The Pediatric Obesity Algorithm – a free state-of-the-science management review from the Obesity Medicine Association – should help clinicians weed through the options for overweight kids, according to Texas pediatrician and lead author Suzanne Cuda, MD.
The group put the latest thinking into one place to serve as a handy guide, and plans to update it every 2 years. The idea was to present choices, not push particular approaches. “Many of my colleagues have expressed concern [that] they do not have the resources to provide the kind of support these kids need,” said Dr. Cuda, director of the weight management clinic at the Children’s Hospital of San Antonio and associate professor of pediatrics at the Baylor College of Medicine. Clinicians can find the guide at www.PediatricObesityAlgorithm.org.
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The effort also will help clinicians prepare for American Board of Obesity Medicine certification, since it was “designed to address the content on the exam. A lot of tools out there for children [emphasize] prevention. Our starting point was children who are already overweight,“ she said.
The document covers risk factors, differential diagnoses, assessment, diet, appropriate activity levels, medications, surgery, comorbidity management, and other issues, often broken down by age and body mass index.
Nothing is particularly controversial, although some clinicians are reluctant to move beyond diet and exercise for kids, Dr. Cuda said.
The Obesity Medicine Association (OMA) was aware of that, and so was careful to note, for instance, which obesity medications are approved for pediatric use – orlistat (Xenical), metformin, and phentermine – and their real-world effect.
“We didn’t cover all the drugs out there” because many haven’t been tested in children, Dr. Cuda said. The group also highlights antiseizure and other drugs that put on weight.
The guide covers birth to adulthood. There can be signs of problems even before the first birthday, such as weight above the 95th percentile. In those cases, evidence supports exclusive breast feeding for as long as possible, and no more than 24 ounces per day in formula-fed children, with no cereal or media watching.
OMA hasn’t submitted its work for endorsement by other groups, so other associations haven’t signed onto it. “We didn’t want to prolong putting it out there to go through that whole process,” Dr. Cuda said.
Even so, some organizations are aware of the contents and support the effort. “It aligns with the resources we have already developed on this topic. These are core competencies ... all physicians should have, regardless of whether they are certified in obesity medicine,” said an American Academy of Pediatrics staff member.
Until recently, OMA was known as the American Society of Bariatric Physicians. It rebranded itself to avoid being mistaken for a bariatric surgery group.
Dr. Cuda and the other authors had no disclosures. There was no industry funding for the work.