | GRADE |
| Graded Strength of Recommendations | Yes | Yes |
| Graded Level of Evidence | Yes | Yes |
| Systematic Review Conducted | Yes | Yes |
| Literature Review Conducted | Yes | Not explicitly stated |
| COIs & Funding Source(s) Disclosed | Yes | Yes |
| Full-text | Clinical Practice Guideline for the Evaluation and Treatment of Children and Adolescents With Obesity | Pediatrics | American Academy of Pediatrics | Pediatric Obesity—Assessment, Treatment, and Prevention: An Endocrine Society Clinical Practice Guideline | The Journal of Clinical Endocrinology & Metabolism | Oxford Academic |
| Summary | 2023 AAP Guidelines for Children and Adolescents With Obesity – AAP Childhood Obesity Guideline Summary | ES Pediatric Obesity—Assessment, Treatment, and Prevention Guideline Summary |
| Other Links | Quiz: AAP Evaluation and Treatment of Children and Adolescents With Obesity Guideline Learning Activities | Pocket Guide: ES Pediatric Obesity—Assessment, Treatment, and Prevention Guideline Pocket Guide |
Assessment Overview:
| AAP | ES | |
|---|---|---|
| BMI Measurement | Use BMI to screen for overweight and obesity in children aged 2 years and older. Overweight: BMI between the 85th and 94th percentiles. Obesity: BMI at or above the 95th percentile. | Similar to AAP, use BMI and CDC normative BMI percentiles for diagnosis. Overweight: BMI between the 85th and 94th percentiles. Obesity: BMI at or above the 95th percentile. Extreme obesity: BMI at or above 120% of the 95th percentile or >35 kg/m². |
| Comorbidity Screening | Evaluate for obesity-related comorbidities such as type 2 diabetes, hypertension, dyslipidemia, and non-alcoholic fatty liver disease. Psychological assessment for mental health issues related to obesity. | Screen for common comorbidities such as type 2 diabetes, hypertension, and dyslipidemia. Psychological assessment for mental health issues. |
| Genetic and Endocrine Evaluation | Consider genetic testing if there are specific historical or physical features suggesting a genetic syndrome. Routine endocrine evaluations are not recommended unless growth patterns are abnormal. | Genetic screening is recommended only if there are specific historical or physical features. Routine endocrine evaluations are not recommended unless growth patterns are abnormal. |
| Lifestyle and Behavioral Assessment | Assess dietary habits, physical activity levels, and screen time. Evaluate family dynamics and readiness to change. | Assess dietary habits, physical activity, and screen time. Evaluate family dynamics and readiness to change. |
Key Takeaways:
- Target Audience:
- Endocrine Society Guideline: Targets a broader audience including endocrinologists, general pediatricians, and other healthcare professionals involved in the management of obesity.
- Assessment Protocols:
- Both guidelines recommend a thorough assessment, including measuring BMI, growth patterns, and psychosocial factors. However, the Endocrine Society may place a greater emphasis on biochemical assessments and hormonal evaluations in specific cases.
- Treatment Recommendations:
- The Clinical Practice Guideline emphasizes a step-wise approach that includes lifestyle interventions, behavioral modifications, and, when necessary, pharmacotherapy and surgery.
- The Endocrine Society Guideline also supports lifestyle changes as first-line treatment but may include more detailed recommendations for pharmacological interventions and surgical options for severe obesity, with specific criteria for when these options should be considered.
- Prevention Focus:
- The Clinical Practice Guideline discusses prevention strategies but may not focus as heavily on public health initiatives.
- The Endocrine Society Guideline incorporates a strong emphasis on prevention strategies, promoting initiatives that engage families and communities to reduce obesity rates.
- Psychosocial Considerations:
- Both guidelines acknowledge the importance of addressing psychosocial aspects. However, the Clinical Practice Guideline may provide more extensive recommendations on integrating mental health support into treatment plans.
- Evidence Base:
- Each guideline relies on systematic reviews of the literature, but they may prioritize different studies or sets of evidence based on their specific focus areas (e.g., endocrinology vs. general pediatrics).
Key Differences:
Extreme Obesity Definition: The Endocrine Society includes a specific category for extreme obesity, which is not explicitly mentioned in the AAP guidelines.
Detailed BMI Percentiles: The Endocrine Society provides more detailed BMI percentiles and specific thresholds for extreme obesity.
Guideline Development: The AAP guidelines are more recent (2023) compared to the Endocrine Society guidelines (2017), potentially reflecting newer evidence and practices.
While both guidelines aim to address pediatric obesity comprehensively, the Clinical Practice Guideline provides a broader framework for assessment and treatment, focusing on practical implementation in pediatric settings. In contrast, the Endocrine Society Guideline dives deeper into the biological and hormonal factors involved in obesity, offering specific insights into pharmacological treatments and preventive strategies. Both are valuable resources for clinicians, but they serve slightly different needs in the management of pediatric obesity.
Navigating the complex guidelines for pediatric obesity requires a deep understanding of the diverse recommendations in order to enhance the care provided for pediatric obesity assessment and weight management. By integrating these guidelines, a comprehensive approach to obesity can be ensured, tailored to meet the unique needs of each patient. Remaining vigilant and adaptable in evaluating evolving recommendations is crucial in refining weight management strategies, fostering collaborative decision-making, and guiding each patient on their journey towards improved health and well-being.
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