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Pediatric Obesity

2 Contact Hours including 2 Pharmacology Hours
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This peer reviewed course is applicable for the following professions:
Advanced Practice Registered Nurse (APRN), Athletic Trainer (AT/AL), Certified Nurse Midwife, Certified Nurse Practitioner, Certified Registered Nurse Practitioner, Clinical Nurse Specialist (CNS), Licensed Practical Nurse (LPN), Licensed Vocational Nurses (LVN), Midwife (MW), Nursing Student, Occupational Therapist (OT), Occupational Therapist Assistant (OTA), Physical Therapist (PT), Physical Therapist Assistant (PTA), Registered Nurse (RN), Registered Nurse Practitioner, Respiratory Care Practitioner, Respiratory Therapist (RT)
This course will be updated or discontinued on or before Thursday, August 20, 2026

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CEUFast, Inc. is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Center's Commission on Accreditation. ANCC Provider number #P0274.

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CEUFast, Inc. (BOC AP#: P10067) is approved by the Board of Certification, Inc. to provide education to Athletic Trainers (ATs).
FPTA Approval: CE25-1239158. Accreditation of this course does not necessarily imply the FPTA supports the views of the presenter or the sponsors.
Outcomes

≥ 92% of participants will know how to care for pediatric patients diagnosed with obesity.

Objectives

After completing this continuing education course, the participant will be able to:

  1. Define the diagnostic criteria for pediatric obesity.
  2. Identify risk factors for pediatric obesity.
  3. Specify three comorbid conditions related to obesity.
  4. Describe the socioeconomic impact on pediatric obesity.
  5. Summarize the healthcare professional's role in combating pediatric obesity.
  6. Explain the treatment options available for treating pediatric obesity.
CEUFast Inc. and the course planners for this educational activity do not have any relevant financial relationship(s) to disclose with ineligible companies whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.
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Pediatric Obesity
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Author:    Sarah Beattie (DNP, APRN-CNP, CDCES)

Introduction

photo of blocks stating child obesity

Obesity is a common chronic condition in the United States (U.S.), affecting both adult and pediatric patients. The Centers for Disease Control and Prevention (CDC) (2024b) notes that 14.7 million children and adolescents in the U.S. are obese. There has been a recent shift in recognizing and treating obesity. Obesity is now considered a chronic illness. The research on the prevention, diagnosis, and treatment is evolving on how best to manage this multifactorial disease process in the pediatric population. Healthcare professionals are integral in understanding the underlying physiologic mechanisms, risk factors, and complications for obese pediatric patients. Healthcare providers must know and understand the evidence-based treatments available for pediatric obesity.

Obesity

Height and weight measurements are collected at each medical visit. The height and weight data are then used to determine the body mass index (BMI). Because the BMI measurement varies across the pediatric population, the growth charts are sex-specific and compare similar ages. The CDC (2024a) growth chart defines pediatric obesity as a BMI within the 95th percentile or higher. Severe obesity is a BMI of 120% of the 95th percentile or greater or 35 kg/m2 or greater.

Pathophysiology of Pediatric Obesity

The pathophysiology of pediatric obesity is complex and multifactorial. The most considerable contribution to obesity is the excess consumption of calories and the decreased energy expenditure. Many more variables also contribute to the long-standing theory that too many calories are consumed versus an insufficient number of calories expended. There are complex humoral and neuronal pathways involved in the gut-brain axis. Food triggers intestinal hormones when consumed, setting off a cascade of events that induce satiety via the neural pathway, signaling the brain to stop eating. Cholecystokinin (CCK) is a hormone that reduces the amount of ghrelin, subsequently decreasing hunger. Glucagon-like peptide 1 (GLP-1) is a hormone that slows gastric emptying, induces satiety in the brain, and increases insulin release.

Additionally, peptide YY (PYY) slows gastric emptying to allow for nutrient absorption in the gut. These intestinal hormones signal neural pathways in the hypothalamus, particularly the arcuate nucleus and within the brainstem. Thus, the brain-gut axis stimulates hunger or satiety depending on the signals received (Pizarroso et al., 2021). Alterations in any one of these areas from genetic mutations or environmental influence can lead to disordered eating and obesity.

Risk Factors

Genetics

A genetic predisposition to obesity, maternal gestational diabetes, maternal weight gain in pregnancy, and smoking during pregnancy are all known risk factors for developing pediatric obesity; this is due to a complex web of hormones and environmental factors affecting multiple genes as well as other known and unknown risk factors. There are cases of single gene mutations, though these are quite rare. These rare genetic causes of obesity typically have early obesity in conjunction with other physical findings in infancy. Rare genetic syndromes that cause pediatric obesity include Prader-Willi, Bardet-Biedl, Cohen, Alström, Albright hereditary osteodystrophy, Beckwith-Wiedemann, and Carpenter syndrome (Kumar & Kelly, 2017).

Obesity rates disproportionally affect different ethnic groups. Current data reports obesity rates for Hispanic children at 26.2% and non-Hispanic Black children at 24.8% but lower rates for non-Hispanic White children at 16.6% and for non-Hispanic Asian children with the lowest rate at 9.0% (CDC, 2024b). There is ongoing research to identify further specific genetic differences and the propensity for obesity within each ethnic group.

Screen Time

Screen time with the use of a computer, phone, tablet, gaming device, or other digital device is associated with an increased risk of obesity in children and adolescents. Studies have demonstrated an association between screen time use of over two hours daily and a greater risk of obesity. The increased screen time use also increases the sedentary time and consumption of calorie-dense, ultra-processed foods and beverages, which are well-known risk factors for obesity at any age (Hampl et al., 2023).

Sleep

Lack of sleep duration and quality directly affects the body's neuronal and hormonal systems, which have a higher association with obesity-promoting factors. Poor sleep quality and quantity can disrupt energy balance, causing an increase in ghrelin, the appetite-stimulating hormone, and a decrease in leptin, the appetite-suppressing hormone; this also affects glucose homeostasis by decreasing insulin sensitivity. Poor sleep and altered biological responses can result in consuming more significant portions of high-calorie foods, increased use of caffeine and sugary drinks, and less physical activity (Gohil & Hannon, 2018).

Obesogenic Environment

An obesogenic environment is an environment that supports obesity-causing behaviors. Scaglioni et al. (2018) identified numerous factors influencing the pediatric obesogenic environment. Children and adolescents are heavily influenced by the environment in which they are raised. Parental influences on the obesogenic environment include the parents' dietary patterns and the parental feeding patterns for their children, which shape the child's food preferences. The home environment, positive or negative, can influence obesity risk in children. The lack of shared family meals has been shown to decrease the consumption of healthy foods and increase the consumption of unhealthy foods (Scaglioni et al., 2018). Influences for ultra-processed foods in the media fuel the desire for increased consumption. The family's socioeconomic status also contributes to the obesogenic environment by increasing food insecurity, a higher risk of living in a food desert, and a lack of safe areas to promote physical activity. Unhealthy school lunches combined with a lack of physical activity in the typical school day also add to an obesogenic environment outside the home.

Medical Risk Factors

Certain medical conditions also carry obesity risk in the pediatric population. Obstructive sleep apnea decreases sleep quality, resulting in fatigue, decreased physical activity, and increased consumption of unhealthy foods. Endocrine disorders such as hypothyroidism, Cushing's disease, growth hormone deficiency, and pseudohypoparathyroidism are also conditions that can promote weight gain in the pediatric population (Kumar & Kelly, 2017).Those with developmental disabilities and autism spectrum disorder have been noted to have a greater risk of obesity due to eating behaviors that include a greater preference for calorie-dense foods. Certain medications that are needed to treat autism, as well as many other medical conditions, can be weight-promoting with a side effect of weight gain, raising the risk of obesity (Sammels et al., 2022). Psychological conditions, such as depression and disordered eating, are also medical risk factors for obesity. Children and adolescents who are medically complex have a 27% greater risk of becoming obese; this is attributed to several risk factors for obesity, including medication, limited physical mobility, and the need for supplemental nutrition (Peinado Fabregat et al., 2023). Obesity affecting the medically complex child can then worsen underlying conditions due to secondary obesity-related comorbidities.

Complications of Obesity

Comorbidities that arise from pediatric obesity can have lifelong implications.The American Academy of Pediatrics (AAP) identifies comorbid conditions in which to screen and identify for early intervention in children meeting the criteria for the diagnosis of obesity (Skinner et al., 2023).

Type 2 Diabetes:  A recent meta-analysis demonstrated that 77% of children or adolescents were obese at the time of a type 2 diabetes diagnosis (Cioana et al., 2022). Altered glucose metabolism in obese children occurs from reduced insulin secretion and insulin resistance. Obesity worsens insulin resistance by adipose tissue releasing free fatty acids and other pro-inflammatory cytokines, which alters the insulin receptor and, in turn, prevents insulin action on the muscle and hepatic cells. This cascade then results in the accumulation of insulin and glucose in the bloodstream. Additionally, consuming highly processed foods and sugary drinks drastically increases the insulin response from pancreatic beta cells. With repeated needs for insulin surge from these foods, the rise in blood glucose and insulin resistance can lead to beta cells starting to burn out, resulting in type 2 diabetes.

Dyslipidemia: Dyslipidemia, described as low high-density lipoprotein (HDL), high triglycerides, and high low-density lipoproteins (LDL), is a common comorbidity in obese pediatric patients. The most significant concern with pediatric dyslipidemia is the drastically increased long-term risk of cardiovascular-related events due to atherosclerosis, as measured by the carotid intima-media thickening (Koskinen et al., 2018). Unfortunately, this comorbidity has not been rigorously studied in larger populations, so the data is inadequate.

Hypertension: High blood pressure is defined as blood pressure measurements over the 90th percentile for sex, age, and height. This comorbid condition is multifactorial, arising from altered autonomic function, abnormal vascular endothelial function, and possibly the effect of insulin resistance. Long-standing hypertension can lead to increased cardiovascular event risk as well as other sequelae, such as left ventricular hypertrophy, creating significant cardiac risk as soon as early adulthood (Sorof & Daniels, 2022).

Non-Alcoholic Fatty Liver Disease (NAFLD): NAFLD is a broad term for varying degrees of fatty liver disease ranging from fatty liver to hepatic steatosis, fibrosis, and cirrhosis. However, partially a genetic risk, the increase in NAFLD parallels the rise in obesity. Consumption of processed carbohydrates, including the dramatic increase in high fructose corn syrup, causes insulin resistance and increased circulating triglycerides. This then causes the dysfunction of the hepatic fatty acids, leading to altered triglyceride metabolism and, thus, accumulation within the hepatocytes. Statistical data has noted up to an 80% risk of NAFLD in obese children with altered glucose metabolism. These results are difficult to generalize as the gold standard for NAFLD diagnosis is liver biopsy, and many studies use serum liver function tests and/or ultrasound to determine diagnosis, which can underestimate the burden of this disease (Marcinkiewicz et al., 2022).

Obstructive Sleep Apnea: Obstructive sleep apnea is when the soft tissue in the upper airway narrows to the point of obstruction, causing snoring, hypopnea, apnea, or hypoxia. This lack of restorative sleep results in excessive daytime sleepiness, chronic headaches, mood changes, nocturnal enuresis, and poor attention. Trends of pediatric obstructive sleep apnea also parallel the increase in weight and neck circumference. This comorbidity also contributes to conditions such as hypertension, type 2 diabetes, depression, and poor cognitive outcomes (Vajravelu et al., 2023).

Depression: Weight stigma in pediatric obesity has a resounding effect on a child's mental health. More than 50% of obese children reported experiencing bullying in school when compared to normal-weight children (Vajravelu et al., 2023). The cycle of weight stigma and resulting shaming or bullying can lead to a pattern of poor coping behaviors and increased food consumption, thus fueling obesity. This cycle can also lead to increased isolation and withdrawal from social interactions, creating or worsening depression.

Disordered Eating: Pediatric obesity can be fueled by an interlude of multiple variables, including genetics, childhood experiences, and social determinants of health, which all can lead to disordered eating. Pediatric obesity itself can cause maladaptive behaviors leading to circumstances such as binge eating, bulimia nervosa, anorexia, or other eating disorders. Binge eating disorder and bulimia nervosa are the two most prevalent comorbid eating disorders in pediatric obesity, requiring healthcare providers to be vigilant in screening (Stabouli et al., 2021).

Evidence-Based Interventions

Just as the etiology of pediatric obesity is multifactorial, a layered approach to treatment is necessary. The best available evidence in treating pediatric obesity has extended over recent years to include behavioral, pharmacologic, and surgical interventions in addition to the long-standing dietary and exercise guidelines. The United States Preventative Services Task Force (USPSTF) (2017) recommends at least 26 hours of intensive behavioral intervention for children ages six and older. This team-based approach to care includes the efforts of the primary care provider, nurses, dietitians, social workers, physical therapists, and psychologists. The recommended minimum of 26 hours of interventions for the child and the family include education on a balanced diet, food label reading, physical activity plans, identifying and limiting triggers for high-calorie foods, reducing sedentary screen time, and problem-solving. The AAP also supports the 2017 USPSTF guideline for intensive behavioral intervention (Hampl et al., 2023). However, they add that the largest improvement in weight reduction correlates with up to 52 hours of face-to-face intensive behavioral intervention. This intervention is to be completed while keeping in mind the child and family's social determinants of health as well as the medical complexity of the child. Using evidence-based interventions can aid in slowing the weight gain trajectory to maintain adequate weight and reduce the risk of obesity-related complications.

Nutrition

A significant intervention in treating pediatric obesity is the implementation of dietary guidelines into the care plan. With many options available to distribute macronutrients ranging from time-restricted eating, ketogenic diet, and plant-based diets, the goal is to reduce calorie consumption and improve food quality. The Obesity Medical Association practice guideline (Browne & Cuda, 2022) on the nutritional recommendations for children above the 85th percentile for weight contains common themes to be implemented at any age, including: 

  • Exclusive breastfeeding until 12 months of age or following recommended portions of formula to avoid overfeeding
  • Do not introduce solid foods until after six months of age
  • No sugary beverages
  • No fast food
  • Balanced meals with primarily non-starchy vegetables, protein, dairy, and fruit
  • Age-appropriate portion sizes
  • Dessert only on special occasions
  • Allowing the child to leave food on the plate

The Endocrine Society also recommends structured meals, avoiding grazing on food throughout the day, and avoiding high fructose corn syrup and products that contain it. The guidelines also highlight the importance of identifying eating cues from the child; this includes families assessing when the child eats outside of regular mealtimes, such as during stress, boredom, loneliness, or screen time (Styne et al., 2017).

 

Physical Activity

Increasing physical activity while decreasing sedentary time, particularly screen time, is yet another layer in the quest toward treating pediatric obesity. Physical activity requires a caloric burn, improves muscle strength and flexibility, has a cardiovascular benefit, and can improve mental health. The current CDC recommendation for pediatric physical activity is 60 minutes of activity every day of moderate to vigorous intensity (CDC, 2024c). Assessment of the child and family values and preferences towards exercise can assist in creating a plan for determining the best form of exercise based on the child's interests, abilities, and age (Tully et al., 2022). Exercise for children and adolescents should be playful and fun. Exercise physiologists and physical therapists are an excellent addition to the treatment team with expertise in creating a safe environment for the child's developing body to exercise without injury and aid in adaptive exercise for those with mobility limitations.

Behavioral Intervention

The education and implementation of dietary and physical activity care plans can only be successfully implemented with behavior change. The identification and treatment of maladaptive behaviors leading to overconsumption of high-calorie foods, sedentary lifestyle, and obesity are imperative to treating pediatric obesity. Studies have shown that intensive behavioral interventions with children and families have the most tremendous success in treating pediatric obesity. Motivational interviewing (MI) and determining readiness to change using Prochaska's Transtheoretical Model of Behavior Change have been found to be patient-centric approaches to determining goal setting. MI uses open-ended questions and allows patients to find their motivation and identify barriers as active participants in the care plan. Prochaska's Transtheoretical Model of Behavior Change assists nurses in identifying the phase in which children and families are ready to move through the change process toward the chosen goals. Creating a plan for behavioral change can be challenging. It may need the assistance of a psychologist or therapist as part of the treatment team, mainly if there is previous trauma that is fueling behaviors. Though many studies demonstrate the reduction in BMI, improvement in quality of life, and reduction in obesity-related complications, significant barriers limit access to intensive behavioral intervention. Outside of a structured research study, real-life barriers to intensive behavioral intervention include limited access to obesity specialist services, time needed out of school or work to attend intervention sessions, and social determinants of health, including cost of care, food insecurity, adequate housing, and safe and supportive communities (Hampl et al., 2023).

Pharmacologic Treatment

In some pediatric patients diagnosed with obesity who are not meeting weight loss goals despite intensive behavioral therapy in conjunction with diet and physical activity recommendations, pharmacologic treatment can be used for children 12 years and older. There are now several Food and Drug Administration (FDA) approved pharmacologic agents that should be considered for assisting in weight loss in children and adolescents. The use of these agents in a pediatric patient must consider each patient's unique clinical picture. The use of pharmacotherapy for obesity during pregnancy or breastfeeding and the use of off-label, non-FDA-approved medications will not be discussed.

Orlistat

Orlistat is approved for children over 12 years old. The recommended dose is 120 mg by mouth three times a day with each meal. Orlistat inhibits gastric and pancreatic lipase enzymes, which break down dietary fat for absorption. Inhibiting these enzymes results in approximately 30% less fat absorbed in the intestine, resulting in a calorie deficit.

Adverse effects include abdominal pain, flatulence, frequent bowel movements, oily rectal discharge and oily stools, headache, and upper respiratory infections. Due to the significant gastrointestinal side effects, the use of this medication is limited (UpToDate, 2024b).

Phentermine

Phentermine is approved for short-term use in adolescents 16 years or older, not exceeding 12 weeks. The recommended dose is 37.5 mg once a day, though lower doses can be utilized if needed. Phentermine stimulates the hypothalamus to release norepinephrine but also inhibits serotonin and dopamine reuptake, resulting in appetite suppression.

Adverse effects can be significant and are dose-dependent, which can limit its use. These important effects can include hypertension, tachycardia, arrhythmias, anxiety, insomnia, psychosis, and irritability. Contraindications for the use of phentermine include existing cardiovascular disease, including cardiac arrhythmia, hyperthyroidism, drug abuse, pregnancy, breastfeeding, glaucoma, and the use of Monoamine oxidase inhibitors (MAO) inhibitors in the past 14 days (UpToDate, 2024c).

Phentermine/Topiramate

Phentermine/topiramate is a combination medication used for children 12-17 years of age who fail to lose weight with intensive behavioral therapy alone. The initial dose is 3.75 mg phentermine/23 mg topiramate once daily for the first two weeks. If tolerating, increase to 7.5 mg phentermine/46 mg topiramate once daily. After 12 weeks, the dose can be continued if BMI has reduced more than 3% from baseline. If there is less than a 3% reduction in BMI from baseline, the dose can be increased to 11.25 mg phentermine/69 mg topiramate once daily for 14 days, then increase to 15 mg phentermine/92 mg topiramate once daily. A dose reduction is recommended if weight loss is more than >0.9 kg per week at any point. As discussed previously, phentermine stimulates norepinephrine release but inhibits serotonin and dopamine reuptake, resulting in appetite suppression. Topiramate, a well-known anti-seizure medication, enhances the neurotransmitter gamma-aminobutyric acid (GABA) and blocks sodium channels in the brain, reducing appetite and enhancing satiety. The combination of both agents' effects on appetite results in a more prominent weight loss capability of the combination agent than phentermine alone.

Adverse effects include those found with phentermine alone in addition to headache, xerostomia, paresthesia, sleep disorders, increased creatinine in adolescents, and decreased bone mineral density. Significant drug interactions have been noted with this medication (UpToDate, 2024d).

Glucagon-Like Peptide Receptor Agonist

Liraglutide was the first glucagon-like peptide receptor agonist (GLP1-RA) to be FDA-approved for pediatric obesity in children 12 years and older. It is administered as a daily subcutaneous injection starting at 0.6 mg once a day and increasing the dose by 0.6 mg once a week until the maximum daily dose of 3 mg is reached.

Semaglutide is another GLP1-RA though is longer acting than liraglutide. This once-a-week subcutaneous injection starts at 0.25 mg once a week and titrates upwards over 16 weeks until the maintenance dose of 4 mg once a week is reached.

GLP-1 RA binds to GLP-1 receptors in the brain, pancreas, and stomach, which decrease gastric emptying and increase satiety, leading to weight loss. GLP-1 RA also lowers glucagon secretion, enhances glucose-dependent insulin production, and improves pancreatic beta cell growth, which can combat rising blood sugar levels.

Adverse effects of GLP-1 RA include nausea, diarrhea, vomiting, injection site reactions, acute kidney injury, and gallbladder disease. It is essential to be aware that a history of medullary thyroid carcinoma or pancreatitis is a contraindication for the use of GLP-1 RA therapy (Bradford et al., 2023; UpToDate, 2024a). These medications are supplied as injections, which can be a limiting factor in their use in the pediatric population.

Setmelanotide

Setmelanotide is a melanocortin 4 receptor (MC4R) agonist used only in children six years old and older who have confirmed genetic testing identifying single gene mutations or in children with a clinical diagnosis of Bardet-Biedl syndrome. The recommended dose for children ages 6-12 is 1 mg subcutaneously once a day and can be titrated up to 3 mg once a day. The recommended dose for children over 12 years old is 2 mg subcutaneously once a day and titrated up to 3 mg once a day. MC4R receptors in the brain are potent receptors in the balance of appetite and energy expenditure. This medication stimulates those receptors, suppressing appetite and increasing energy expenditure.

Adverse reactions include new or worsening depression, suicidal ideation, sexual arousal disturbance, skin hyperpigmentation, nausea, vomiting, abdominal pain, and injection site reactions (UpToDate, 2024e).

Metabolic Surgery

Metabolic surgery is now part of the evidence-based treatment plan for pediatric obesity. Metabolic surgery encompasses procedures including laparoscopic and open Roux-en-Y gastric bypass surgery, adjustable gastric band, and sleeve gastrectomy. The AAP and the American Society for Metabolic and Bariatric Surgery endorse metabolic surgery as an option for obesity management in qualifying pediatric patients. Though there is no current age limit in which to recommend metabolic surgery, most of the studies evaluated for the guidelines were the adolescent population of children 13 years or older (Skinner et al., 2023).

Children and adolescents can be considered for metabolic surgery with established class 2 obesity BMI ≥ 35 kg/m2 or 120% of the 95th percentile for age and sex, whichever is lower with a comorbid condition. Comorbid conditions include type 2 diabetes, NAFLD, idiopathic intracranial hypertension, gastroesophageal reflux disease, obstructive sleep apnea, hypertension, hyperlipidemia, insulin resistance, or poor quality of life due to obesity. Pediatric patients can also be considered for metabolic surgery with established class 3 obesity, BMI ≥ 40 kg/m2, or 140% of the 95th percentile for age and sex, whichever is lower, and without comorbid conditions (Hampl et al., 2023).

Metabolic surgery as an option for the treatment of pediatric obesity has resulted in successful and sustainable weight loss with improvement and, at times, resolution of comorbid obesity-related conditions. Studies have demonstrated minor postoperative complications in this age group. Due to the nature of these procedures, long-term nutritional deficiencies are a potential risk, supporting the need for regular follow-up with the surgical and/or primary care team (Hampl et al., 2023).

Pediatric Obesity Care

The risk factors, comorbidities, and treatment of pediatric obesity are equally as multifactorial as in approaching the care of children and adolescents with obesity. The genetic, environmental, and social aspects of these children's lives can open the door to bias and stigma. Even in healthcare, the stigma of obesity can be a direct or implicit bias. Healthcare workers, unfortunately, can portray bias and weight stigma unknowingly. The use of language aimed at inclusiveness can help limit stigma. The AAP recommends using the term child with obesity versus the term obese child to reduce the stigma associated with antiquated terms (Hampl et al., 2023). Improving inclusive language can help remove barriers to implementing patient-centered care. Use age and development-appropriate input from the child or adolescent in the treatment planning process to achieve patient-centric care. Ensuring the equipment used on patients is appropriate for this population. Chairs should be large enough for pediatric patients and their adult caregivers who may also be suffering from obesity. Blood pressure cuffs and scales should be large enough to obtain accurate measurements. Ensure images posted in the office setting are inclusive and portray children or adolescents with obesity.

Children are victimized about their weight in the form of bullying, teasing, and harassment. Children and adolescents with obesity require healthcare interventions approached with kindness and support. Creating family-focused and patient-centric care plans empowers the child or adolescent to facilitate behavior change. In those without supportive families or communities, the healthcare encounter could be the only source of support for implementing the plan of care. Educating patients not only on dietary and physical activity goals but also on self-esteem must be included in the care plan. Though many children and adolescents experience low self-esteem and negative self-image, a recent study noted that with age increasing from 11 years old to 14 years old, as BMI increased, both self-esteem and negative self-image worsened (Creese et al., 2023). If care is inadequate to address this psychological complexity, referral to a mental health therapist or a psychiatrist is imperative.

The care of patients with obesity does not stop at the end of the face-to-face encounter. Healthcare professionals are essential to educating children, families, and communities. Educating those in schools and communities about the prevalence of obesity, obesity-related health conditions, and evidence on how to build supportive communities to help prevent and treat obesity locally. Healthcare professionals also advocate for patients outside of the hospital or clinic. Healthcare professionals are advocating for state, local, and federal funding to improve communities and their commitment to reducing obesity rates. Healthcare professionals also partner with larger organizations and campaigns to rally support in creating change at any of the many levels of the obesity epidemic.

Conclusion

Pediatric obesity is a prevalent chronic condition in which the multileveled etiology requires an equally multileveled approach to care. Nursing care of pediatric patients with obesity requires a fundamental knowledge of the causes as well as the potential lifelong implications of this disease. Understanding treatment options and current guideline recommendations can facilitate a successful treatment plan to reduce complications and improve quality of life. With this knowledge, nurses can reduce healthcare stigma and create an inclusive environment inside and outside of healthcare.

Case Study

Jennifer is a thirteen-year-old female patient seen today in the pediatric clinic for her well-child visit. She is accompanied by her grandmother, who is her guardian. Today, her height is 5 ft 3 inches, her weight is 170 pounds, and her BMI is 31.1 kg/m2, which is in the 97.4th percentile for age and gender. This is 114% above the 95th percentile. Her blood pressure is elevated at 142/85, over the 90th percentile for her age and gender. Jennifer did not make eye contact with you during the rooming process and was tearful when getting weighed on the scale. When answering questions, Jennifer kept her head down and let her grandmother answer most of the questions. Recent lab work shows normal blood sugar, lipid panel, and thyroid function tests.

Jennifer's BMI has been elevated for many years, and she reports all her immediate family members are overweight. Jennifer does not like to exercise. She prefers to play video games or watch movies.

Throughout the visit, you speak directly to Jennifer using age-appropriate language. You explain to her the BMI data, which shows she does have a chronic medical condition called obesity. You explain to her and her grandmother that her lab work is normal now. However, if the obesity is not treated, Jennifer could develop type 2 diabetes or hyperlipidemia in the future. You discuss with them that Jennifer's blood pressure is elevated, which is a common complication of obesity. You also explain that this is a treatable condition with intensive behavioral therapy as well as an option for medication or surgery if needed. You avoid using derogatory language and ask her to help decide her treatment goals. By the end of the visit, she is referred to intensive behavioral therapy with a dietician, physical therapist, and psychologist. Ongoing follow-up is scheduled to determine the effectiveness of the intensive behavioral therapy and if medication or surgery is appropriate.

This scenario demonstrates that the nurse had to help explain data and a diagnosis and pick up on the patient's social cues. Simple explanations of this complex condition in age-appropriate language help the adolescent understand her health. The avoidance of using derogatory terms and the focus on describing obesity as an illness and not a character flaw is the best practice. Having a complete understanding of obesity and its etiology, as well as options for treatment, allows the nurse to have an informative and educational conversation to make patient-centered decisions. If approached with the mindset that obesity was the patient's fault or lack of willpower, it would create a bias that would cloud decision-making and limit access to resources to help cure this chronic disease.

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Implicit Bias Statement

CEUFast, Inc. is committed to furthering diversity, equity, and inclusion (DEI). While reflecting on this course content, CEUFast, Inc. would like you to consider your individual perspective and question your own biases. Remember, implicit bias is a form of bias that impacts our practice as healthcare professionals. Implicit bias occurs when we have automatic prejudices, judgments, and/or a general attitude towards a person or a group of people based on associated stereotypes we have formed over time. These automatic thoughts occur without our conscious knowledge and without our intentional desire to discriminate. The concern with implicit bias is that this can impact our actions and decisions with our workplace leadership, colleagues, and even our patients. While it is our universal goal to treat everyone equally, our implicit biases can influence our interactions, assessments, communication, prioritization, and decision-making concerning patients, which can ultimately adversely impact health outcomes. It is important to keep this in mind in order to intentionally work to self-identify our own risk areas where our implicit biases might influence our behaviors. Together, we can cease perpetuating stereotypes and remind each other to remain mindful to help avoid reacting according to biases that are contrary to our conscious beliefs and values.

References

  • Bradford, C., Tung, W., Magalona, J., Catalan, N., & Alm, D. M. (2023). Advancements in FDA approvals for pediatric obesity treatment. Contemporary Pediatrics, 40(6). 14-15. Visit Source.
  • Browne, N. T., & Cuda, S. E. (2022). Nutritional and activity recommendations for the child with normal weight, overweight, and obesity with consideration of food insecurity: An Obesity Medical Association (OMA) Clinical Practice Statement 2022. Obesity Pillars, 2. 100012. Visit Source.
  • Centers for Disease Control and Prevention. (2024a). Child and Teen BMI Categories. Centers for Disease Control and Prevention. Visit Source.
  • Centers for Disease Control and Prevention (CDC). (2024b). Childhood Obesity Facts. Centers for Disease Control and Prevention. Visit Source.
  • Centers for Disease Control and Prevention (CDC). (2024c). What You Can Do to Meet Physical Activity Recommendations. Centers for Disease Control and Prevention. Visit Source.
  • Cioana, M., Deng, J., Nadarajah, A., Hou, M., Qiu, Y., Song Jie Chen, S., Rivas, A., Banfield, L., Pal Toor, P., Zhou, F., Guven, A., Alfaraidi, H., Alotaibi, A., Thabane, L., & Samaan, M. C. (2022). The prevalence of obesity among children with type 2 diabetes: A systematic review and meta-analysis. JAMA Network Open,5(12). e2247186. Visit Source.
  • Creese, H., Saxena, S., Nicholls, D., Sanchez, A. P., & Hargreaves, P. (2023). The role of dieting, happiness with appearance, self-esteem, and bullying in the relationship between mental health and body-mass index among UK adolescents: a longitudinal analysis of the Millennium Cohort Study. eClinical Medicine, 60. Visit Source.
  • Gohil, A. & Hannon, T. S. (2018). Poor sleep and obesity: Concurrent epidemics in adolescent youth. Frontiers in Endocrinology, 9, 364. Visit Source.
  • Hampl, S., Hassink, S. G., Skinner, A. C., Armstrong, S. C., Barlow, S., Bolling, C. F., Edwards, K. C., Eneli, I., Hamre, R., Joseph, M. M., Lunsford, D., Mendonca, E., Michalsky, M. P., Mirza, N., Ochoa, E. R., Sharifi, M., Staiano, A. E., Weedn, A. E., Flinn, S. K., . . . Okechukwu, K. (2023). Clinical practice guideline for the evaluation and treatment of children and adolescents with obesity. Pediatrics, 151(2): e2022060640. Visit Source.
  • Koskinen, J., Juonala, M., Dwyer, T., Venn, A., Thomson, R., Bazzano, L., Berenson, G. S., Sabin, M. A., Burns, T. L., Viikari, J. S. A., Woo, J. G., Urbina, E. M., Prineas, R., Hutri-Kähönen, N., Sinaiko, A., Jacobs, D., Steinberger, J., Daniels, S., Raitakari, O. T., & Magnussen, C. G. (2018). Impact of lipid measurements in youth in addition to conventional clinic-based risk factors on predicting preclinical atherosclerosis in adulthood: International Childhood Cardiovascular Cohort Consortium. Circulation, 137(12), 1246-1255. Visit Source.
  • Kumar, S. & Kelly, A. S. (2017). Review of childhood obesity: From epidemiology, etiology, and comorbidities to clinical assessment and treatment. Mayo Clinic Proceedings, 92(2), 251-265. Visit Source.
  • Marcinkiewicz, K., Horodnicka-Józwa, A., Jackowski, T., Strączek, K., Biczysko-Mokosa, A., Walczak, M., & Petriczko, E. (2022). Nonalcoholic fatty liver disease in children with obesity – observations from one clinical centre in the western Pomerania region. Frontiers in Endocrinology, 13, 992264. Visit Source.
  • Peinado Fabregat, M. I., Saynina, O., & Sanders, L. M. (2023). Obesity and overweight among children with medical complexity. Pediatrics, 151(1). e2022058687. Visit Source.
  • Pizarroso, N. A., Fuciños, P., Gonçalves, C., Pastrana, L., & Amado, I. R. (2021). A review on the role of food-derived bioactive molecules and the microbiota–gut–brain axis in satiety regulation. Nutrients, 13(2). 632. Visit Source.
  • Sammels, O., Karjalainen, L., Dahlgren, J., & Wentz, E. (2022). Autism spectrum disorder and obesity in children: A systematic review and meta-analysis. Obesity Facts, 15(3). 305–320. Visit Source.
  • Scaglioni, S., De Cosmi, V., Ciappolino, V., Parazzini, F., Brambilla, P., & Agostoni, C. (2018). Factors influencing children’s eating behaviours. Nutrients, 10(6,. 706. Visit Source.
  • Skinner, A. C., Staiano, A. E., Armstrong, S. C., Barkin, S. L., Hassink, S. G., Moore, J. E., Savage, J. S., Vilme, H., Weedn, A. E., Liebhart, J., Lindros, J., & Reilly, E. M. (2023). Appraisal of clinical care practices for child obesity treatment. Part II: Comorbidities. Pediatrics, 151(2). e2022060643. Visit Source.
  • Sorof, J. & Daniels, S. (2022). Obesity hypertension in children. Hypertension, 40(4). 441-447. Visit Source.
  • Stabouli, S., Erdine, S., Suurorg, L., Jankauskienė, A., & Lurbe, E. (2021). Obesity and eating disorders in children and adolescents: The bidirectional link. Nutrients, 13(12), 4321. Visit Source.
  • Styne, D. M., Arslanian, S. A., Connor, E. L., Farooqi, I. S., Murad, M. H., Silverstein, J. H., Yanovski, & J. A. (2017). Pediatric obesity—Assessment, treatment, and prevention: An endocrine society clinical practice guideline. The Journal of Clinical Endocrinology & Metabolism, 102(3). 709–757. Visit Source.
  • Tully, L., Arthurs, N., Wyse, C., Browne, S., Case, L., McCrea, L., Smith, S. M., Walsh, A., & Ward, F. (2022). Guidelines for treating child and adolescent obesity: A systematic review. Frontiers in Nutrition, 9, 902865. Visit Source.
  • UpToDate. (2024a). Liraglutide: Patient drug information. UpToDate. Visit Source.
  • UpToDate. (2024b). Orlistat: Pediatric drug information. UpToDate. Retrieved February 24, 2024. Visit Source.
  • UpToDate. (2024c). Phentermine: Pediatric drug information. UpToDate. Visit Source.
  • UpToDate. (2024d). Phentermine and topiramate: Pediatric drug information. UpToDate. Visit Source.
  • UpToDate. (2024e). Setmelanotide: Patient drug information. UpToDate. Visit Source.
  • U.S. Preventive Services Task Force (USPSTF). (2017). Obesity in children and adolescents: Screening. U.S. Preventive Services Task Force. Visit Source.
  • Vajravelu, M.E., Tas, E., & Arslanian, S. (2023). Pediatric obesity: Complications and current day management. Life, 13(7). 1591. Visit Source.