Association of the USA indicates medicine and bariatric for children with obesity

The American Pediatric Association (AAP) has updated, after 15 years, its recommendations for the treatment of overweight and obese children and adolescents.

Although it reinforces that therapy focused on changing lifestyle is the most effective, the entity admitted for the first time the possibility of combined intervention with weight loss drugs (from 8 years old) or metabolic and bariatric surgery (in cases of severe obesity and patients 13 years and older).

The document is released at a time when obesity, a chronic disease, is considered an “epidemic”, aggravated by the social isolation imposed by Covid-19. In addition, says the association, the United States has an “increasingly obesogenic” environment, which promotes sedentary behavior and unhealthy food choices.

In Brazil, according to the 2019 National Health Survey, the proportion of people with obesity in the adult population, between 2003 and 2019, more than doubled, from 12.2% to 26.8%. Last year, the Ministry of Health reported that childhood obesity affects 3.1 million children under 10 years of age in the country; and overweight – 6.4 million.

“Brazil curiously jumped from malnutrition to obesity. We didn’t have an intermediary”, says Durval Damiani, head of Pediatric Endocrinology at the Institute for Children and Adolescents at Hospital das Clínicas, Faculty of Medicine, USP.

endorsement

Experts welcome the new recommendations. They highlight that the plan validates options already made by physicians, but that suffered resistance, in their view, because of stigmas. Another praised point is the document recognizing obesity as a multifactorial disease, not a choice; and, above all, a challenge not for some medical specialists, but for all those who serve the young public.

“What draws a lot of attention is the Society of Pediatrics, as a whole, discussing something previously seen as a matter for some physicians specializing in obesity, who were even somewhat marginalized by others”, says endocrinologist Bruno Halpern, president of the Brazilian Association for Study of Obesity and Metabolic Syndrome (Abeso).

He points out that this is an important preventative step. “No one develops obesity overnight. We have struggled a lot so that the pediatrician draws the attention of the child or adolescent to obesity, even if this has not been the primary cause of the consultation”.

A pediatric endocrinologist at the Hospital Pequeno Príncipe, in Curitiba, Julienne Carvalho says that the treatment of children depends a lot on parents and guardians. “The pediatrician has always been the family’s trusted doctor. He has to be aware of this new information, so that the family feels really safe in undergoing a treatment that, until then, they did not imagine possible”.

According to Damiani, drugs and surgery are considered only when changing behavior alone does not produce results. He says that his team was a pioneer in bariatric surgery for adolescents in the country. In 2007, they operated on a 15-year-old patient. “She had to walk with the support of her parents on her side, as if they were crutches. She didn’t go to school. You can’t imagine how much they fell on us, saying we were crazy to operate on a 15-year-old child, ”he says.

“It shocked the world (the indication of medication or surgery) because people are prejudiced against obesity. There is still the old-fashioned and prejudiced view that obesity is a choice and is only related to bad lifestyle habits”, says Halpern.

In the document, the AAP points out that pharmacotherapy can be prescribed for children as young as 8 years old in “specific conditions”, after assessing the risk and benefit, although it emphasizes that there is not a wide scope of evidence for the use of these drugs in patients under the age of 8. 12 years.

In Brazil

Asked about the recommendations for the treatment of childhood obesity and plans for updates, the Ministry of Health reported that the Unified Health System (SUS) “offers comprehensive assistance to overweight and obese people, with preventive activities such as food surveillance, follow-up nutrition, in addition to clinical and surgical care, such as bariatric and reconstructive surgery to correct excess skin”.

Prevention involves family, and extensions like school. For Durval Damiani, prevention is a fundamental weapon in the fight against the “epidemic”.

“Where does this prevention have to be strongly encouraged? Evidently, in the family and in the so-called extended family, where the school plays a fundamental role”, he argues. “People need to pay attention to the weight of their children. Going to the pediatrician and demanding: ‘Doctor, how is my son? Is he growing well’?”

The information is from the newspaper O Estado de S. Paulo.