Peds 2022060641
Peds 2022060641
Peds 2022060641
PEDIATRICS Volume 151, number 2, February 2023:e2022060641 FROM THE AMERICAN ACADEMY OF PEDIATRICS
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recommendations are child-centric obesity prevention, which will be considering obesity because obesity-
and not specific to a particular addressed in a forthcoming AAP related risk factors are embedded in
health care setting. The term policy statement. the socioecological and environmental
“pediatricians and other PHCPs” fabric of children’s lives. There is a
includes pediatric primary and Obesity is a Chronic Disease With danger of stigmatizing children with
specialty care providers as well as
Complex Contributing Factors obesity and their families on the basis
allied health care professionals, all Childhood obesity results from a of race or ethnicity, age, and/or
of whom will encounter and may multifactorial set of socioecological, sex based on the disparities of
treat children with overweight, environmental, and genetic outcome—without recognizing the
obesity, and obesity-related influences that act on children and systemic challenges that cause and
comorbidities. families (see Epidemiology section maintain inequities.11,12 Inequities are
of CPG [https://doi.org/10.1542/ often associated with each other13
The CPG is based on a peds.2022-060640]). The CPG de- and result in disparities in obesity
comprehensive evidence review of scribes risk factors for overweight risk and outcomes across the
controlled and comparative and obesity, many of which are socioecological spectrum. Importantly,
effectiveness trials and high-quality SDoHs. These SDoHs include they represent neighborhood-,
longitudinal and epidemiologic factors related to broader policies community-, and population-level
studies. The accompanying technical and systems; institutions and organi- factors that can be changed.14
reports (https://doi.org/10.1542/ zations (ie, schools); neighborhoods Inequities that promote obesity in
peds.2022-060642 and https://doi. and communities; and family, socio- childhood can have a longitudinal
org/10.1542/peds.2022-060643) economic, environmental, ecological, effect, which leads to disparities in
provide detailed descriptions of the genetic, and biological factors2,3 (see adult health and contributes to adult
evidence review supporting the Risk Factors section of CPG [https:// obesity and other chronic diseases.15
CPG’s development. Based on this ev- doi.org/10.1542/peds.2022-060640]).
idence, the CPG contains Key Action These risk factors often overlap and/ Attainment of health equity for
Statements (KASs), which represent or influence one another and can op- children with obesity requires
evidence-based recommendations erate chronically throughout child- addressing inequities in available
from randomized controlled and hood and adolescence, initiating resources and systemic barriers to
comparative effectiveness trials and weight gain and escalating degrees of quality health care services.16 To
high-quality longitudinal and epide- existing obesity. The subcommittee that end, “practice standards must
miologic studies. The CPG details an recommends that pediatricians and evolve to support an equity-based
evidence table for each KAS (Table other PHCPs perform initial and longi- practice paradigm,” and payment
1) and Appendix 1 in the CPG con- tudinal assessment of individual, strategies must promote this
tains a helpful algorithm to guide structural, and contextual risk factors approach to care.17
care based on these KASs. KASs are to provide individualized and tailored
supplemented by Consensus Rec- treatment of the child/adolescent Individuals with overweight and
ommendations to provide expert with overweight/obesity. obesity experience weight stigma and
opinion on topics that were not weight-based victimization, teasing,
part of the TRs. These Consensus The term “disparities” is commonly and bullying. This experience
Recommendations are supported used to describe differences in contributes to binge eating, social
by American Academy of Pediatrics disease prevalence and outcomes in isolation, avoidance of health care
(AAP)-endorsed guidelines, clinical populations, defined by ethnicity, services, and decreased physical
guidelines, and/or position state- race, gender, and/or age. This word, activity, further complicating the
ments from professional societies however, does not acknowledge the health trajectory.11,17 It is important
in the field of obesity, and an ex- causes of these disease prevalence for pediatricians and other PHCPs to
tensive literature review (see differences, better labeled “inequities,” communicate support and alliance
Methodology section of CPG a term that includes structural racism with children, adolescents, and
[https://doi.org/10.1542/ and the lack of “economic, civil- parents/caregivers as they evaluate
peds.2022-060640]). political, cultural, or environmental patients, diagnose obesity and
conditions that are required to overweight, and guide obesity
The CPG does not include guidance generate parity and equality.”4 treatment. Discussions about weight
for overweight and obesity and obesity—even when conducted
evaluation and treatment of children This distinction between health using nonstigmatizing language and
younger than 2 years of age. Nor disparities and inequities is preferred terms—can elicit strong
does the CPG discuss primary particularly important when emotional responses, including
DOI: https://doi.org/10.1542/peds.2022-060641
Address correspondence to Sarah Hampl, MD. Email: shampl@cmh.edu
PEDIATRICS (ISSN Numbers: Print, 0031-4005; Online, 1098-4275).
Copyright © 2023 by the American Academy of Pediatrics
FINANCIAL/CONFLICT OF INTEREST DISCLOSURES: An independent review for bias was completed by The American Academy of Pediatrics. Dr Barlow has
disclosed a financial relationship with the Eunice Kennedy Shriver National Institute of Child Health and Human Development as a co-investigator.
COMPANION PAPER: A companion to this article can be found online at https://doi.org/10.1542/peds.2022-060640.
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