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Pediatric Obesity

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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|⊕ )

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