In this video, Amanda Calhoun, MD, M.P.H., Yale Child Research Center in New Haven, Connecticut, discusses new American Academy of Pediatrics (AAP) clinical practice guidelines for the evaluation and treatment of obese children and adolescents. doing.
Below is a transcript of her remarks.
Essentially, the American Academy of Pediatrics has released a set of guidelines for clinicians caring for children.What the AAP has done is basically create a set of categories. Where appropriate, it provides instructions and considerations for clinicians and physicians caring for children regarding a particular topic (in this case, obesity).
The idea is that the guidelines not only define obesity, but also what you, as a clinician, already know about obesity, but also what you do about it. , is very important. So pediatricians and other clinicians who care for children will read these guidelines and change their view of children in the office.
My problem with providing medicine and surgery is that I don’t think enough attention is being paid to step one, which is lifestyle modification.
I can speak from the perspective of a child and adolescent psychiatrist who prescribes drugs that actually contribute to weight gain and metabolic syndrome in children. We doctors are not well educated about nutrition. I mean, do you think there was one segment in medical school?
So if you’re the doctor prescribing these drugs and you’re really wrestling with whether patients should ask for the drugs, you have a problem managing it. Because we don’t have enough nutrition education.
Honestly, I should have measured more than BMI [body mass index]I know some people do, but how do you best articulate it? This is a racist, highly restrictive and narrow guideline. When BMI was created, it was based on adults of European descent. What it does is that it basically has a narrow set of guidelines for what a healthy weight is, then what is overweight, and what is obesity. .
Obviously, if someone is at one extreme or the other, i.e. very overweight or very thin, it’s obvious, right? But for those who are in-between, muscle, skeletal muscle, or bone density are not considered.
Consider an adolescent girl who is an athlete. She runs, lifts weights, is muscular and very dense in her bones. She may be recorded as overweight, but she is not. She’s actually much healthier than other adolescent girls who are sedentary, don’t eat food that nourishes their body, and aren’t athletes.You need to look at the big picture of your child.
Honestly, I think anyone doing nutritional counseling would benefit from getting one of those.This isn’t really a scale, but a full body measurement if you can afford to practice. It actually looks at skeletal muscle and bone density, and it looks at a lot more than just weight.
I think we need to start with that, and I think even obese patients would say, “It’s not just weight, it’s muscle, it’s bone density, it’s not just reducing the amount of excess fat, but in the long run, the organs are functioning well. Let’s talk about building bone density, as well as potentially helping you to do more.Let’s talk about all the muscle you have.
Examining a more complete approach may help patients feel that we are not only focusing narrowly on weight in such a negative way, but more broadly on health. I hope it will be useful.