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Endocrine Society issues practice guidelines on paediatric obesity
The Endocrine Society has issued a Clinical Practice Guideline advising healthcare providers on how to prevent and treat childhood obesity with lifestyle changes. The guideline has been published in The Journal of Clinical Endocrinology & Metabolism (JCEM). The Clinical Practice Guideline was co-sponsored by the European Society of Endocrinology and the Pediatric Endocrine Society.
In addition to prevention and treatment, the guideline provides recommendations on how to evaluate affected children for medical or psychological complications, when to evaluate children for rare genetic causes of obesity and when to consider medications or surgery for the most severely affected older adolescents.
According to the US Centers for Disease Control and Prevention, 17 percent of American children and teenagers between the ages of 2 and 19 were affected by obesity in 2011-2014. Obesity in this age group was associated with an estimated US$14.1 billion in additional prescription drug, emergency room and outpatient medical visit costs each year.
The guideline authors noted unmet needs for future research include understanding the causes of paediatric obesity and its complications, prevention and treatment. In addition, research is needed to examine how environmental and economic factors can drive worldwide cultural changes in diet and activity.
Recommendations from the guidelines, ‘Pediatric Obesity—Assessment, Treatment, and Prevention: An Endocrine Society Clinical Practice Guideline’, include:
- Children or teens with a BMI greater than or equal to the 85th percentile should be evaluated for related conditions such as metabolic syndrome and diabetes
- Youth being evaluated for obesity do not need to have their fasting insulin values measured because it has no diagnostic value
- Children or teens affected by obesity do not need routine laboratory evaluations for endocrine disorders that can cause obesity unless their height or growth rate is less than expected based on age and pubertal stage
About 7 percent of children with extreme obesity may have rare chromosomal abnormalities or genetic mutations. The guideline suggests specific genetic testing when there is early onset obesity (before 5 years old), an increased drive to consume food known as extreme hyperphagia, other clinical findings of genetic obesity syndromes, or a family history of extreme obesity.
"Intensive, family-centred lifestyle modifications to encourage healthy diet and activity remain the central approach to preventing and treating obesity in children and teenagers," said Dr Dennis M Styne of the University of California Davis Medical Center in Sacramento, CA. Styne chaired the task force that developed the guideline. "Since the Society last issued a paediatric obesity guideline in 2008, physicians have access to new information on genetic causes of obesity, psychological complications associated with obesity, surgical techniques and medications that are now available for the most severely affected older teenagers. The guideline offers information on incorporating these developments into patient care."
The Society established the Clinical Practice Guideline Program to provide endocrinologists and other clinicians with evidence-based recommendations in the diagnosis, treatment, and management of endocrine-related conditions. Each guideline is created by a task force of topic-related experts in the field. Task forces rely on evidence-based reviews of the literature in the development of guideline recommendations. The Endocrine Society does not solicit or accept corporate support for its guidelines. All Clinical Practice Guidelines are supported entirely by Society funds.