4.19.2023 Board Book

Response to the AAP Clinical Practice Guideline (AAP CPG) for the Evaluation and Treatment of Children and Adolescents with Obesity: A Joint Collaborative Statement from the Obesity Medical Association (OMA) and the Pediatric Endocrine Society (PES) Obesity Special Interest Group (SIG)

The treatment of children and adolescents with obesity is evolving rapidly. Previous guidelines from the American Academy of Pediatrics (2007), the Endocrine Society (2017) and the Pediatric Obesity Algorithm (POA) (from the Obesity Medicine Association (OMA) updated in 2020) are now outdated. In response to the growing need to address the management and treatment of children and adolescents with obesity, especially with newer advanced therapies, both the AAP 2 and the OMA 3 have published a Clinical Practice Guideline (AAP) and Clinical Practice Statement (OMA). In addition, the OMA is publishing an update to the Pediatric Obesity Algorithm in spring 2023. The intent of this collaborative paper between the Pediatric Endocrine Society (PES), Obesity Special Interest Group (SIG) and the OMA is to share our approach to the management and treatment of children and adolescents with obesity. Successful intervention with the chronic disease of obesity begins as soon as it is identified-whether as an infant, toddler, or in early childhood. We strongly recommend early intervention for this chronic disease as many studies have shown that ongoing deterioration in weight status and associated complications occur when effective intervention is delayed. For children and adolescents, treatment is limited due to the lack of controlled medication trials under the age of 12 and further complicated by little to no insurance coverage for obesity management, anti-obesity medication (AOM) or for metabolic bariatric surgery (MBS). Management of children and adolescents with obesity is best done collaboratively between Obesity Medicine specialists and Primary Care providers. Primary Care providers identify and frequently start intervention when children present with obesity. An Obesity Medicine specialist is trained to manage not only the disease of obesity but also the complications of obesity. An Obesity Medicine specialist can limit medical costs by reducing referrals to multiple subspecialists. Referrals to other subspecialty providers are indicated if improvement in the disease of obesity will not be enough to address the complications. If an Obesity Medicine specialist is not available, then this burden can fall to the Primary Care provider. It is a challenge to those of us caring for children and adolescents with obesity to increase access to Obesity Medicine specialists. The intervention is dictated by a shared decision-making process among the provider, the patient and the family. The patient and the family must be prepared for ongoing management similar to the expectation of ongoing management for any other chronic diseases, such as asthma or hypertension. Management and treatment of the chronic disease of obesity should be directly addressed. Management of complications of obesity, such as hyperglycemia, elevations in liver enzymes, sleep apnea, and polycystic ovarian syndrome may not be the primary focus of the provider but are addressed as many of these complications are alleviated with an improvement in weight status. Likewise, the disease of obesity is more prevalent and severe in certain populations such as those with compromised social determinants of health. Most chronic diseases are often worse in these populations and success of treatment is not possible until some of the exacerbating conditions are addressed. However, treatment of the disease of obesity should still be the primary focus. The use of intensive health behavior and lifestyle therapy (IHBLT) is done for all patients as a means of optimizing nutritional health, behavioral health, achieving a safe and nurturing home, and improving cardiorespiratory fitness. Unfortunately, IHBLT is not an effective means of achieving a healthy weight in most patients, with the

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