Association of the USA indicates bariatric remedy for children with obesity

The American Association of Pediatrics (AAP) updated, after 15 years, its recommendations for the treatment of children and adolescents with overweight and obesity.

Embora reinforces that therapy focused on changing lifestyle is more effective, for entities admitted for the first time with the possibility of combined intervention with emaciating drugs (from 8 years of age) or metabolic and bariatric surgery (in cases of severe obesity and patients with 13 years or more).

The document was disclosed at the time when obesity, a chronic illness, was considered an “epidemic”, aggravated by the social isolation imposed by Covid-19. In addition, the association says, the United States has an “increasingly obesogenic” environment, which promotes sedentary behavior and unhealthy dietary choices.

No Brazil, according to Pesquisa Nacional de Saúde 2019, the proportion of people with obesity in the adult population, between 2003 and 2019, more than double, going from 12.2% to 26.8%. Last year, the Ministry of Health reported that childhood obesity affects 3.1 million children under 10 years of age in the Country; or excess weight – 6.4 million.

“O Brazil curiously jumped from malnutrition to obesity. We don’t have an intermediary”, says Durval Damiani, head of Pediatric Endocrinology at the Institute for Children and Adolescents at the Hospital das Clínicas of the Faculty of Medicine at USP.

Endorsement

Specialists see good advice on the new recommendations. They emphasize that the plan validates options that have been made by doctors, rather than suffering resistance, in view of them, due to stigmata. Another point praised is the document recognizing obesity as a multifactorial disease, not a choice; and, above all, a challenge not for some medical specialists, but for all those who attend to the young public.

“What calls a lot of attention is the Pediatric Society, as a whole, discussing something previously seen as a matter for some obesity specialists, who were at the same time marginalized by others,” says endocrinologist Bruno Halpern, president of the Brazilian Association for Study of Obesity and Metabolic Syndrome (Abeso).

He points out that this is an important preventive step. “No one develops obesity from one day to the next. People have struggled a lot for the pediatrician to call the attention of the child or the adolescent for obesity, even though this was not the primary cause of the consultation”.

Pediatric endocrinologist at Hospital Pequeno Príncipe, in Curitiba, Julienne Carvalho says that the treatment of children depends very much on the two countries and who are responsible. “The pediatrician has always been a trusted family doctor. I am afraid to be up to date with these new information, so that the family feels really safe in carrying out a treatment that, at that time, they could not have imagined”.

According to Damiani, remedies and surgery are only taken when changing behavior, so, it does not show results. He tells that his team was a pioneer in bariatric surgery in adolescents in the country. In 2007, we operated on a 15-year-old patient. “She has to walk as if she supported two countries on either side, as if she had a crutch. She didn’t go to school. You can’t imagine how much we would fall on top of people, saying that we were crazy to operate a 15-year-old child ”, he affirms.

“Shock the world (indicating a remedy or surgery) because people are preconceived with obesity. There is still an outdated and preconceived view that obesity is a choice and is only related to bad lifestyle habits”, says Halpern.

In the document, the AAP emphasizes that pharmacotherapy can be prescribed for children from 8 years of age in “specific conditions”, after evaluation of risk and benefit, it seems that there is not a wide scope of evidence for the use of these drugs in patients under the age of 12 years.

No brazil

When asked about what were the recommendations for the treatment of childhood obesity and the update plans, the Ministry of Health informed that the Unified Health System (SUS) “offers comprehensive assistance to overweight and obese people, with preventive activities such as food surveillance, follow-up nutrition, in addition to clinical and surgical assistance, as well as bariatric and restorative surgery to correct excess skin”.

Prevention involves family, and extensions such as school. For Durval Damiani, prevention is a fundamental weapon, it does not combat the “epidemic”.

“Where is this prevention afraid of being strongly stimulated? Obviously, in the family and in the so-called extended family, where the school plays a fundamental role”, he defends. “People need to pay attention not to weigh two children. Go to the pediatrician and collect: ‘Doctor, how is my child? He is crescendo bem’?”

As informações são do jonal O Estado de S. Paulo.