Why is body mass index (BMI) used as a measurement?
BMI is a measure of growth based on height and weight. For children and teens of the same age and sex, overweight is defined as a BMI at or above 85% and obesity as a BMI at or above 95%.
BMI is not an extremely specific measure, but we do have really consistent evidence that the BMI cut offs in the guidelines are a good screening tool for assessing overweight, obesity, and severe obesity. It can help clinicians understand when to progress to recommend intensive lifestyle interventions, weight-loss medications, and metabolic or bariatric surgery in a more timely fashion.
But when I talk to patients, I don’t talk about weight and BMI. I ask about how they are doing and what is going on in their life. Then we talk about what they want to work on and come up with a plan together.
Are treatments like medication and surgery safe for adolescents?
Just in the past year or two, new safe and effective medications have been approved for children who have obesity, and we have an abundance of evidence that metabolic or bariatric surgery should be considered the standard of care for qualifying adolescents who have severe obesity. The idea of surgery can be daunting for families. However, knowledge is power, and seeking a consultation to understand more about what surgery means does not mean a commitment to it.
For teens with severe obesity who do decide with their families to pursue metabolic or bariatric surgery, they can expect to participate in intensive lifestyle interventions for at least six months. The patient will also undergo a thorough medical evaluation to ensure they have the safest surgery possible. Our adolescent bariatric surgery center has a multidisciplinary team that supports families through this journey and beyond.
There is an abundance of scientific evidence to support these interventions, compared to watchful waiting, which studies show can lead to excessive weight gain and a greater risk for chronic diseases. It is also important to understand that these therapies are recommended together with intensive lifestyle interventions to continually work on healthy behaviors.
Will parents see a difference at an annual checkup?
Pediatricians have always checked weight and height to make sure children are growing in a healthy way, and that will not change. The new guidelines state that offering the most intensive evidence-based intervention available should be the standard of care. If the child is gaining weight more quickly than expected, there may now be an escalated time frame for recommending intensive lifestyle interventions — meaning on average one hour per week — at a younger age. Recommendations to start medications may occur more quickly than in the past. And for adolescents with severe obesity, pediatricians may refer them to bariatric surgery earlier on.
What would you say to parents who are concerned their child is gaining weight too quickly?
No parent or child is at fault. We have evidence to show that placing blame on the individual doesn’t help treat the problem. General health guidance says that everyone should drink plenty of water, eat fruits or vegetables with every meal, avoid processed foods and sugary drinks, get age-appropriate physical activity and play, and limit screen time. But our modern world is complex, and no one is perfect.
I think it can be really stressful. I would remind parents that they should put the oxygen mask on first, take some breaths, and talk to the pediatrician to see if other treatments or evaluations are warranted.