HJAR Mar/Apr 2024

CHILDHOOD OBESITY 34 MAR / APR 2024 I  HEALTHCARE JOURNAL OF ARKANSAS   industry, I would encourage them to think of and move forward with ways to create collaborations between pediatric healthcare providers and community resource pro- grams that would benefit both the children and families in their community. The AAP CPG suggests calling attention to the coverage of comprehensive obesity prevention, evaluation, and treatment as well as multisector partnership to expand access to evidence-based pediatric obesity treatment programs. What if you have a pediatric patient sitting in your office, and there is no available IHBLT program — what do you do? How do you effectively treat this patient? As an author of the AAP CPG and a researcher of childhood obesity, I am keenly aware of the lack of availability and limited availability of IHBLT programs nation- wide. We definitely need capacity building in this area. Many of us have been striving toward this for many years, and the AAP CPG should prompt renewed efforts along with guidelines from other organizations like theAcademy of Nutrition and Dietetics, theAmerican Psychological Association, the U.S. Preventive Services Task Force (which are currently being updated), and the CDC. It is important for pediatricians and other health practitioners to call upon the exper- tise of local dietitians and behavioral health professionals in their community and offer referrals to patients when possible. Tele- health can help bridge the geographical gap to provide services to rural and underserved areas, though we need to recognize some areas still have bandwidth and cellular con- nectivity problems. If an IHBLT or dietitian is not available, pediatric healthcare providers can offer to increase the intensity of weight man- agement support by connecting fami- lies with community resources to support nutrition and address food insecurity (e.g., food provision programs), physical activ- ity (e.g., local parks, recreation programs), and counselors or social workers to help families with mental health and social determinants of health. Pediatricians and other pediatric healthcare providers should familiarize themselves with resources and actively collaborate with other specialists and community programs. Also, visit the AAP and CDC links listed in the previous questions — some of these endorsed IHBLT programs are packaged and available to bring to your clinical practice. You can also reach out through your professional orga- nizations such as the AAP to access imple- mentation resource assistance. At Pennington Biomedical, we are work- ing to update our Toolkit, “Childhood Obe- sityAssessment, Evaluation, and Treatment: A Practical Toolkit for Louisiana Primary Care Providers,” as a way to assist pedia- tricians and connect them with local/state resources for families. Other states are undergoing similar initiatives, and the CDC is one example of an entity that is actively funding bringing more family weight man- agement programs to counties with high obesity prevalence, especially rural and underserved areas. We know that obesity does not affect all population groups equally. Children who experience levels of social disadvantage (like poverty, racism, other SDOH) are more likely to be overweight or obese. Do you think the limited availability and requirements needed for IHBLT will exacerbate obesity prevalence, particularly in underserved communities? This is where capacity building and com- munity partnerships are very important for our children. We need access to treatment to be openly available to all children, not an additional mechanism of inequality. We need to use creative approaches to increase treatment access, train the workforce of healthcare providers and counselors/ coaches, and accommodate families’ busy schedules and resource limitations. But we also shouldn’t deny services to any child who qualifies. The 2023 CPG provides pediatricians and pediatric PCPs with information for prescribing medications for children and adolescents with obesity. Can you tell us more about the comfort level of pediatricians prescribing these new medications if they have not previously been trained in this approach? Medication treatment is pharmacother- apy — to be used in conjunction with IHBLT. No provider should only be writing pre- scriptions and then sending children out of the door. The AAP CPG provides guidance and evidence-based research on the medi- cations that are approved for use in chil- dren with obesity. I think with every new wave of treatment options that pediatricians encounter in their practice, especially when these weren’t available during their medical training, it will take further education and practice to lead to comfort in prescribing the medications for childhood obesity. Some may want to consult with pediatricians who are board certified in obesity medicine (ABOM) or reach out to tertiary care clin- ics that are offered throughout the country. But clinicians should also take comfort that there is now solid evidence, as we found in the CPG and technical reports, for a number of medications that show safety and effi- cacy in weight loss reductions that are also improving comorbidities and quality of life, and many have few or negligible side effects. If a child is placed on obesity medication, does this mean they will be on the medicine for the rest of their lives? Obesity is not an acute episode but rather a chronic, remitting, and relapsing disease. Medications are changing the physiology of