Children’s Expert Helps Develop Clinical Practice Guideline on Obesity

ARSLANIAN_SILVA_MD_PD_20150709_Today, the Endocrine Society issued a Clinical Practice Guideline advising healthcare providers on how to prevent and treat childhood obesity with lifestyle changes.

The guideline, which is titled “Pediatric Obesity—Assessment, Treatment, and Prevention: An Endocrine Society Clinical Practice Guideline,” was published online and will appear in the March 2017 print issue of The Journal of Clinical Endocrinology & Metabolism (JCEM), a publication of the Endocrine Society.

Silva Arslanian, MD, chief, Weight Management and Wellness Center at Children’s Hospital of Pittsburgh of UPMC, is co-author of the guideline.

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.

Pediatric obesity is a pervasive international problem. Seventeen percent of American children and teenagers between the ages of 2 and 19 were affected by obesity in 2011-2014, according to the U.S. Centers for Disease Control and Prevention. Obesity in this age group was associated with an estimated $14.1 billion in additional prescription drug, emergency room and outpatient medical visit costs each year, according to the Society’s Endocrine Facts & Figures Report.

“Childhood obesity is on a relentless upward trajectory pulling with it multiple obesity-related complications such as type 2 diabetes, nonalcoholic fatty liver disease, increased risk of cardiovascular disease, reproductive abnormalities, sleep apnea, etc.,” said Arslanian.

Children’s Hospital was a pioneer in founding the Weight Management & Wellness Center in 2004 to provide assessment and care of children afflicted with obesity. This Center and Dr. Arslanian’s research in childhood obesity and its complications put Children’s Hospital at the forefront of this epidemic nationally and internationally.

When the Endocrine Society realized the gravity of the childhood obesity crisis and decided to develop a clinical guideline to guide the assessment and management of childhood obesity by health care providers, they reached out to Dr. Arslanian to join in on the effort.

“As is very clear in this guideline, it is imperative that every child with obesity be properly evaluated for existing obesity-related complications and be managed appropriately while focusing on family-based healthy lifestyle interventions,” added Arslanian.

Recommendations from the 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.

For more statistics and data on pediatric obesity, visit the Society’s Endocrine Facts & Figures Report.

Other members of the Endocrine Society task force that developed this guideline include: Dennis M. Styne, MD, of the University of California Davis Medical Center in Sacramento, CA; Ellen L. Connor of the University of Wisconsin in Madison, WI; Ismaa Sadaf Farooqi of the University of Cambridge in Cambridge, U.K.; M. Hassan Murad of the Mayo Clinic in Rochester, MN; Janet H. Silverstein of the University of Florida in Gainesville, FL; and Jack A. Yanovski of the National Institutes of Health in Bethesda, MD.

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.

The Clinical Practice Guideline was co-sponsored by the European Society of Endocrinology and the Pediatric Endocrine Society.

For more information on Dr. Arslanian and the Weight Management and Wellness Center, please visit  www.chp.edu/our-services/weight-management.