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Prevention and Treatment of Pediatric Obesity: An Endocrine Society Clinical Practice Guideline Based on Expert Opinion

Professor Emeritus of Pediatrics, George Washington University School of Medicine (G.P.A.), Washington, D.C. 20037; Yale University School of Medicine (S.C.), New Haven, Connecticut 06510; Columbia University (I.F.), New York, New York 10027; Duke University Medical Center (M.F.), Durham, North Carolina 27710; Children’s Hospital of Los Angeles (F.R.K.), Los Angeles, California 90027; University of California San Francisco (R.H.L.), San Francisco, California 94143; University of Florida (J.H.S.), Gainesville, Florida 32611; Schneider Children’s Hospital (P.W.S.), New Hyde Park, New York 11040; University of California–Davis Medical Center (D.M.S.), Sacramento, California 95817; and Mayo Clinic (V.M.M.), Rochester, Minnesota 55905

Address all correspondence and requests for reprints to: The Endocrine Society, 8401 Connecticut Avenue, Suite 900, Chevy Chase, Maryland 20815. E-mail: govt-prof{at}endo.society.org. Telephone: 301-941-0200. Address all reprint requests for orders of 101 and more to: Menna Burgess, Reprint Sales Specialist, Cadmus Professional Communications. Telephone: 410-819-3960, fax: 410-684-2789, or e-mail: reprints2{at}cadmus.com. Address all reprint requests for orders of 100 or less to Society Services. Telephone: 301-941-0210, or e-mail: societyservices{at}endo-society.org.

Objective: Our objective was to formulate practice guidelines for the treatment and prevention of pediatric obesity.

Conclusions: We recommend defining overweight as body mass index (BMI) in at least the 85th percentile but < the 95th percentile and obesity as BMI in at least the 95th percentile against routine endocrine studies unless the height velocity is attenuated or inappropriate for the family background or stage of puberty; referring patients to a geneticist if there is evidence of a genetic syndrome; evaluating for obesity-associated comorbidities in children with BMI in at least the 85th percentile; and prescribing and supporting intensive lifestyle (dietary, physical activity, and behavioral) modification as the prerequisite for any treatment. We suggest that pharmacotherapy (in combination with lifestyle modification) be considered in: 1) obese children only after failure of a formal program of intensive lifestyle modification; and 2) overweight children only if severe comorbidities persist despite intensive lifestyle modification, particularly in children with a strong family history of type 2 diabetes or premature cardiovascular disease. Pharmacotherapy should be provided only by clinicians who are experienced in the use of antiobesity agents and aware of the potential for adverse reactions. We suggest bariatric surgery for adolescents with BMI above 50 kg/m², or BMI above 40 kg/m² with severe comorbidities in whom lifestyle modifications and/or pharmacotherapy have failed. Candidates for surgery and their families must be psychologically stable and capable of adhering to lifestyle modifications. Access to experienced surgeons and sophisticated multidisciplinary teams who assess the benefits and risks of surgery is obligatory. We emphasize the prevention of obesity by recommending breast-feeding of infants for at least 6 months and advocating that schools provide for 60 min of moderate to vigorous daily exercise in all grades. We suggest that clinicians educate children and parents through anticipatory guidance about healthy dietary and activity habits, and we advocate for restricting the availability of unhealthy food choices in schools, policies to ban advertising unhealthy food choices to children, and community redesign to maximize opportunities for safe walking and bike riding to school, athletic activities, and neighborhood shopping.