New weight-management algorithm
The long-awaited American Academy of Pediatrics (AAP) weight-management algorithm for obesity provides a comprehensive, evidence-based translation for real-world use, said Ihuoma Eneli, MD, MS, FAAP, at the AAP’s 2016 National Conference. She discussed the guideline in her session "The new AAP algorithm: Finally! What the evidence says Is the best way to manage obesity."
Until an Expert Committee convened by the American Medical Association Health Resources and Service Administration and the Centers for Disease Control and Prevention published obesity recommendations in 2007,1 pediatricians had no structured format to translate these guidelines into treatment for childhood obesity. The new AAP Algorithm for the Assessment and Management of Childhood Obesity in Patients 2 Years and Older2 incorporates these guidelines along with recent evidence and expert opinions.
Like the Expert Committee recommendations, the AAP algorithm links treatment recommendations to community resources, giving clinicians a coordinated approach by bringing all the evidence together to support specific suggestions in areas such as assessing the family situation, ordering laboratory tests, and setting treatment goals.
The algorithm divides obesity treatment into 4 stages, marked by increasing interventional intensity. Children should begin at the lowest stage appropriate for their body-mass index, age, and presence of comorbidities.
The first 2 stages, Prevention Plus and Structured Weight Management, occur in the primary care pediatrician's office. Stage 2 requires primary care pediatricians to provide counseling with assistance from an allied health professional such as a dietitian or health coach.
At every stage, the algorithm spotlights the importance of motivational interviewing, using tactics such as shared agenda setting and eliciting self-motivational statements from patients to boost compliance. To hone this skill, pediatricians may access the free Change Talk program developed by the AAP Institute for Healthy Childhood Weight via the interactive app available at Google Play and Apple iTunes. Through an online avatar, Change Talk walks users through common scenarios that occur in the primary care office.
1. Barlow SE; Expert Committee. Expert committee recommendations regarding the prevention, assessment, and treatment of child and adolescent overweight and obesity: summary report. Pediatrics. 2007;120(suppl 4):S164-S192.
2. American Academy of Pediatrics Institute for Healthy Childhood Weight. Algorithm for the assessment and management of childhood obesity in patients 2 years and older. Available at: https://ihcw.aap.org/Documents/Assessment and Management of Childhood Obesity Algorithm_FINAL.pdf. Updated August 2016. Accessed October 21, 2016.