The growing problem of pediatric obesity is addressed in a specific clinical practice guideline for pediatric obesity that has been issued by the Endocrine Society. It has implications for families, children and medical providers in our community, according to Jay Cohen, MD, medical director of The Endocrine Clinic, P.C., in Memphis, and board member of Healthy Memphis Common Table.

 

"The guideline folds easily into the vision of Healthy Memphis Common Table, which is devoted to decreasing the incidence of obesity and type 2 diabetes in Memphis and the Mid-South through a variety of initiatives including community education and collaboration with area healthcare providers. Using this guideline will make it easier for clinicians to treat pediatric patients who are at risk for obesity, high blood pressure and prevention of type 2 diabetes," explained Cohen. "It gives direction to pediatricians, family practice physicians, and endocrinologists as to what to evaluate, how and when. It also gives direction to insurance companies regarding standards of care. The guideline recommends that clinicians define overweight as a body mass index greater than the 85th percentile and obesity as a BMI greater than the 95th percentile."

 

Cohen points out that the most important elements of the guideline that clinicians can use immediately are the recommendations for changes in daily exercise patterns and dramatic adjustments in food behaviors. The complete guideline is currently available online at http://jcem.endojournals.org (search for keyword "pediatric obesity").

 

The guideline recommends breastfeeding of infants for at least six months as part of a strategy to prevent obesity. And as a first-line treatment for obesity in children and adolescents, the guideline emphasizes intensive lifestyle changes in diet, exercise, and behavior. To help with lifestyle modification, the guideline encourages clinicians to advocate for 60 minutes of moderate to vigorous exercise each day for all school-aged children in all grades.

 

While pharmacotherapy is included in the guideline, it should be considered for children only after lifestyle modification has failed, or if severe associated problems such as high blood pressure, elevated cholesterol, abnormal glucose levels or fatty liver disease persist despite lifestyle modification. And medication should be given only by clinicians who have experience in using anti-obesity drugs and who understand the possible side effects and adverse reactions. This process would also help identify children who might benefit from specialized treatment such as bariatric surgery.

 

"Implementation of this guideline into clinical practice poses many challenges, including the amount of time needed on a consistent basis to educate, support, and give follow-up care to young patients at risk for obesity," said Cohen. "And, that reimbursement for care remains an issue. Insurance companies must start covering for nutritionists and counseling in the doctor's office." If you have patients who are interested in the above mentioned lifestyle changes for better health, www.healthymemphis.org offers a range of resources.