Childhood Obesity Guidelines Send A Signal Of Urgency

For this reason, the American Academy of Pediatrics announced earlier this month a new set of guidelines that instructs pediatricians and other healthcare providers who treat children to approach childhood obesity earlier and more aggressively.

The study that serves as the peer-reviewed foundation of these guidelines shows that 14.4 million American children, or 1 out of every 5, fall under the childhood obesity category. This number has continued to increase since the 1960s, when only around five-percent of children were considered obese.

Touro University California College of Osteopathic Medicine Dean Dr. Tami Hendriksz says the condition is one of the most common things pediatricians see in their patients – and the rate of obesity tends to be much higher, the study states, in communities with inequalities in poverty, home ownership, unemployment, racism and immigrant status.

“One of the big shifts that has occurred in approaches to obesity is the recognition that obesity is a chronic condition, and not simply a temporary state that can easily be changed,” Dr. Hendriksz said. “The AAP outlined how health disparities, systemic racism, weight bias and stigma, and adverse childhood experiences all play a role in the complexities of childhood obesity.”

Dr. Hendriksz helps coordinate Project HAPPY, a healthy lifestyle course for children and families that pairs a family with a medical student who helps discuss fun fitness activities and healthy eating habits.

Strategies outlined in the guidelines include up to 26 hours of in-person lifestyle and behavioral treatment for the entire family for children 2 years and up. Prescription medications to promote weight loss and decrease appetite are recommended for certain children 12 years and up, and bariatric surgery, a normally irreversible procedure that drastically limits the amount of food a person can eat during a meal is recommended for some children at especially high risk due to severe obesity starting at age 13 years and older.

The stigma associated with being obese, particularly among children, was a strong consideration in the study. There is some debate, however, if the emphasis on Body Mass Index, or BMI, will increase or decrease this stigma.

“Alternate recommendations to the AAP’s new aggressive treatment approach shift away from weight and BMI-focused metrics, and towards working with families on their health priorities. In this way promoting healthy lifestyles along with improved psychological well-being,” Dr. Hendriksz said.

The study noted that socioeconomic status, race, and ethnicity can play a major role in preventing families from accessing proper care in the first place.

Dr. Farid Kalafalla, Associate Dean and Associate Professor with Touro’s College of Education and Health Sciences, helps coordinate a program, ASPIRE, that aims at removing these barriers.

“This program has previously trained 60 pharmacy, medical, and dietetic students in Central California,” Dr. Kalafalla said. “Many of these students volunteered and provided coaching sessions for ~60 family members of underserved Hispanic field workers. The ASPIRE program has been recognized by a national grant from the American Association of Colleges of Pharmacy (AACP), which has been recently transferred to Touro.”

Guided by diabetes and research experts, Drs. Jay Shubrook and Jean-Marc Schwarz, TUC and research partners like the University of California San Francisco (UCSF), have been involved in extensive work to examine the metabolic causes of this rise in childhood obesity.

In a study in Latino and African American children with obesity and habitual high sugar consumption, Touro University and UCSF investigators have shown that nine days of sugar restriction without changing total calorie intake significantly improved cardiometabolic risk factors. Independent of weight loss, the children experienced significant decreases in liver fat, visceral fat, circulating triglycerides (blood fat) and a marker of inflammation.

“These findings support efforts to reduce sugar consumption as an effective way to reduce metabolic makers, associated type 2 diabetes, cardiovascular diseases, and non-alcoholic fatty liver diseases,” Dr. Schwarz said.

Dr. Shubrook noted why this issue is so critical.

“What we now know is that type 2 diabetes is much worse in children than adults. It is more progressive, less responsive to existing treatments, and complications can develop more rapidly,” he said. “This represents both a personal and a public health challenge. Touro University California is taking a multi-prong approach to address these challenges.”

The Diabetologists at the Metabolic Research unit at Touro University are currently running a trial using a novel agent to treat both type 2 diabetes and obesity, Dr. Shubrook explained. “This medication (tirzepatide) has been called a ‘game changer’ in adults and the team is hopeful this will provide an important treatment for children as well,” he said.

It’s an area Touro is uniquely positioned to address.

“Touro University has one of six programs in the country that trains primary care diabetologists,” Dr. Shubrook said. “There are not enough endocrinologists to meet the need in the US. In fact, 93% of US counties do not have an endocrinologist. There is a great need to expand the expertise in the primary care force and these fellowships are one solution.”

This research, programs like Project HAPPY and ASPIRE, and TUC’s approach to train clinicians across a range of academic programs seeks to hit the issue from all sides.

“Both Project HAPPY and the ASPIRE program provide additional training to TUC students to help better equip them to help their future patients,” Dr. Hendriksz said. “TUC Diabetologists also work with TUC medical students, pharmacy students, PA students, nursing students, and Public Health students in classroom and clinical settings to give additional education and training around state-of-the-art diabetes care.”