Evaluation and Treatment of Children and Adolescents With Obesity
Assessment and Evaluation
Key Action Statements
Consensus Recommendations
- Perform initial and longitudinal assessment of individual, structural, and contextual risk factors to provide individualized and tailored treatment of the child or adolescent with overweight or obesity.
- Obtain a sleep history, including symptoms of snoring, daytime somnolence, nocturnal enuresis, morning headaches, and inattention, among children and adolescents with obesity to evaluate for OSA.
- Obtain a polysomnogram for children and adolescents with obesity and at least 1 symptom of disordered breathing.
- Evaluate for menstrual irregularities and signs of hyperandrogenism (ie, hirsutism, acne) among female adolescents with obesity to assess risk for PCOS.
- Monitor for symptoms of depression in children and adolescents with obesity and conduct annual evaluation for depression for adolescents 12 years and older with a formal self-report tool.
- Perform a musculoskeletal review of systems and physical examination (eg, internal hip rotation in growing child, gait) as part of their evaluation for obesity.
- Recommend immediate and complete activity restriction, nonweight-bearing with use of crutches, and refer to an orthopedic surgeon for emergent evaluation, if SCFE is suspected. PHCPs may consider sending the child to an emergency department if an orthopedic surgeon is not available.
- Maintain a high index of suspicion for IIH with new- onset or progressive headaches in the context of significant weight gain, especially for females.
Treatment
Key Action Statements
Consensus Recommendations
- Deliver the best available intensive treatment to all children with overweight and obesity.
- Build collaborations with other specialists and programs in their communities.
- May offer children ages 8 through 11 years of age with obesity weight loss pharmacotherapy, according to medication indications, risks, and benefits, as an adjunct to health behavior and lifestyle treatment.
Additional Information
Implementation Consensus Recommendations
- The subcommittee recommends that the AAP and its membership strongly promote supportive payment and public health policies that cover comprehensive obesity prevention, evaluation, and treatment. The medical costs of untreated childhood obesity are well-documented and add urgency to provide payment for treatment.122 There is a role for AAP policy and advocacy, in partnership with other organizations, to demand more of our government to accelerate progress in prevention and treatment of obesity for all children through policy change within and beyond the health care sector to improve the health and well-being of children. Furthermore, targeted policies are needed to purposefully address the structural racism in our society that drives the alarming and persistent disparities in childhood obesity and obesity-related comorbidities.
- The subcommittee recommends that public health agencies, community organizations, health care systems, health care providers, and community members partner with each other to expand access to evidence-based pediatric obesity treatment programs and to increase community resources that address social determinants of health in promoting healthy, active lifestyles.
- The subcommittee recommends that EHR vendors, health systems, and practices implement CDS systems broadly in EHRs to provide prompts and facilitate best practices for managing children and adolescents with obesity.
- The subcommittee recommends that medical and other health professions schools, training programs, boards, and professional societies improve education and training opportunities related to obesity for both practicing providers and in preprofessional schools and residency and fellowship programs. Such training includes the underlying physiologic basis for weight dysregulation, MI, weight bias, the social and emotional impact of obesity on patients, the need to tailor management to SDoHs that impact weight, and weight-related outcomes and other emerging science.
Table 22. Role of the Pediatrician or PCHP
Focus | Role of the Pediatrician or PHCP |
Diagnosis and measurement | Measure height and weight |
Calculate BMI and assess BMI Percentile | |
Communicate BMI and weight status to patient and family | |
Risk factors | Assess individual, structural, and contextual risk factors |
Evaluation | Perform comprehensive patient history |
Conduct physical exam | |
Evaluate for comorbidities0 | |
Order relevant diagnostic studies and laboratories | |
Assess readiness to change | |
Treat comorbidities | Treat obesity and comorbidities concurrently |
Treat obesity | Manage children with overweight & obesity following principles of chronic care model and medical home |
Deliver nonstigmatizing care | |
Use MI to engage patient and families in addressing overweight and obesity, set goals and promote participation or utilization of local resources or programs | |
Promptly engage and refer children to intensive HBL T treatment, if available. If intensive HBL T treatment is not available in your area, deliver highest intensity HBL T treatment possible. | |
Foster self-management strategies | |
Refer to subspecialists if needed | |
Serve as medical home, coordinate care, advocate for family, and support transition to adult care. | |
Offer weight loss pharmacotherapy, to eligible patients, according to medication indications, risks, and benefits, as an adjunct to HBL T. | |
For eligible patients with severe obesity, offer referral to a local or regional comprehensive multidisciplinary pediatric metabolic and bariatric surgery center for surgical evaluation. |
Table 1. Selected Examples of Multilevel Influencers and Contributors to Obesity
- Marketing of unhealthy foods
- Underresourced communities
- Food insecurity
Neighborhood and community factors
- School environment
- Lack of fresh food access
- Fast food proximity
- Access to safe physical activity
- Environmental health
Family and home environment factors
- Parenting feeding style
- Sugar-sweetened beverages
- Portion sizes
- Snacking behavior
- Dining out and family meals
- Screen time
- Sedentary behavior
- Sleep duration
- Environmental smoke exposure
- Psychosocial stress
- Adverse childhood experiences
Individual Factors
Genetic factors
- Monogenetic syndromes and polygenetic effects
- Epigenetic effects
Prenatal risk
- Parental obesity
- Maternal weight gain
- Gestational diabetes
- Maternal smoking
Postnatal risk
- Birth weight
- Early breastfeeding cessation and formula feeding
- Rapid weight gain during infancy and early childhood
- Early use of antibiotics
Childhood risk
- Endocrine disorders
- Children and youth with special health care needs
- Children with autism spectrum disorder
- Children with developmental and physical disabilities
- Children with myelomeningocele
- Attention-deficit/hyperactivity disorder
- Weight-promoting appetitive traits
- Medication use (weight-promoting medications)
- Depression
Table 2. Genetic Syndromes Associated With Obesity
Table 4. Special Considerations in the Review of Systems for the Patient With Overweight or Obesity
Table 5. Assessment Components
Table 8. NHLBI Criteria for Lipid Testing Results
Table 10. Criteria for Diagnosing Prediabetes and T2DM
Table 12. BP Categories by Age and Number of Visits Needed for Diagnosis
Table 18. Behavior Strategies
Recommendation Grading
Overview
Title
Evaluation and Treatment of Children and Adolescents With Obesity
Authoring Organization
American Academy of Pediatrics
Publication Month/Year
January 8, 2023
Last Updated Month/Year
August 29, 2024
Document Type
Guideline
Country of Publication
US
Inclusion Criteria
Male, Female, Adolescent, Child
Health Care Settings
Ambulatory
Intended Users
Dietician nutritionist, nurse, nurse practitioner, physician, physician assistant
Scope
Diagnosis, Assessment and screening, Treatment, Management
Diseases/Conditions (MeSH)
D009765 - Obesity, D063766 - Pediatric Obesity
Keywords
obesity, pediatric obesity, childhood obesity
Source Citation
Sarah E. Hampl, Sandra G. Hassink, Asheley C. Skinner, Sarah C. Armstrong, Sarah E. Barlow, Christopher F. Bolling, Kimberly C. Avila Edwards, Ihuoma Eneli, Robin Hamre, Madeline M. Joseph, Doug Lunsford, Eneida Mendonca, Marc P. Michalsky, Nazrat Mirza, Eduardo R. Ochoa, Mona Sharifi, Amanda E. Staiano, Ashley E. Weedn, Susan K. Flinn, Jeanne Lindros, Kymika Okechukwu; Clinical Practice Guideline for the Evaluation and Treatment of Children and Adolescents With Obesity. Pediatrics 2023; e2022060640. 10.1542/peds.2022-060640