Watchful waiting is not recommended for childhood obesity

For the first time in 15 years, the American Academy of Pediatrics (AAP) published guidelines to treat a problem the group says affects more than 14.4 million children in the United States: obesity. While some of the options like surgery and medication may raise parents’ eyebrows, experts are clearing up some things. Obesity can lead to serious health problems like heart disease, asthma and diabetes. But it is treatable, and every family should speak to a health care provider to find out what treatment is best. The AAP says waiting and hoping things get better is not a good choice.

The new guidelines build on proven diet and exercise methods. But other suggestions include:

• In-person, family-based behavioral health treatment over a period of three to 12 months
• For children 12 and older, doctors should consider prescribing weight-loss medications.
• For children 13 years and older with severe obesity, providers should consider recommending bariatric surgery.

Carly Zimmer is a registered dietitian-nutritionist at OSF HealthCare in Pontiac, Illinois. She says it’s not easy for children to eat well and exercise. Less healthy foods are more readily available, portions have increased, and screen time is decreasing gaming time.

Zimmer is on board with mental health treatment for someone struggling with an unhealthy diet.

“Often our eating habits stem from events in our past, trauma, or emotions,” Zimmer says. “A mental health professional can delve into these topics and help establish a healthy relationship with food.

“Food is not the enemy,” adds Zimmer.

Zimmer says drugs and surgery for weight loss can seem a bit extreme. But they can be effective when done correctly and under the guidance of a doctor.

On weight-loss drugs, Zimmer says it can’t be a band-aid to fix the problem.

“We take this medicine and maybe we stop taking it. Or over time it becomes less effective. If we haven’t changed our habits, that weight will probably come back,” Zimmer says.

Zimmer says a common weight loss procedure is gastric sleeve surgery. This makes your stomach smaller, sending a signal to the brain that you are full sooner. It also changes the way food is digested. The goal is to decrease the amount of food you eat.

But she considers an extreme option and families should have a thorough discussion about it. The child must follow guidelines after surgery to avoid complications such as dumping syndrome, where foods high in sugar pass too quickly from your stomach to your small intestine. This can cause vomiting, cramps, diarrhea, dizziness, and rapid heartbeat.

In other words, it’s a lot of responsibility for someone as young as 13.

“Usually it’s a low-calorie diet,” Zimmer says of eating habits after surgery. “You don’t want to eat a lot of high fat foods. Avoid fried foods, high fat dairy products and concentrated sugars. Staying hydrated is very important.

Perhaps the most important message of the AAP guidelines is that action is needed now to treat overweight children. The so-called “watchful waiting”, where you see if obesity will go away with age, just won’t reduce it.

“You develop healthy eating habits at a young age. As you age, these habits tend to follow you. So childhood obesity tends to be equated with adult obesity,” says Zimmer.