New guidelines for treating childhood obesity prompt debate among Philly health experts

New guidelines for treating childhood obesity recommend more invasive action, including the possibility of weight-loss medication and bariatric surgery for children as young as 13.

The new guidelines, the first in 15 years, reflect a rising sense of urgency to stem a troubling trend that could lead to lifelong health problems. Obesity is associated with conditions including hypertension, diabetes, and fatty liver disease, which can be especially concerning when developed at a young age.

Medical providers in the Philadelphia region largely agree that the consequences of childhood obesity are so serious aggressive interventions may be necessary.

“If we’re offering you anything: medications, vaccines, surgery,” said Elana McDonald, a Philadelphia pediatrician who is one of the “Twin Sister Doctors,” two sisters who focus on treating chronic conditions in the city’s poorer communities, “the benefits must outweigh the risks.”

» READ MORE: Treating childhood obesity requires addressing neighborhood risks | Expert Opinion

The guidelines have prompted debate, though, about the effects of recommending such intense treatments and the stigma that could accompany them.

Here’s what you should know about the new AAP guidelines:

A child with a body mass index at or above the 95th percentile among peers their age and sex is considered clinically obese. They are considered overweight if their BMI is between the 85th percentile to 95th percentile. More than 14.4 million American children are obese, according to the Centers for Disease Control and Prevention.

Environment, genetics, and socioeconomic status all play a role in childhood obesity. Stress, screen time, inactivity, irregular sleep, and increased snacking increase risk, said Sandra Hassink, the director of the American Academy of Pediatrics’ Institute for Healthy Childhood Weight.

Many risk factors disproportionately affect low-income communities. For instance, people who live in neighborhoods without a grocery store may rely on convenience stores stocked with snacks that are high in fat, salt and sugar.

Neighborhoods without safe recreation areas and parks or walkable streets inhibit children’s opportunities to get the activity they need.

The AAP report also noted children of immigrants could be at risk as families as families adopt American eating habits.

A 2023 Penn State College of Medicine study noted children with public health insurance, which covers low-income families, were more likely to gain weight in 2020 than those with private insurance.

Children of color experience obesity at greater rates than white children, research shows.

That means the new, more invasive approach to treating childhood obesity will disproportionately put families of color in a position of making difficult decisions about their children’s care.

More than a quarter of Latino children, and almost a quarter of Black children in the United States have obesity, according to the Centers for Disease Control and Prevention. Just over 16% of white children have the condition.

Hassink emphasized that environment, not race, was a critical determinant of childhood obesity.

“Don’t do racial or ethnic labeling,” she said. “The accessibility of the outdoors, of having a Y(MCA) or walking to the Y, that’s huge for families and kids. Anything that compromises that is going to increase your obesity risk.”

Among the organization’s recommendations for pediatricians:

The AAP guidelines note there is ample evidence the interventions the organization recommended are safe. The AAP is responding to a stubborn and growing problem of childhood obesity in the United States, McDonald said.

“For years, it’s always been exercise and diet, but sometimes that’s not enough,” she said. “This is another tool in our tool box to help manage pediatric obesity.”

Children who experience obesity may struggle to ever reach a healthy weight as an adult. And the more excess weight a child gains, the harder it is to lose, as hormones adapt to maintain body mass.

“The more severe the obesity, the more difficult it would be for them to lose significant amount of weight without medicine and without surgery,” said Stephan Myers, chief of bariatric surgery at St. Christopher’s Hospital for Children in Philadelphia and a pediatric surgeon at Tower Health in Reading.

Daniel Taylor, medical director of the outpatient center at St. Christopher’s Hospital for Children, is concerned about the repercussions of prescribing surgery for children, “before their bodies and minds are developed.”

The surgery isn’t a one time event, he said. Children who receive it have to maintain restrictive diets after it to gain the full weight loss benefits of the procedure.

About 13% to 25% of patients need additional procedures up to 5 years following metabolic and bariatric surgery, according to the AAP.

The AAP is clear its guidelines aren’t intended to address obesity prevention, but Taylor wants to see an increased focus on the condition’s causes.

“We have potentially this huge swath of children in lower income communities in Philadelphia and nationally that are now potentially going to be on very expensive medication for issues that should have a societal responsibility,” he said.

Others worry the new guidelines will lead children to become obsessed with their weight.

Helping people with obesity understand the importance of a healthy weight without feeding into the cultural notions of beauty is challenging, said Kelly Allison, director of the Center for Weight and Eating Disorders at University of Pennsylvania.

“It’s those kinds of discussions that can trigger an eating disorder to emerge,” she said.

McDonald emphasized the importance of recognizing the social determinants of health when treating children in Philadelphia’s lower income neighborhoods, which often are predominantly Black or Latino.

“They don’t have access to a grocery store, don’t have access to a Produce Junction,” she said. “Quality and price are both hard to access.”

The frequency of gun violence in some of those neighborhoods is another important factor, she said.

“Sometimes my parents may say, ‘Doc, sometimes I don’t feel comfortable sending my children outside,’” she said.

Doctors must recognize what’s realistic for their patients. McDonald asks parents worried about safety outdoors if it’s possible for children to work out indoors, like in a basement.

“We need them moving enough to get their heart rate up and for them to sweat,” she said.