Treatment of obesity in US children and adolescents before and after the AAP guidelines

Abstract

Importance: The American Academy of Pediatrics (AAP) published new comprehensive guidelines for childhood obesity treatment, including pharmacotherapy. However, changes in treatment patterns following these guidelines remain unknown. Objective: To assess changes in childhood and adolescent obesity treatment following the new AAP guidelines. Design: Using Truveta electronic health record (EHR) data, this cohort study analyzed outpatient visits between January 2021 and June 2024 for children (age 8-11) and adolescents (age 12-17) with obesity and no evidence of type 2 diabetes (T2D). For patients with multiple visits, one visit was randomly selected. Patients without a recent history of specific obesity treatments were followed for evidence of obesity treatment at or following their visit, including nutrition referral within 14 days or nutrition counseling within 90 days, and, separately, pharmacotherapy prescriptions for weight management (on- or off-label) within 14 days. Interrupted time series models were used to compare differences in nutrition counseling or referral and pharmacotherapy before versus after the AAP guidelines were released. Setting: Clinical and prescribing data from EHRs from a collective of US health systems. Participants: 329,357 patients aged 8 to 17 with an outpatient office visit, a BMI percentile indicating obesity, and no T2D diagnosis. Exposure: Release of the AAP guidelines in January 2023. Main Outcomes and Measures: Evidence of obesity treatment at or following the eligible visit with (1) nutrition referral or counseling, and (2) pharmacotherapy. Results: The study population of 329,581 patients included 120,734 (36.6%) children and 208,847 (63.4%) adolescents. The mean (SD) BMI percentile was 97.4 (1.6), with 119,864 (36.4%) having severe obesity (class 2 or 3). Overall, a minority of patients without a recent history of obesity treatment had evidence of nutrition referral or counseling (4.0%) or pharmacotherapy (0.4%) during or shortly after their visit. Following the AAP guidelines, indicators of both immediate (odds ratio [95% CI]: 1.38 [1.08-1.75]) and gradual monthly changes (1.06 [1.04-1.08]) were observed for pharmacotherapy use. An immediate change in nutrition counseling and referral was observed following guidelines (1.34 [1.24-1.45]), but no additional gradual monthly changes were observed (1.0 [0.99-1.01]). Conclusions and Relevance: While nutrition counseling or referral and pharmacotherapy use increased, overall rates of obesity treatment remained low.