July 10, 2023
The lives of children and adolescents have changed significantly over the last decade. Increased consumption of calorie-dense food and beverages, environmental changes and community concerns that limit outdoor activities may be fueling increases in childhood obesity. In 1 analysis, the rate of BMI increase in kids doubled during the pandemic period.
In response to those trends, last January the American Academy of Pediatrics issued its first update to guidelines for childhood obesity in 15 years. The guidelines recommend a shift from watch and wait to beginning robust treatment earlier.
“The guidelines are very specific about how complex this problem is,” says Stephen Lauer, MD, PhD, a pediatrician at the health system. They address this complexity by recommending more comprehensive and robust treatment programs that try to address societal factors as well as medical ones.
Why we’re concerned about childhood obesity
Excess weight in kids is a serious health issue. It can lead to type 2 diabetes as well as cardiovascular, musculoskeletal, kidney problems and more. Obesity is a chronic disease.
“Just about every organ system is affected if your body is just carrying too much weight, and the effects of that excess weight over long periods of time impact everybody's health and are incredibly expensive ways to live,” Dr. Lauer says.
Kids usually don’t grow out of obesity. Children and adolescents with obesity have a greater risk of obesity in adulthood, which may lead to additional chronic health conditions and even premature death.
How childhood obesity is being treated
Previously, the number of options for the treatment of childhood obesity was somewhat limited. Now, we recognize that obesity results from a wide number of factors – including those that are environmental, sociological and genetic. For example, children who have experienced poverty, racism, immigration or discrimination are at higher risk of obesity.
The new AAP guidelines recommend intensive and long-term care. As a chronic condition, obesity should be managed beyond routine annual well-child visits.
Specifically, the AAP outlined a treatment program lasting 3-12 months with at least 26 hours of intervention. Treatments should include in-person behavior and lifestyle treatment in addition to things like medication or even surgery.
“I’m really excited for those guidelines because they allow for us to understand it's multifactorial how kids and adults struggle with obesity,” says Danielle Johnson, PhD, a child psychologist at Marillac Campus.
Obesity treatment requires care to be delivered with individual patient factors in mind. The pediatrics team at The University of Kansas Health System has been leading the nation in implementing this kind of care with its Healthy Hawks program. We take into consideration household and familial influences, access to healthy food, ability to engage in physical activities and other social determinants of health. This is also part of our medical home model, which is the preferred standard of care for children with chronic conditions.
Your patient-centered medical home
We’re proud to hold National Committee for Quality Assurance recognition as a patient-centered medical home. We focus on long-term patient-provider relationships to promote care coordination and wellness.
Healthy Hawks is for kids, 18 months to approximately 18 years old, who are overweight or have obesity. It meets or exceeds all the new AAP recommendations. Parents can request a Healthy Hawks visit or may be referred. The program team includes a nurse practitioner, a psychologist and a dietitian/nutritionist. They assess and treat medical, behavioral and nutrition issues.
I approach it from the aspect of health and what's healthy and what's not healthy. We focus on being able to help build some resiliency in these kiddos – that they have the ability to manage through these hard times. We've all been adolescents and teens once and remember what it was like for someone to make fun of wearing glasses or the clothing you wore. So we are helping them to build the skills internally to manage those emotions to assert themselves and stand up for themselves. Danielle Johnson, PhDPsychologist
About Healthy Hawks
“Our primary focus in Healthy Hawks is talking about how to be healthy and strong and to live a long life,” says Eva Chevreux, APRN, IBCLC, nurse practitioner for the program.
It starts by looking at multiple measures of health – cholesterol, blood pressure, heart rate and BMI among others. Then the care team may make referrals to a specialty, like gastroenterology or cardiology, if needed.
“Some things that used to be problems of adulthood, and even the elderly, are now creeping down into the teenage years, which is just so concerning because we’re talking about the possibility of a lifetime of these diseases impacting kids,” says Dr. Johnson.
It is likely because of those long-term effects that the AAP approved considering options like anti-obesity medications and bariatric surgery for kids as young as 12.
However, Dr. Lauer says treating a child with a weight-loss medication like Wegovy is still considered an extreme treatment.
“It’s something we want to be avoiding, if at all possible,” he says. “But in extreme cases, these medications do seem to work.”
Additionally, our care team has noted that kids are more likely to struggle with self-esteem issues and with anxiety and depression when they carry excess weight. This is why it’s important the Healthy Hawks program includes access to a psychologist.
“I approach it from the aspect of health and what's healthy and what's not healthy. (We focus on) being able to help build some resiliency in these kiddos – that they have the ability to manage through these hard times,” Dr. Johnson says. “We've all been adolescents and teens once and remember what it was like for someone to make fun of wearing glasses or the clothing you wore. So we are helping them to build the skills internally to manage those emotions to assert themselves and stand up for themselves.”
Most important, the program focuses on helping the entire family make lifestyle changes. Those can include modifying the amount of physical activity the family gets, changing the types of food served at meals or changing eating habits. We partner to set realistic goals and provide reasonable incentives.
“We can talk to families about changing some of the cultures behind how we move our bodies, how we interact with food, how we think about health,” says Dr. Johnson.
What to look for when choosing weight-management care
There are many places to get weight management care, but not all of them are informed by the kind of expertise you can find at the health system. In fact, research has shown that as many as 95% of weight-loss attempts fail at long-term change. It’s important to look for programs that have a staged approach and address all 3 prongs: medical, behavioral and nutritional.
Pediatric care at The University of Kansas Health System offers 2 different stages of care. All stages are open to kids who have a BMI greater than the 85th percentile. Parents can request to participate in the Healthy Hawks program, or a provider can refer you. To start, kids get expanded visits with their pediatrician and additional care plans for 3 months. Care can also progress beyond 3 months, and in some cases, you may be referred to an intensive program.
Established patients may benefit from a concierge appointment with the program’s registered dietitian.
It is best to start a treatment like Healthy Hawks preventively before chronic issues develop. Talk to your pediatrician or call 913-588-1227.
In-person visits with the Healthy Hawks team are available at the pediatrics office in Prairie Village, Kansas. Telehealth is also an option.