Preventing Childhood Obesity

Pediatric Obesity: Highlighting the New Recommendations

By: Christine Finck, MD, FACS, and Melissa Santos, PhD

More than 17 million U.S. children and teens live with a common chronic disease that has been stigmatized for years – pediatric obesity. In Connecticut, 15.3% of 10-17 year olds a nd 14.5% of 2-4 year olds suffer from obesity. The causes of obesity are complex ranging from genetics, the environment, metabolism, screen time and more. Obesity is not simply a “failure of willpower.”  This sets up the vicious cycle of obesity (Figure 1) which demonstrates the ramifications of untreated obesity and medical disease.

The American Academy of Pediatrics (AAP) published its first comprehensive guideline on evaluating and treating children and adolescents with obesity. The highlights of this publication include the following:

  1. Recognizing obesity as a chronic disease
  2. Using person first language: a child with obesity as opposed to an obese child
  3. Youth suffering from obesity should be treated by a multi-disciplinary program that focuses on all aspects of health
  4. Behavioral and intense psychological therapy should be a component of the program
  5. Pharmacotherapy should be offered in children starting as an adjunct to health and behavior and lifestyle treatment
  6. Surgery is safe and effective and should be offered to children and adolescents age 12 years and older with consideration for those younger if the benefits outweigh the risks.

Read the American Academy of Pediatrics Clinical practice guideline for the evaluation and treatment of children and adolescents with obesity.

This publication was extensive and focused on many aspects of treatment and the recognition that obesity is a multi-factorial disease. Despite this, there was much criticism in the media focusing on the use of medications and surgery in the treatment of childhood obesity. It is imperative that the medical community advocate for our children and remember that these are comprehensive guidelines with recommendations for medical, psychological and surgical treatment. There are still many hurdles including insurance reimbursement. The Washington Post published an article highlighting that despite recommendations by the AAP, the drugs used in children at risk of serious health problems have not been approved by many insurers, citing their high prices and limited track records. Only an estimated 30 to 40% of commercial health insurance plans and 19 Medicaid programs cover anti-obesity drugs at some level and many impose additional barriers to access such as requiring prior authorization. This must change.

The Pediatric Obesity Center for Treatment, Research and Education at Connecticut Children’s has a multi-disciplinary approach to treating obesity. The program consists of dietitians, psychologists, pediatricians with certificates of added qualification in obesity, physical therapists, endocrinologists and surgeons. In addition, the program has a strong collaboration with Darren Tishler, MD, FACS, and Pavlos Papasavas, MD, FACS, of the Medical and Surgical Weight Loss Center at Hartford Hospital. The mission of the Pediatric Obesity Center is to optimize the care of children with obesity and improve access to care. The center’s team explores all aspects of treatment with patients and their families. For more information, please visit the website or email the team at

Christine Finck, MD, FACS, is Surgeon-in-Chief at Connecticut Children’s. Dr. Finck is one of six women surgeon-in-chiefs at 45 children’s hospitals around the country.

Melissa Santos, PhD, is the Division Head of Pediatric Psychology at Connecticut Children’s and the Clinical Director of the Pediatric Obesity Center for Treatment, Research and Education at Connecticut Children’s.

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