Eliminating Bias: How to Approach Pediatric Obesity Treatment
by Suzanne Cuda, MD, FOMA, FAAP
Dr. Cuda is a Fellow of the Obesity Medicine Association (OMA), has participated as an OMA committee member, and was the past Secretary/Treasurer for the Obesity Treatment Foundation. She is the primary author for the Pediatric Obesity Algorithm and the editor of the OMA Pediatric Self-Assessment program.
Funding: No funding was provided.
Disclosures: The author has no conflicts of interest relevant to the content of this article.
Bariatric Times. 2021;18(8):20
As healthcare providers, we understand the magnitude of childhood obesity, but often we underestimate the influence and impact we have on patients and their families. A prevalent disease, childhood obesity affects 12.7 million infants, children, and adolescents. It should be addressed the same way we would approach any other chronic disease, such as asthma, attention deficit hyperactivity disorder (ADHD), or hypertension.
Childhood obesity treatment requires an understanding of the patient’s family and cultural background, as well as medical and psychological expertise. We have the potential to make a huge difference in a child’s or a family’s health, and I believe we are ethically obligated to address any chronic disease with known long-term consequences (such as obesity) that can be mitigated with treatment. Even a small amount of weight loss or a slight change in a family’s dietary habits can decrease risks for diabetes and metabolic syndrome.
Approaching obesity treatment in kids vs. adults. There are several differences in treating kids for obesity compared to adult patients. The management of obesity in a growing child requires an assessment of the anticipated increase in stature and appropriate weight gain, maintenance, or in some cases, weight loss. Utilizing a specific body mass index (BMI) chart for children with obesity that allows tracking on the percent of the 95th percentile is helpful for both diagnosis and tracking progress. In addition to physiology, another notable difference between treating kids and adults is the dependence of the child on the family structure and the willingness of the family to make changes to promote a less obesogenic environment.
Recent changes in pediatric obesity. A major recent change in pediatric obesity is the more widespread use of anti-obesity medication in children. We previously hoped that some of the medications we used to treat other conditions, such as ADHD, migraine headaches, or prediabetes (e.g., stimulants, topiramate, and metformin), had a weight loss side effect or did not promote weight gain. Over the last several years the use of anti-obesity medication has increased. Although there has not been a change in the United States (US) Food and Drug Administration (FDA) approval age for phentermine (>16 years), and topiramate is not approved for the treatment of obesity, these medications are now more commonly used after appropriate counseling in children and explanation of risks, benefits, and side effects. We also now have an approved glucagon-like peptide 1 (GLP-1) agonist for use in children aged 12 years and older with obesity.
While there have been several recent strides on the medicine side, insurance coverage remains challenging for childhood obesity treatment. Another big change is increased recognition of metabolic and bariatric surgery in children with severe obesity. The American Society for Metabolic and Bariatric Surgery came out with guidelines in 2018,1 and the American Academy of Pediatrics followed with a policy statement in 20192 calling for better access to bariatric surgery for teens with severe obesity.
Obesity treatment bias. We still have a bias against treatment for obesity in the US, and this is amplified in the treatment of children with obesity. The majority of insurance plans do not cover medical care for obesity, and many either do not cover or only partially cover anti-obesity medications; even fewer plans cover surgery. A significant amount of children receive public insurance, and these plans limit coverage for medication use. For our complicated pediatric patients on public insurance, their families have to simultaneously deal with the medical problems that their child has and negotiate a healthcare system that requires referrals from the primary care provider for specialist visits and testing. The system limits care by being so cumbersome, and, as a society, we need to do better.
Leveraging tools for treatment. The Pediatric Obesity Algorithm3 is an easily accessible reference for a healthcare provider to look for information on most aspects of childhood obesity. Our committee of experts synthesizes the evidence and literature and provides summaries for providers, and the algorithm is updated every two years to serve as a valuable and timely resource. As practicing healthcare providers ourselves, we know how precious time is. We use our extensive collective experience in treating pediatric patients with obesity to distill information into a useful format.
Another great tool to leverage is the Obesity Medicine Association (OMA)’s pediatric Self-Assessment Program4, a comprehensive self-exam designed by pediatric obesity medicine expert clinicians. Intended to enhance understanding of pediatric obesity medicine, it contains 60 case-based scenarios and questions focused on the unique challenges of treating pediatric obesity. The set of questions is followed by detailed critiques of each answer and references.
Staying in the know about developments in obesity medicine is critical. Continue your education advancement in this field by registering for OMA’s fall conference today.5 The four-day event—including a pediatric-specific track beginning on September 25–brings healthcare practitioners together so they can share expertise, earn up to 30 CME/CE credits, and stay on top of advancements in the field in regard to special populations.
References
- Pratt JSA, Browne A, Browne NT, et al. ASMBS pediatric metabolic and bariatric surgery guidelines, 2018. ASMBS website. https://asmbs.org/app/uploads/2018/08/PIIS155072891830145X-Pediatric-in-Press.pdf. Accessed 15 July 2021.
- Armstrong SC. AAP guidance calls for better access to bariatric surgery for teens with severe obesity. 27 Oct 2019. American Academy of Pediatrics website. https://www.aappublications.org/news/2019/10/27/bariatricsurgery102719. Accessed 15 Jul 2021.
- Pediatric obesity algorithm: a clinical tool for treating childhood obesity. Obesity Medicine Association website. https://obesitymedicine.org/childhood-obesity/?utm_campaign=pr&utm_source=aug_bt&utm_medium=article. Accessed 15 Jul 2021.
- New self-assessment program (SAP)–volume II–pediatrics. Obesity Medicine Association website. https://obesitymedicine.org/oma-sap-peds/?utm_campaign=pr&utm_source=aug_bt&utm_medium=article. Accessed 15 Jul 2021.
- Overcoming obesity 2021 conference. Obesity Medicine Association website. https://obesitymedicine.org/fall/?utm_campaign=pr&utm_source=aug_bt&utm_medium=article. Accessed 15 Jul 2021.
Category: Medical Methods in Obesity Treatment, Past Articles
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