At a recent Provider Relations CME Lunch and Learn sesssion, Dr. Michelle Henning — pediatrician and Medical Director of CHKD's Healthy You for Life program — defines pediatric overweight and obesity, and addresses weight stigma and the need to treat obesity as a chronic disease. Learn more in this Lunch and Learn recap.
Understanding Pediatric Overweight and Obesity
The first step in effective management is defining the condition. Overweight and obesity are rising health concerns in the pediatric population, with an unfortunately higher percentage seen in older children (ages 12–19) and certain ethnic groups.
- Key Action: Clinicians can utilize specific tools to calculate the severity (percent of the 95th percentile) for appropriate reporting and authorization when needed.
2. Addressing Weight Bias and Stigma
It is crucial to recognize and mitigate the impact of weight bias and stigma on patient care. Weight bias — negative attitudes and judgments, such as viewing patients as lazy or non-compliant — can lead to weight stigma, which is social devaluation and discrimination.
Actionable Steps for Healthcare Providers:
- Create an Inclusive Environment: Ensure your office space has appropriate-sized furniture and equipment.
- Prioritize Patient-First Language: Always ask permission to discuss a child’s weight. Use person-first language like "patient with obesity," similar to "patient with diabetes," to ensure the disease does not define the individual.
3. Obesity as a Chronic Disease
The medical community, including the American Medical Association (AMA) since 2013, recognizes obesity as a complex, chronic disease. As a chronic, relapsing, multifactorial, neurobehavioral disease, it affects every major organ system and requires long-term, ongoing management.
- Core Principle: This chronic nature means there is no evidence to support "watchful waiting" or delaying appropriate treatment once obesity is identified. Early intervention is key.
4. The Foundation of Comprehensive Treatment
The American Academy of Pediatrics (AAP) guidelines emphasize a comprehensive, longitudinal treatment approach tailored to the ongoing needs of the patient and family.
- Intensive Health Behavior and Lifestyle Treatment (IHBLT): This is the foundation of care, involving the patient and family with a multi-disciplinary team. It should deliver at least 26 hours of education and support over 3–12 months. If a multidisciplinary team/program is not available, it can also be offered by a primary care provider/medical home utilizing available community resources.
- Quick Tips for Primary Care: For busy clinicians, focus on high-impact changes, such as:
- Reducing sugar-sweetened beverages.
- Using the MyPlate concept for nutrition guidance.
- Encouraging consistent breakfast eating.
- Reducing sedentary activity and promoting adequate sleep.
5. Pharmacotherapy Options
For patients who have developed obesity, pharmacotherapy should be offered as an adjunct to IHBLT.
|
Medication Type |
FDA Approval/Age |
Key Information |
|
GLP-1 Receptor Agonists (Semaglutide/Wegovy, Liraglutide/Saxenda) |
Age 12+ for long-term treatment. |
Highly effective by reducing hunger/cravings. Requires careful patient counseling to manage GI side effects by avoiding overeating. |
|
Phentermine/Topiramate ER (Qsymia) |
Age 12+ for long-term treatment. |
Combination medication that suppresses appetite. Counsel females of childbearing potential on birth defect risks. |
|
Phentermine (Short-Acting) |
Age 16+ for short-term (3 months). |
Appetite suppressant. Often used off-label long-term, but requires close blood pressure and heart rate monitoring. |
|
Orlistat |
Age 12+ for long-term treatment. |
Works by binding fat in the gut. Use is limited by severe GI side effects (greasy stools, gas). |
|
Off-Label Use (Metformin, Topiramate, Lisdexamfetamine) |
Varies, e.g., Metformin is approved for Type 2 Diabetes. |
May be considered for patients with certain comorbidities (Metformin for insulin resistance/PCOS) or as a cash-pay option. |
6. Ongoing Care and Transition
Because obesity is a chronic, relapsing disease, treatment must be ongoing.
- Determining Endpoints: Once a patient achieves a healthy BMI, the goal shifts to maintenance, often involving a reduction or spacing out of the medication dosage, rather than stopping it entirely to prevent weight regain.
- Aging Out: As pediatric patients age out (typically up to 21), their care is seamlessly transitioned to an adult primary care physician (PCP) or an adult weight management program, ensuring the continuity of their long-term treatment plan.
Questions?
If you have questions or would like additional information, please reach out to Dr. Michelle Henning at Michelle.Henning@CHKD.org or call (757) 668-7957.
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