Endocrine Society Releases Clinical Practice Guideline on Pediatric Obesity

The Endocrine Society has released a new clinical practice guideline for the prevention and treatment of pediatric obesity. A rapid release version of the guideline has been published on-line and will appear in the December issue of the Journal of Clinical Endocrinology & Metabolism (JCEM).

The prevalence of obesity in 6- to 11-year-old children increased almost four-fold between 1970 and 2000. Although rates vary among different ethnic groups, the overall prevalence of childhood obesity is 17.1 percent.

“The increased prevalence of childhood obesity is particularly important as it is predictive of adult obesity which is associated with cardiovascular disease, diabetes, metabolic syndrome, and hypertension,” said Dr. Gilbert August of the George Washington School of Medicine in Washington, D.C., and chair of the task force that developed this guideline. “This new guideline provides evidence-based recommendations to prevent and treat this growing epidemic.”

The guideline recommends that:

• Overweight be defined as having a body mass index (BMI) > 85th percentile by < 95th percentile, and obesity as BMI > 95th percentile.

• Prescribing and supporting intensive lifestyle (dietary, physical activity, and behavioral) modification as the prerequisite for any treatment.

• Evaluating for obesity-associated co-morbidities in children with BMI > 85th percentile.

• Pharmacotherapy (in combination with lifestyle modification) be considered in 1) obese children only after failure of a formal program of intensive lifestyle modification and in 2) overweight children only if severe co-morbidities persist despite intensive lifestyle modification.

• Pharmacotherapy should be provided only by clinicians who are experienced in the use of anti-obesity agents and aware of the potential for adverse reactions.

• Bariatric surgery should be pursued for adolescents with BMI > 50, or > 40 with severe co-morbidities in whom lifestyle modification and/or pharmacotherapy have failed.

• Clinicians should emphasize the prevention of obesity by recommending breast-feeding of infants for at least 6 months and advocating that schools provide for 60 minutes of moderate to vigorous daily exercise in all grades.

Other members of the task force that developed this guideline included Sonia Caprio of Yale University School of Medicine in New Haven, Conn.; Ilene Fennoy of Columbia University in New York, N.Y.; Michael Freemark of Duke University Medical Center in Durham, N.C.; Francine Kaufman of Children’s Hospital of Los Angeles in Calif.; Robert Lustig of University of California San Francisco in Calif.; Janet Silverstein of the University of Florida in Gainesville, Fla.; Phyllis Speiser of Scheider Children’s Hospital in New Hyde Park, N.Y.; Dennis Styne of University of California Davis Medical Center in Sacramento, Calif.; and Victor Montori of the Mayo Clinic in Rochester, Minn.