2017 Guidelines: Pediatric Obesity

"Pediatric obesity remains an ongoing serious international health concern affecting ∼17% of US children and adolescents, threatening their adult health and longevity. Pediatric obesity has its basis in genetic susceptibilities influenced by a permissive environment starting in utero and extending through childhood and adolescence.

Endocrine etiologies for obesity are rare and usually are accompanied by attenuated growth patterns. Pediatric comorbidities are common and long-term health complications often result; screening for comorbidities of obesity should be applied in a hierarchal, logical manner for early identification before more serious complications result.

Genetic screening for rare syndromes is indicated only in the presence of specific historical or physical features. The psychological toll of pediatric obesity on the individual and family necessitates screening for mental health issues and counseling as indicated."

J C E M


J C E M

Guidelines

March 2017

  • We recommend using body mass index (BMI) and the Centers for Disease Control and Prevention (CDC) normative BMI percentiles to diagnose overweight or obesity in children and adolescents ≥2 years of age.

  • We recommend diagnosing a child or adolescent >2 years of age as overweight if the BMI is ≥85th percentile but <95th percentile for age and sex, as obese if the BMI is ≥95th percentile, and as extremely obese if the BMI is ≥120% of the 95th percentile or ≥35 kg/m2

  • We suggest that a child <2 years of age be diagnosed as obese if the sex-specific weight for recumbent length is ≥97.7th percentile on the World Health Organization (WHO) charts, as US and international pediatric groups accept this method as valid.

  • We recommend against routine laboratory evaluations for endocrine etiologies of pediatric obesity unless the patient’s stature and/or height velocity are attenuated (assessed in relationship to genetic/familial potential and pubertal stage).

  • We recommend that children or adolescents with a BMI of ≥85th percentile be evaluated for potential comorbidities

  • We recommend against measuring insulin concentrations when evaluating children or adolescents for obesity.

  • We suggest genetic testing in patients with extreme early onset obesity (before 5 years of age) and that have clinical features of genetic obesity syndromes (in particular extreme hyperphagia) and/or a family history of extreme obesity.

  • We recommend breast-feeding in infants based on numerous health benefits. However, we can only suggest breast-feeding for the prevention of obesity, as evidence supporting the association between breast-feeding and subsequent obesity is inconsistent.

  • We suggest pharmacotherapy for children or adolescents with obesity only after a formal program of intensive lifestyle modification has failed to limit weight gain or to ameliorate comorbidities. We recommend against using obesity medications in children and adolescents <16 years of age who are overweight but not obese, except in the context of clinical trials.

  • We suggest that clinicians should discontinue medication and reevaluate the patient if the patient does not have a >4% BMI/BMI z score reduction after taking antiobesity medication for 12 weeks at the medication’s full dosage.

We suggest bariatric surgery only under the following conditions:

  • The patient has attained Tanner 4 or 5 pubertal development and final or near-final adult height, the patient has a BMI of >40 kg/m2 or has a BMI of >35 kg/m2 and significant, extreme comorbidities

  • Extreme obesity and comorbidities persist despite compliance with a formal program of lifestyle modification, with or without pharmacotherapy

  • Psychological evaluation confirms the stability and competence of the family unit [psychological distress due to impaired quality of live (QOL) from obesity may be present, but the patient does not have an underlying untreated psychiatric illness]

  • The patient demonstrates the ability to adhere to the principles of healthy dietary and activity habits

  • There is access to an experienced surgeon in a pediatric bariatric surgery center of excellence that provides the necessary infrastructure for patient care, including a team capable of long-term follow-up of the metabolic and psychosocial needs of the patient and family.