In this video, Amanda Calhoun, MD, MPH, of the Yale Child Study Center in New Haven, Connecticut, discusses the new American Academy of Pediatrics (AAP) Clinical Practice Guideline for the Evaluation and Treatment of Children and Adolescents with Obesity.
The following is a transcript of her remarks:
Essentially, the American Academy of Pediatrics released a series of guidelines that are meant to be geared towards clinicians who are taking care of children. What the AAP has done is to basically have a series of categories, if you will, steps and things that clinicians and doctors taking care of children should keep in mind regarding certain topics — in this case, obesity.
The idea is the guidelines not only define obesity, which we kind of already know as clinicians, but also what you do about it. It’s pretty important, because the idea is that these guidelines will shape clinical practice, so pediatricians and other clinicians taking care of children will be reading these guidelines and then they will change how they see children in their offices. So, I think it’s a pretty big deal.
My problem with offering medicine and surgery is that I think there has not been enough attention placed on step one, which is lifestyle modifications.
I can speak from the standpoint of a child and adolescent psychiatrist who prescribes medicines that actually do contribute to weight gain and metabolic syndromes in children. We as doctors don’t get a lot of education in nutrition. I mean, I think we had one segment in medical school?
So really, if you are a doctor who is prescribing these medications, who’s really working with patients on whether they should seek medications, I have a problem with doctors managing that, because we don’t have enough nutrition education. I would prefer there to be even more emphasis on funding physicians to be able to have better nutrition education.
Honestly, I wish that we measured more than BMI [body mass index]. I know some people do, but — what’s the way to put it in a nice way? I guess I can’t really say it in a nice way. It’s a racist, very limited, narrow guideline. When BMI was created, it was based on adults of European descent. What that does is it basically has a narrow set of guidelines of what is a healthy weight and then what is overweight, and then what is obese.
Obviously, if someone is on one extreme or the other — very overweight or very underweight — that’s obvious, right? We need to have a conversation about how they become healthy. But for people who are in between, which is a lot of people, it does not take your muscles into account, your skeletal muscles, or your bone density.
Let’s take an adolescent girl who’s an athlete — she runs, she lifts weights, she’s muscular, her bones are very dense. She may track as overweight, but she is not, and is in fact much healthier than perhaps another adolescent girl who is sedentary and doesn’t eat foods that fuel her body and is not an athlete. You need to look at the whole picture of the child.
I would actually say that, honestly, for people who are going to be doing counseling for nutrition, you would benefit from getting one of those — it’s not actually a scale, but it’s a full-body measure, if your practice can afford it. It actually looks at skeletal muscle, it looks at bone density, it looks at a lot more things than just weight.
I think we need to start with that, and I think that carries over into a patient that is even obese to say, “Hey, let’s not only look at your weight. Let’s look at your muscle, let’s look at your bone density, and let’s talk about not just reducing the amount of excess fat, which may be helpful in the long-term for your organs to function well, but let’s also talk about increasing your bone density. Let’s talk about all the muscle you have.”
I think by looking at a more full approach it will help patients feel that we’re not just focusing so narrowly on weight in such a negative way and rather focusing more broadly on health.