Obesity Pillars 13 (2025) 100160

Contents lists available at ScienceDirect

Obesity Pillars
journal homepage: www.journals.elsevier.com/obesity-pillars

Clinical considerations in the management of obesity in children

and adolescents
Whitney Herring a , Carina Kugelmas b , Evan P. Nadler c , Marsha Novick d , Melissa Santos e,
Rachana Shah f, Gitanjali Srivastava g,* , Stephanie Walsh c
a
Mississippi Center for Advanced Medicine, 7730 Old Canton Road Building A, Madison, MS, 39110, USA
b
Denver Health, 501 28th Street, Denver, CO, 80205, USA
c
ProCare Consultants, District of Columbia, Washington, USA
d
Weight Management & Wellness Online, Harrisburg, PA, USA
e
Connecticut Children’s, 282 Washington Street, Hartford, CT 06106, USA
f
Children’s Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA 19104, USA
g
Vanderbilt University Medical Center, 719 Thompson Lane Suite 22200, Nashville, TN, 37232, USA

A R T I C L E I N F O A B S T R A C T

Keywords Background: Obesity is a complex, chronic disease affecting more than one-fifth of adolescent children aged
Adolescent obesity 12–19 years in the United States. Recent guidelines have recommended optimization of diagnosis and treatment
Obesity management approaches to help improve the immediate and long-term health of people with obesity.
Obesity treatment
Methods: Here, we describe the insights and recommendations of 9 nationally recognized experts in pediatric
Pediatric obesity
obesity, summarized from a virtual advisory board discussion.
Results: Advisors described their background, experiences, and patient populations, conveyed the journey
experienced by many pediatric patients with obesity, discussed the recent landscape for pharmacotherapy in
adolescents, and provided their perspectives on updated American Academy of Pediatrics Clinical Practice
Guidelines.
Conclusion: Overall, the advisors agreed that the key to addressing the growing prevalence of obesity in children
and adolescents depends on increased education in the medical field and community-wide initiatives to promote
early intervention. Collaboration among all parties (e.g., physicians, policymakers, insurance companies, aca-
demic institutions, and researchers) to address barriers to treatment and reduce the social stigma surrounding
obesity is also essential.

1. Introduction Guidelines for the evaluation and treatment of children and adolescents
with obesity highlight the need to address the growing prevalence of
Obesity is a chronic disease that results in an increase in car- obesity in pediatric patients through optimization of evaluation and
diometabolic risk factors and, for children and adolescents, an increased treatment practices [11]. Barriers to the care of pediatric patients with
risk of obesity in adulthood [1–4]. The prevalence of obesity in US ad- obesity have made addressing unmet needs difficult [12,13]. Clinicians
olescents, aged 12–19 years, was estimated to exceed 21 % in experience many challenges, including weight bias and stigma against
2017–2018 [5]. The etiology of obesity in children and adolescents is patients and their families by payers leading to poor insurance coverage
complex and multifactorial, with underlying biological predisposition and limited access to treatment, and knowledge gaps related to obesity
[6] and socioeconomic, behavioral, and geographic factors [7–9]. Risk and its treatment options [12,13].
of childhood obesity is associated with racial or ethnic identity [10] and In addition to these known barriers to care, limitations in utilization
social drivers of health, which can be understood as part of an obeso- of treatment for adult patients with obesity highlight the difficulties that
genic environment [11]. pediatric patients may also face. Data from US electronic health records
The American Academy of Pediatrics (AAP) Clinical Practice from 2010 to 2019 show that of nearly 11.2 million adults with obesity,

* Corresponding author. Vanderbilt University Medical Center, 719 Thompson Lane Suite 22200, Nashville, TN, 37232, USA.
E-mail address: [email protected] (G. Srivastava).

https://doi.org/10.1016/j.obpill.2025.100160
Received 7 November 2024; Received in revised form 13 January 2025; Accepted 13 January 2025
Available online 16 January 2025
2667-3681/© 2025 The Authors. Published by Elsevier Inc. on behalf of Obesity Medicine Association. This is an open access article under the CC BY-NC-ND license
(http://creativecommons.org/licenses/by-nc-nd/4.0/).
W. Herring et al. Obesity Pillars 13 (2025) 100160

only 2.4 % were prescribed an antiobesity medication (AOM) [14]. The 3. Results
utilization of bariatric surgery in eligible US adults in 2018 was ~0.6 %
[15], while a study of adolescent patients with class II/III obesity found 3.1. KIT 1: advisor background and experience
that ~0.2 % received bariatric surgery between 2015 and 2018 [16].
To address these unmet needs, nationally recognized specialists with 1. Describe your clinical practice setting and patient population.
expertise in pediatric obesity convened for a virtual advisory board
(VAB). Their goal was to describe their experiences and perspectives on At the time of the VAB, 7 advisors practiced in multidisciplinary
the care of children and adolescents with obesity. In developing this weight management centers, 4 of which focus on the care of pediatric
publication, the authors aimed to summarize their perspectives in order patients (Table 1). One advisor, a pediatric surgeon, worked in an aca-
to provide guidance to clinicians and improve the care of children and demic tertiary care children’s hospital and co-directed the multidisci-
adolescents with obesity. plinary weight management program. Another worked in a private
practice in a single-specialty pediatric organization. Most advisors (n =
2. Methods 6) noted that their patients continued to utilize a primary care practi-
tioner (PCP) for wellness visits.
Nine nationally recognized experts (advisors) in the field of pediatric Most advisors (n = 7) worked with children and adolescents, aged
obesity were selected based on their professional qualifications. Most 2–21 years. Some advisors (n = 5) indicated they had no minimum age
advisors were either ABOM certified (n = 5) or received formal training requirement and/or worked with patients into adulthood. Some advisors
in the management of obesity (n = 3). The advisors had between 6 and (n = 5) indicated that most of their patients self-identify as Black. One
22 years of experience working with children and/or adolescents with advisor indicated that most of their patients were Hispanic, 2 indicated
obesity. Of the 9 advisors, 7 (78 %) were female and 2 (22 %) were male. that most of their patients were non-Hispanic White, and one advisor did
The age range of the advisors at the time of the VAB was 41–56 years. not answer the question. Four advisors noted that a significant majority
The advisors were asked questions regarding the patient journey and (≥60 %) of their patient population was female. Seven advisors indi-
experiences of children and adolescents with obesity. The asynchronous, cated that most of their patients had Medicaid and 1 advisor reported
virtual discussion was conducted over 2 weeks, beginning in April 2023. that most of their patients had commercial insurance.
Three moderators were designated by the funding sponsor. The virtual Most advisors (n = 5) indicated that their patients were most
discussion was conducted through a messaging platform and all com- commonly diagnosed as having the disease of Class 1 or Class 2/3
ponents of the discussion were saved. In compliance with patient pri- obesity. Other common diagnoses included prediabetes (n = 4), type 2
vacy laws, no identifying patient information was used during this diabetes (n = 2), dyslipidemia (n = 2), obstructive sleep apnea (n = 3),
discussion. metabolic dysfunction-associated steatotic liver disease (n = 3), poly-
The objectives of this VAB were: 1) To provide insights into the pa- cystic ovary syndrome (n = 2), mental health disorders (n = 2), and
tient journey – from the initial health care visit to the initiation and attention-deficit hyperactivity disorder (n = 1). Two advisors indicated
intensification of treatment – and explore the clinician’s perspective on working with children with special health needs, developmental dis-
treatment in this population, considering guidelines, personal philoso- abilities, and rare disorders.
phy, and clinical practice. 2) To share real-world experiences of children
and adolescents with obesity from the clinician’s viewpoint. 2. Do you consider yourself a primary care provider or a specialist?
The advisors answered questions grouped by key insight topic (KIT). What are the rewards and challenges of that role?
The moderators asked follow-up questions when necessary. Questions
often included multiple parts, and advisors were not obligated to Most advisors (n = 8) indicated that they consider themselves to be
respond to all components. specialists in pediatric obesity; one advisor considered himself to be a
primary care pediatrician rather than a specialist, as his propensity to

Table 1
KIT 1: advisor background and experience.
Topic Summary of advisor responses

Advisor background and experience Specialize in pediatric obesity

summary Characteristics of the advisor’s patient populations
• Aged 2–21 years
•Primarily Black or Hispanic
•Primarily using Medicaid insurance
Advisor description of roles:
•Rewarding
•Challenging
•Advocates, educators, and reformers
Advisor definition of obesity Complex, chronic medical disease characterized by excess adiposity; influenced by genetic, epigenetic, socioeconomic, and
environmental factors
Growth charts for diagnosis and risk assessment:
•BMI >95th percentile
•Used to determine the suitability of certain treatments and monitor weight trajectories
•Some flexibility for younger age groups
BMI can be limiting; it is not a direct measurement of excess adiposity
Concerns with excess weight Mental health or mental illness (as a cause, effect, or exacerbating factor)
•Referrals made to psychiatrists for ORC medication management
•Need for greater education/intervention regarding body dysmorphic disorder
Rapid weight gain or BMI trajectory
Metabolic complications
Limitations to activity

BMI, body mass index; KIT, key insight topic; ORC, obesity-related comorbidity.

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treat pediatric patients with obesity is due to the lack of specialists in his Table 2
area. KIT 2: the adolescent patient journey.
The advisors described poor insurance coverage for obesity treat- Topic Summary of advisor responses
ments and lack of financial support for pediatric care by both hospital
Management of obesity in Patients often referred to weight management
systems and insurance companies as challenges they face. The barriers to adolescents programs from PCPs
care that children and adolescents with obesity face may further impact Multidisciplinary teams: pediatricians,
the clinician (see KIT 2). The advisors described the fulfillment of endocrinologists, family physicians, nurse
working in the context of a multidisciplinary team to improve the lives practitioners, physician assistants, advanced
practice clinicians, dieticians, health coaches,
of patients and described their roles – advocates, educators, reformers, exercise physiologists, psychologists, social
and transformers – as the most rewarding aspect of their position. workers, and behavioral health providers
Management goals Holistic health improvement
3. How do you define obesity? Behavior modification: nutrition, activity, sleep,
screen time, social interactions, mental health
Quality of life improvement: self-confidence, self-
Advisors described obesity as a complex, chronic disease character- esteem, empowering self-care
ized by excess adiposity and influenced by genetic, epigenetic, socio- Reduction of complications
economic, and environmental factors, which aligns with the AAP Weight stabilization or weight loss depending on
Clinical Practice Guidelines [11]. Regarding diagnosis, advisors sug- syndromic or genetic obesity considerations and
other factors
gested that it is important to consider not only anthropometrics, but also Helping kids understand the chronicity of their
other clinical components (e.g., quality of life, psychosocial effects of disease:
excess weight), and mental and physical comorbidities. BMI is an •Treatment and prevention habits should become
imperfect tool in assessing obesity. Many patients, such as those of Asian innate, “like brushing your teeth”
•Conveying that they will always have increased
descent, demonstrate obesity-related comorbidities (ORCs) before
susceptibility to weight gain
reaching a BMI ≥95th percentile [17–19]. When discussing concerns Promotion and empowerment of family-centered
related to obesity with pediatric patients and their families, advisors care
recommended focusing on teaching healthy habits and conveying how Physician and patient goal alignment
choices can affect the health of the patient, rather than focusing on BMI Programs for patients Collaborations with organizations to promote
health and wellness:
or weight.
•Family-centered gyms
•Insurance programs
4. What factors cause concern about a patient’s excess weight? •Weight management companies
•Medical clinics (bariatric surgery program,
lifestyle, or weight management program)
Advisors listed several causes for concern, including rapid or sus-
Management challenges Barriers to the management of obesity in
tained ongoing weight gain, the development of ORCs, a family history adolescents:
of obesity or its related comorbidities, or a history of trauma or mental •Social drivers of health
illness, or more generally, when the patient’s weight gain is adversely •Limited resources
impacting their physical or mental health. However, the advisors noted •Lack of insurance coverage
•Lack of public health investment
that for a health care provider to act on their concerns, they must first
•Continued stigma and bias
confirm that the patient and family are ready for change. In the advisors’ •Independent adolescent decision-making
experience, negative social drivers of health and adverse childhood ex- Need for collaboration, advocacy, team-based
periences are also likely to have an impact on the treatment of obesity. approaching, and education to overcome barriers
Family involvement Involvement of the family is key to successful
These factors reinforce the need for holistic treatment, either through a
change
multidisciplinary team or through referrals to experts that can address Patient factors influencing No specific treatment approaches based on sex or
the patient’s needs. Notably, fear of treatment or mistrust of the care approach to treatment gender identity, but these may impact patient goals
team can lead to difficulties enacting a care plan. Advisors suggested or be a source of trauma
that education and the use of motivational interviewing with patients Transition care Starting age ranges from 18 to 22 years

and families can be integral in building trust. KIT, key insight topic; PCP, primary care practitioner.
Advisors additionally noted that the development of mental health
conditions is often related to weight trajectory, either as contributory to 6. What are your goals for obesity management in adolescents?
weight gain or in response to it. Susceptibility to weight gain can be
related to medication use (e.g., antipsychotics or antidepressants), and Advisors agreed that the primary goal is to improve health in a
must be considered when assessing a patient’s health. manner that aligns with the goals of the patient and family. The advisors
acknowledged that health improvement differs for every patient but
3.2. KIT 2: the adolescent patient journey may be related to preventing or improving ORCs, teaching lifelong tools
for healthy living, improving mental health, and reducing the stigma
5. Describe how obesity in adolescents is managed within your health surrounding obesity.
system.
7. What are key challenges of obesity management in adolescents?
Advisors relayed that this process may vary, and PCPs are primarily
responsible for conducting initial weight assessments and ordering Negative social drivers of health may limit access to nutritious food
blood tests (Table 2). Patients in need of treatment are provided dietary and exercise resources. Poor insurance coverage (which may also be
and/or exercise recommendations. If the patient continues to gain related to weight bias in the payer system) can limit access to treatment
weight, the PCP will refer them to a weight management program. options. Stigma and bias regarding obesity care, which is pervasive in
For most advisors, PCP referrals account for 60%–70 % of all re- the general population and clinicians alike, may prevent children and
ferrals. Alternatively, specialists who treat children and adolescents for adolescents or their families from seeking treatment. Finally, older ad-
ORCs may refer patients to weight management programs. Most advi- olescents have a level of autonomy that may complicate implementation
sors agreed that few patients are self-referred; however, one advisor (the of treatment plans. For example, independence in daily routines may
pediatric surgeon) often had self-referred patients.

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Table 3 adolescents. Commercial weight management companies such as

KIT 3: pharmacotherapy for obesity in adolescents. WeightWatchers®, and food delivery services may aid patients and
Topic Summary of advisor responses families in learning how to cook culturally sensitive, well-balanced
meals. Insurance companies may offer fitness tools, such as food
AOMs for adolescents Advisor comfort levels for AOMs use in adolescents:
•Very comfortable (n = 4) tracking or fitness apps, a smart scale, or a fitness coach and/or dietitian
•Comfortable (n = 4) counseling. Finally, medical clinics offer comprehensive treatment for
•Uncomfortable (n = 1) patients with obesity, including lifestyle, behavioral, weight manage-
Regarding the duration of treatment with AOMs: ment, and/or bariatric surgery programs.
•More information is needed on starting at younger ages
o Long-term safety, efficacy, and duration of treatment
oQuality of life 9. How is the family involved in the care of adolescent patients?
•Payers require data on duration and cost:
oAOMs Advisors agreed that involvement by family members, particularly
oBariatric surgery
those involved in meal times, is integral to the improvement of child and
oAOMs and bariatric surgery in conjunction
adolescent health. The advisors have observed a relationship between
AOM, antiobesity medication; KIT, key insight topic. the viewpoint of the family and the patient’s progress. The advisors
cautioned that children and adolescents need stability, structure, and
result in purchase of unhealthy meals, resistance to exercise, or irregular accountability to make improvements, and families are in a unique
eating and sleeping patterns. position to provide this support. The highest chance of success, they
The advisors posited that lack of education for clinicians may also reported, occurs when the whole family makes changes.
play a role in restricting treatment for children and adolescents with
obesity. Poor understanding of the science of obesity along with a 10. How do the patient’s sex, gender identity, and culture affect how
rapidly changing treatment landscape may lead clinicians to believe that you approach treatment?
patients with Class 2 or 3 obesity may be treated with behavioral and
dietary intervention alone. Alternatively, clinicians who fear triggering The advisors reiterated that patients must be treated holistically,
an eating disorder in patients with obesity may limit referrals to the including taking into consideration cultural factors that may influence
appropriate weight management programs. their choices, such as food choices, meal timing, and exercise opportu-
The advisors believe that overcoming these barriers may involve nities. Sex and gender identity and experiences of bullying, weight bias
empowering patients and their families to make changes that will result and stigma, or traumatic events should also be taken into consideration
in a healthier life, improved education among clinicians, collaboration in the management of a patient.
among clinicians and weight management teams, and advocacy on
behalf of the patients. Additionally, advocating for improved compen- 11. At what age do you start transitioning care to adult providers?
sation by payers for obesity treatment may help PCPs and specialists How?
meet the AAP recommendations for intensive lifestyle intervention.
The advisors discussed their experiences regarding the transition to
8. Are there programs to which adolescents with obesity can be adult care and agreed that this generally occurs between the ages of
referred? 18–22 years. Some advisors noted that their programs have an official
transition pathway. Others simply refer their patients to adult physicians
The advisors discussed programs that provide education and tools for with whom they are familiar. Conversations regarding the transition
people with obesity, which may prove beneficial to improving health. typically begin around the age of 18 years.
Fitness centers may offer reduced cost or free memberships to

Table 4
KIT 4: perspectives on the 2023 American Academy of pediatrics clinical practice guidelines.
Topic Summary of advisor responses

Advisors’ key takeaways from the AAP Clinical Practice Obesity is a chronic, complex, and relapsing disease
Guidelines Recommended to diagnose and treat early
Treat the patient holistically; consider:
•Medical comorbidities
•Psychological conditions
•Socioeconomic conditions
•Cultural influences
•Developmental age
Multidisciplinary team should assist with lifestyle and behavior interventions
AOMs:
•Patients aged 12 years and older with a BMI >95th percentile
•With lifestyle and behavior intervention
Metabolic and bariatric surgery:
•Patients aged 13 years and older with a BMI >120th percentile
Thoughts around risk of stigma sparked by clinical Adolescents already feel weight-related stigma from their clinicians and others
practice guidelines May be a decrease in disordered eating when obesity is addressed appropriately
Age cut-offs may be used by insurance companies to deny care in children younger than the ages specified, which will
increase stigma in younger patients
Clinical practice guidelines can help clinicians change their messaging to alleviate shame and guilt

AOM, antiobesity medication; BMI, body mass index; KIT, key insight topic.

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3.3. KIT 3: pharmacotherapy for obesity in adolescents 4. Discussion

12. What is your comfort level with using AOMs in adolescents? Given the social and medical limitations imposed on obesity treat-
ment in pediatric patients, it is crucial for clinicians to adhere to best
Most advisors (n = 8) indicated some level of comfort (Table 3). practices to facilitate the holistic treatment of this growing population.
Advisors recommended that prescribing physicians have comprehensive The insights provided here reflect the unique experiences of the advisors
training and experience with AOMs. The advisors noted that for many and highlight the need for more programs focusing on the holistic
PCPs, hesitation regarding GLP-1 agonist prescription in adolescents is treatment of obesity and its comorbidities at a community, state, and
related to limitations imposed by payers, who may deny coverage for national level.
several reasons. Weight or BMI alone may raise concerns and should prompt lifestyle
counseling, but treatment intensification is often initiated when the
13. How do you think about the duration of AOM use in adolescents? physical or mental health of the patient is adversely affected. Outside of
pediatric obesity experts, comfort with pharmacotherapy is limited by
Advisors agreed that due to the chronic nature of obesity, most pa- lack of education/experience, uncertainty about long-term effects, and
tients will need to take AOMs long-term. However, AOMs lack long-term failure of insurance companies to authorize the medication. Concerns
safety and efficacy data in children. The advisors believe that this is about stimulating eating disorders by treating obesity are inconsistent
especially important when considering developmental plasticity in with available group-level data but cannot be dismissed at the individual
children and adolescents. In the absence of a long-term study, most level. Everyone should be assessed for risk and treated or referred
advisors agreed that a study to examine durability may suffice. One appropriately.
advisor posited that, within long-term studies, it is important to deter- It is important to note that since the completion of the VAB, ad-
mine if AOM use at an early age aids in long-term quality-of-life main- vancements have been made in treatment options for obesity, which
tenance. Advisors agreed that these data would be beneficial in may induce a change of opinion regarding topics surrounding treatment
supporting payer coverage. of children and adolescents with obesity. Four-year data on treatment of
obesity with injectable semaglutide 2.4 mg in adults demonstrated a
3.4. KIT 4: perspectives on the 2023 AAP Clinical Practice Guidelines sustained average weight loss of ~10 % [20]. Additionally, ORC im-
provements have been demonstrated in adults with both semaglutide
14. What are the major take-home messages of the 2023 AAP Clinical 2.4 mg [21] and tirzepatide [22].
Practice Guidelines [11]? Despite the challenges, the advisors believe that the key to
addressing obesity in pediatric patients lies in the following: 1)
Although these guidelines are a key subject of discussion for this increased investment in education for the medical community regarding
publication, the advisors were not involved in guideline development. treatment of pediatric obesity to reduce stigma and bias; 2) harnessing
This publication is completely independent of the AAP guidelines. the family as a key driver for successful change; 3) early intervention,
Advisors agreed on the following messages (Table 4). Obesity is a including lifestyle/behavioral modifications at an early age and before
complex, chronic disease requiring prompt, intensive, and comprehen- exceeding the overweight category; 4) ensuring clinicians understand
sive action through early diagnosis and treatment, preferably under the how sex, gender, and culture can affect treatment approach; 5) recog-
guidance of a multidisciplinary team. The advisors agreed that this nizing that weight/BMI alone may raise concerns, but treatment inten-
definition of obesity will help reduce the stigma surrounding obesity, sification is often prompted when the physical or mental health of the
including the mistaken belief that obesity is a lifestyle choice, rather patient is adversely affected; and 6) collaboration with policy makers,
than a chronic disease. Previously, physicians have been predisposed to insurance companies, the food industry, researchers, educators, and
monitoring the patient’s condition and responding to complications, clinicians to reduce barriers to treatment.
rather than taking decisive action with the underlying disease. Early Future efforts to address the challenges posed by the management of
intervention is critical to the long-term health of the patient. children and adolescents with obesity should focus on filling knowledge
Overall, the advisors believe that these updated guidelines are one gaps that cannot be addressed by this panel of experts alone. For
positive step in the process of engaging families, motivating clinicians to example, a follow-up VAB can be conducted with patients, or patients
treat obesity, and enabling advocacy to secure better funding and in- and providers, to elicit the patient perspectives surrounding the chal-
surance coverage for people with obesity. However, one advisor noted lenges outlined here. Additionally, a VAB comprised of non-clinician
that AAP guidelines are flawed due to the recommendations regarding advisors (i.e., nurses or other health care professionals) may offer
age limitation for AOMs/bariatric surgery treatment, which will likely alternative clinical insights. Finally, increased attention should be given
increase the difficulty of treating children aged <12 years. to finding viable solutions to the pervasive social stigma surrounding
obesity.
15. A criticism of the AAP Guidelines is the risk of increased stigma,
weight-related distress and eating-disordered thoughts/behavior 4.1. Limitations
associated with the recommendation to initiate active treatment
in adolescents with BMI ≥95th percentile. What are your The insights shared here are based on the unique perspectives of
thoughts? experts in pediatric obesity. However, these may not encompass the full
range of experiences and treatment algorithms for children and ado-
The advisors agreed that this risk does not outweigh the need for lescents with obesity. While the advisors are from different geographical
treatment. Due to current societal bias surrounding obesity, adolescents areas and treat different populations, their experiences and recom-
are already significantly impacted by stigma, and disordered thoughts or mendations may not apply all populations.
behaviors are already a risk and apparent at initial visits. Advisors
agreed that improvements in messaging regarding obesity may aid in 5. Conclusion
reducing risk of disordered eating; this should therefore be a priority for
clinicians. The advisors suggested that the AAP guidelines may act as a In conclusion, the management of pediatric obesity requires a
tool for clinicians to optimize their messaging surrounding obesity. comprehensive, empathetic, and child- and family-centered approach
that considers the unique challenges and needs of this population. The
advisors hope the insights and recommendations provided here serve as

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a supplement to the AAP guidelines to help address this complex and Publication Practice guidelines.
pervasive issue.
References
• The management of pediatric patients with obesity requires consid-
eration of the sex, gender, and culture of the patient and their family [1] Kit BK, Kuklina E, Carroll MD, Ostchega Y, Freedman DS, Ogden CL. Prevalence of
and trends in dyslipidemia and blood pressure among US children and adolescents,
• To effectively address the growing prevalence of obesity in pediatric 1999-2012. JAMA Pediatr 2015;169:272–9.
patients, increased focus should be placed on medical education [2] Sun SS, Liang R, Huang TT, Daniels SR, Arslanian S, Liu K, et al. Childhood obesity
surrounding treatment guidelines and options, as well as community- predicts adult metabolic syndrome: the Fels Longitudinal Study. J Pediatr 2008;
152:191–200.
wide initiatives to promote early intervention and awareness [3] Jarvisalo MJ, Ronnemaa T, Volanen I, Kaitosaari T, Kallio K, Hartiala JJ, et al.
• Collaboration between the medical community, policy makers, in- Brachial artery dilatation responses in healthy children and adolescents. Am J
surance companies, food industry, researchers, educators, and cli- Physiol Heart Circ Physiol 2002;282:H87–92.
[4] Woo JG, Zhang N, Fenchel M, Jacobs Jr DR, Hu T, Urbina EM, et al. Prediction of
nicians may help reduce barriers to the care of obesity adult class II/III obesity from childhood BMI: the i3C consortium. Int J Obes 2020;
44:1164–72.
Author contributions [5] Tsoi MF, Li HL, Feng Q, Cheung CL, Cheung TT, Cheung BMY. Prevalence of
childhood obesity in the United States in 1999-2018: a 20-year Analysis. Obes Facts
2022;15:560–9.
All authors participated in the virtual advisory board. All authors [6] Elks CE, den Hoed M, Zhao JH, Sharp SJ, Wareham NJ, Loos RJ, et al. Variability in
revised the manuscript content and approved the final version. the heritability of body mass index: a systematic review and meta-regression. Front
Endocrinol 2012;3:29.
[7] Vargas CM, Stines EM, Granado HS. Health-equity issues related to childhood
Disclosures obesity: a scoping review. J Public Health Dent 2017;77(Suppl 1):S32–42.
[8] Alvarado SE. Neighborhood disadvantage and obesity across childhood and
All authors participated in the virtual advisory board reported here. adolescence: evidence from the NLSY children and young adults cohort (1986-
2010). Soc Sci Res 2016;57:80–98.
Whitney Herring acted as site principal investigator for Rhythm Phar- [9] Pratt CA, Loria CM, Arteaga SS, Nicastro HL, Lopez-Class M, de Jesus JM, et al. A
maceuticals (NCT05093634). Evan Nadler participated in an advisory systematic review of obesity disparities research. Am J Prev Med 2017;53:113–22.
board with Novo Nordisk and Rhythm Pharmaceuticals. Gitanjali Sri- [10] Hales CM, Carroll MD, Fryar CD, Ogden CL. Prevalence of obesity among adults
and youth: United States, 2015-2016. NCHS Data Brief; 2017. p. 1–8.
vastava participated in advisory boards with Rhythm and Eli Lilly; acted [11] Hampl SE, Hassink SG, Skinner AC, Armstrong SC, Barlow SE, Bolling CF, et al.
as site principal investigator for Eli Lilly; and in a Speaker’s Bureau for Clinical practice guideline for the evaluation and treatment of children and
Novo Nordisk and Rhythm. adolescents with obesity. Pediatrics 2023;151.
[12] Ray D, Sniehotta F, McColl E, Ells L. Barriers and facilitators to implementing
practices for prevention of childhood obesity in primary care: a mixed methods
Ethical review systematic review. Obes Rev 2022;23:e13417.
[13] Serban CL, Putnoky S, Ek A, Eli K, Nowicka P, Chirita-Emandi A. Making childhood
obesity a priority: a qualitative study of healthcare professionals’ perspectives on
As this is a commentary on expert insights and recommendations
facilitating communication and improving treatment. Front Public Health 2021;9:
through a virtual advisory board, ethical review was not required. 652491.
[14] Elangovan A, Shah R, Smith ZL. Pharmacotherapy for obesity-trends using a
Declaration of artificial intelligence (ai) and ai-assisted population level national database. Obes Surg 2021;31:1105–12.
[15] Altieri MS, Irish W, Pories WJ, Shah A, DeMaria EJ. Examining the rates of obesity
technologies and bariatric surgery in the United States. Obes Surg 2021;31:4754–60.
[16] Messiah SE, Xie L, Atem F, Mathew MS, Qureshi FG, Schneider BE, et al. Disparity
During the preparation of this work, the authors did not use Artificial between United States adolescent class II and III obesity trends and bariatric
surgery utilization, 2015-2018. Ann Surg 2022;276:324–33.
Intelligence technology. [17] Misra A. Ethnic-specific criteria for classification of body mass index: a perspective
for asian Indians and American diabetes association position statement. Diabetes
Source of funding Technol Ther 2015;17:667–71.
[18] Lear SA, James PT, Ko GT, Kumanyika S. Appropriateness of waist circumference
and waist-to-hip ratio cutoffs for different ethnic groups. Eur J Clin Nutr 2010;64:
The virtual advisory board and development of this manuscript was 42–61.
financially supported by Novo Nordisk Inc. [19] Expert Consultation WHO. Appropriate body-mass index for Asian populations and
its implications for policy and intervention strategies. Lancet 2004;363:157–63.
[20] Ryan DH, Lingvay I, Deanfield J, Kahn SE, Barros E, Burguera B, et al. Long-term
Acknowledgements weight loss effects of semaglutide in obesity without diabetes in the SELECT trial.
Nat Med 2024;30:2049–57.
[21] Kosiborod MN, Verma S, Borlaug BA, Butler J, Davies MJ, Jon Jensen T, et al.
The authors acknowledge the contribution of Peter Silas, MD, who
Effects of semaglutide on symptoms, function, and quality of life in patients with
participated in the VAB but was unable to contribute to manuscript heart failure with preserved ejection fraction and obesity: a prespecified analysis of
development. The authors additionally acknowledge the moderators of the STEP-HFpEF trial. Circulation 2024;149:204–16.
the virtual advisory board, including Anthony Fabricatore, PhD, Kris [22] Malhotra A, Grunstein RR, Fietze I, Weaver TE, Redline S, Azarbarzin A, et al.
Tirzepatide for the treatment of obstructive sleep apnea and obesity. N Engl J Med
Washington, PharmD, and Alannah Yoder, PharmD, all of Novo Nordisk 2024;391:1193–205.
Inc.; and the medical writing assistance of Amy Ryan, PhD of Precision
AQ. This manuscript was written in compliance with international Good