Treatment
12
Î ES suggests that the health care team evaluate for psychosocial
comorbidities and prescribe assessment and counseling when
psychosocial problems are suspected. (2|⊕
)
Î ES suggests pharmacotherapy for children or adolescents with obesity
only after a formal program of intensive lifestyle modification has
failed to limit weight gain or to ameliorate comorbidities (2|⊕
).
ES recommends against using obesity medications in children and
adolescents <16 years of age who are overweight but not obese,
except in the context of clinical trials. (1|⊕
)
Î ES suggests that Food and Drug Administration (FDA)–approved
pharmacotherapy for obesity be administered only with a concomitant
lifestyle modification program of the highest intensity available and
only by clinicians who are experienced in the use of anti-obesity
agents and are aware of the potential for adverse reactions. (2|⊕
)
Î ES suggests that clinicians should discontinue medication and
reevaluate the patient if the patient does not have a >4% BMI/BMI z
score reduction after taking anti-obesity medication for 12 weeks at
the medication's full dosage. (2|⊕
)
Î ES suggests bariatric surgery only under the following conditions:
(2|⊕⊕
)
• the patient has attained Tanner 4 or 5 pubertal development and final or near-final
adult height, the patient has a BMI of >40 kg/m
2
or has a BMI of >35 kg/m
2
and
significant, extreme comorbidities.
• extreme obesity and comorbidities persist despite compliance with a formal
program of lifestyle modification, with or without pharmacotherapy.
• psychological evaluation confirms the stability and competence of the family unit
[psychological distress due to impaired quality of live (QOL) from obesity may be
present, but the patient does not have an underlying untreated psychiatric illness]
• the patient demonstrates the ability to adhere to the principles of healthy dietary
and activity habits.
• there is access to an experienced surgeon in a pediatric bariatric surgery center of
excellence that provides the necessary infrastructure for patient care, including a
team capable of long-term follow-up of the metabolic and psychosocial needs of
the patient and family.
Î ES suggests against bariatric surgery in preadolescent children,
pregnant or breast-feeding adolescents (and those planning to become
pregnant within 2 years of surgery) and in any patient who has not
mastered the principles of healthy dietary and activity habits and/or
has an unresolved substance abuse, eating disorder, or untreated
psychiatric disorder. (2|⊕
)
