Abstract
The 2023 release of the American Academy of Pediatrics' clinical practice guidelines on the treatment of child and adolescent obesity 1 highlighted a major gap between the extensive evidence on safe effective treatment and the availability of these services for the one in five U.S. children affected by obesity. 2 Also launched in 2023, the Pediatric Obesity Health Services Research Work Group of the Nutrition and Obesity Policy Research and Evaluation Network (NOPREN; https://nopren.ucsf.edu/pediatric-obesity-health-services-research-work-group) aims to study and advance implementation of equitable evidence-based practices and policies for pediatric obesity prevention and treatment.
To facilitate this aim, 183 interdisciplinary attendees joined a video conference in June 2023 to discuss the future of health services for youth with obesity and determine the critical gaps. This editorial summarizes the overarching themes identified.
Obesity Is Not a Disease of Willpower
Curbing the obesogenic environment is critical; one identified example was the overwhelming production and marketing of ultraprocessed calorie-dense foods and beverages. More work needs to be done to help leaders in health care, government, and public policy overcome weight bias and recognize obesity as a complex and chronic disease. Many individuals are constrained by social determinants of health such as housing and transportation access, and food insecurity, which need to be addressed and mitigated to support healthy foundational behaviors for obesity treatment to be effective.
Health Care Providers Need Training and Technical Assistance
Providers desire to learn and implement evidence-based obesity care; this requires access to existing training programs, clinical decision support tools, and ongoing technical assistance. Support is needed across the continuum, from medical education to professional development and quality improvement opportunities. Providers need support to reconcile a patient's need for obesity treatment with time and payment for comprehensive screening as groups call for augmenting the use of only body mass index. Information on the availability of evidence-based treatment is 10 years old 3 and pre-dates the newest scientific evidence on safe, effective medical, surgical, and pharmacological treatments. Updated resources to identify available treatment are necessary to address gaps in services and focus areas for investment.
A Child-Centered Approach Requires Treating Multiple Comorbidities
Child-centered obesity care requires a whole-child evaluation and offering multimorbidity treatments for co-occurring conditions. Current practices and clinical trials for weight management screen out individuals with eating disorder diagnoses, creating a gap in the knowledge for safe effective obesity treatment.
Long-Term Data Are Needed to Monitor Effectiveness and Safety of Obesity Treatment
Clinical trials on metabolic and bariatric surgery and pharmacological treatments need to monitor both physical and psychological health outcomes and must include long-term follow-up for safety and effectiveness.
Financial Coverage Is Required for Equitable Access to Obesity Treatment
Securing insurance coverage of obesity treatment with sufficient payments to dietitians and other providers is critical to ensure families have access to care.
The NOPREN work group encourages professionals interested in supporting children's health to consider: how will we efficiently synchronize, delegate, and collaborate as invested parties to close the gap and to improve the equitable access to safe effective pediatric obesity treatment?
Footnotes
Acknowledgments
Authors of this publication are members of the Pediatric Obesity Health Services Research Work Group, supported by the NOPREN. NOPREN is funded by the Centers for Disease Control and Prevention's (CDC) Division of Nutrition, Physical Activity, and Obesity and Prevention Research Centers Program. The findings and conclusions in this publication are those of the author(s) and do not necessarily represent the official position of the CDC or Department of Health and Human Services (DHHS).
The authors thank Sam Pierce, Aly Goodman, Amy Warnock, and Heidi Blanck for their contributions. We also thank the participants of the June 2023 video conference comprising health practitioners, research scientists, government scientists, health economists, and community leaders across the United States for their insightful contributions and perspectives.
Authors' Contributions
A.M.B. contributed to conceptualization, original draft, and project administration. A.E.S. was involved in conceptualization, review and editing, and project administration. H.K.S. carried out review and editing, and project administration.