HJNO Jul/Aug 2023

HEALTHCARE JOURNAL OF NEW ORLEANS I  JUL / AUG 2023 33 improving comorbidities and quality of life, and many have few or negligible side effects. If a child is placed on obesity medication, does this mean they will be on the medicine for the rest of their lives? Obesity is not an acute episode but rather a chronic, remitting, and relapsing disease. Medications are changing the physiology of the body to fight against a setpoint of ele- vated weight. Often, this change only occurs when the medication is taken, and the body fights to return to the setpoint if the medica- tion is stopped. So, for many patients, treatments may be needed throughout one’s life. We have to remember that treating pediatric obe- sity is not a one-size-fits-all approach — there are many varied, multi-layered fac- tors that determine whether and how a child will respond to treatment. Often, a differ- ent medication or combination of medi- cations might need to be tried to find the right prescription for the individual child. Just as with other chronic diseases, there will likely need to be continued use. In clini- cal trials for both adolescents and adults, we see weight rebound when medication stops. There are other medications taken for decades of life — including birth control, diabetes control, blood pressure control — but people are still struggling to understand that obesity is a chronic disease that needs a life-long approach. We do need more long- term safety data, which are currently being collected, along with phase 4 trials as these medications hit the market, and they will continue to be regulated by the FDA. To maintain lost weight, the child needs to engage in IHBLT to set the child up for success — changing their environment and building behavior skills and habits that they can sustain throughout childhood, adoles- cence, into adulthood. The CPG makes it clear that medication is not a monotherapy and should be offered in conjunction with IHBLT. The guidelines recommend surgical and medical interventions. This stance has been questioned by some due to a lack of long-term research and the failure to focus on preventative measures. While the “fix it with a pill and surgery approach” might ultimately be necessary for some, it seems to lack the obvious solution — a societal commitment to feed these kids healthier food and make sure they exercise. Can you give us some insight to the behind-the-scenes discussions that ultimately downplayed those options? TheAAP commissioned this clinical prac- tice guideline to move toward a more sci- entifically rigorous review beyond the 1997 and 2007 expert consensus recommenda- tions specific to the treatment of child obe- sity. Our task on the technical report and guidelines committees was to review the scientific evidence for obesity treatment options delivered via healthcare settings to answer two questions: “What are clinically based, effective treatments for obesity”and “What is the risk of comorbidities of obe- sity?” In doing so, we canvassed nearly 16,000 scientific papers and ultimately arrived at 382 studies that met the rigorous inclusion criteria. Many of these focused on behavioral approaches, with some meeting the guidelines of “intensive health behavior and lifestyle programs.”Other studies tested pharmacological treatments, and others tested surgical treatments. The key action statements, which are grounded on the highest level of scientific evidence, include evaluation and treatment and represent the evidence of these clinical trials. Prevention and treatment are on a spec- trum and are not dichotomous or divorced from each other. As I mentioned in my intro, the AAP has put forth several policy “If an IHBLT or dietitian is not available, pediatric healthcare providers can offer to increase the intensity of weight management support by connecting families with community resources to support nutrition and address food insecurity (e.g., food provision programs), physical activity (e.g., local parks, recreation programs), and counselors or social workers to help families with mental health and social determinants of health.”