The AAP’s Clinical Practice Guidelines for Obesity Management

Written By Jake Soens

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The following is summarized from the AAP’s Clinical Practice Guidelines for treating obesity and overweight status in children ages 2 to 18.

For children with BMI 85th to 95th percentile (i.e., overweight):

Benefits of testing (i.e., early treatment of T2DM, NAFLD) clearly outweigh risks (e.g., false positives, distress); evidence for ALT for liver evaluation over other tests particularly strong

Additionally, for children with BMI ≥ 95th percentile (i.e., obese):

Sample screening questions for SCFE include pain anywhere between the groin and knee. Literature strong regarding association between low socioeconomic status and overweight/obesity. (See “Clinical Practice Guideline for the Evaluation and Treatment of Children and Adolescents With Obesity” for specific ways one may screen for sequelae.) Effective pharmacotherapy per RTCs and/or observational studies includes metformin, policaptel gel retard, orlistat, exenotide, and phentermine. Metformin efficacy strongest if T2DM concurrent with obesity, inconsistent effectiveness without. Topiramate not effective at inducing clinically significant weight loss for obesity. Usually, clinicians order a glycosylated hemoglobin (HbA1c) to assess T2DM due to literature ubiquity, but AAP also suggests clinicians may order a fasting plasma glucose or 2-h plasma glucose after 75-g oral glucose tolerance test (OGTT). Referral for surgery particularly indicated if obesity concurrent with SCFE, depression, and other severe sequelae. Intensive health behavior and lifestyle treatment difficult to study but generally produced moderately dose-dependent decreases in BMI.

To read more: Hampl, S. E., Hassink, S. G., Skinner, A. C., Armstrong, S. C., Barlow, S. E., Bolling, C. F., Avila Edwards, K. C., Eneli, I., Hamre, R., Joseph, M. M., Lunsford, D., Mendonca, E., Michalsky, M. P., Mirza, N., Ochoa, E. R., Sharifi, M., Staiano, A. E., Weedn, A. E., Flinn, S. K., Lindros, J., … Okechukwu, K. (2023). Clinical Practice Guideline for the Evaluation and Treatment of Children and Adolescents With Obesity. Pediatrics, 151(2), e2022060640. https://doi.org/10.1542/peds.2022-060640

Skinner, A. C., Staiano, A. E., Armstrong, S. C., Barkin, S. L., Hassink, S. G., Moore, J. E., Savage, J. S., Vilme, H., Weedn, A. E., Liebhart, J., Lindros, J., & Reilly, E. M. (2023). Appraisal of Clinical Care Practices for Child Obesity Treatment. Part I: Interventions. Pediatrics, 151(2), e2022060642. https://doi.org/10.1542/peds.2022-060642

Skinner, A. C., Staiano, A. E., Armstrong, S. C., Barkin, S. L., Hassink, S. G., Moore, J. E., Savage, J. S., Vilme, H., Weedn, A. E., Liebhart, J., Lindros, J., & Reilly, E. M. (2023). Appraisal of Clinical Care Practices for Child Obesity Treatment. Part II: Comorbidities. Pediatrics, 151(2), e2022060643. https://doi.org/10.1542/peds.2022-060643

Jake Soens