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Pediatric obesity: Sessions offer insights into complex, chronic disease

September 20, 2023

Editor’s note: The 2023 AAP National Conference & Exhibition will take place from Oct. 20-24 in Washington, D.C. For coverage, visit and follow @AAPNews on Facebook and at

Dietary interventions. Exercise. Medication. When and how should each of these be used to tackle overweight and obesity in children? Do they have any unintended consequences? How is obesity related to food insecurity and eating disorders? How does weight bias affect youths?

Myriad sessions aim to answer these and other questions about obesity, which affects about one in five children and one in four Hispanic/Latino children. Take a look at the offerings.

Innovations in Obesity Prevention, Assessment, and Treatment Forum (C1006) from 8-10:30 a.m. EDT Friday, Oct. 20 in room 147 of the convention center

This year’s forum will feature presentations on how pediatricians can implement the new Clinical Practice Guideline for the Evaluation and Treatment of Children and Adolescents With Obesity, said Sandra G. Hassink, M.D., FAAP, medical director of the AAP Institute for Healthy Childhood Weight.

Attendees will hear about implementation of the clinical practice guideline (CPG) at the point of care using interoperable decision support, using quality improvement (QI) to support implementation in pediatric well visits and focusing on adolescents in primary care.

There also will be presentations on testing a resource package to support CPG implementation, bringing anti-obesity medication into practice, the effects of QI on stigmatizing language in primary care, dissemination and spread of family healthy weight programs in federally qualified health centers and an update on outcomes of sleeve gastrectomy in children with special health care needs.

“CPG implementation is being actively pursued in primary care with numerous models and approaches to help pediatric practitioners implement the CPG in their own practices,” Dr. Hassink said. “Attending the innovations forum is a great way to jump-start your implementation in practice of the new AAP CPG and network with pediatricians from all practice settings who want to update their care of children and adolescents with obesity.”

How to Improve the Care of Hispanic/Latino Children and Families Living With Obesity
(S1106) from 1-2 p.m. EDT Friday, Oct. 20 in room 145 of the convention center

One out of every four Hispanic/Latino children has obesity, the highest rate of any racial/ethnic group in the United States.

“Most pediatric providers I know, both general and subspecialists, have asked me for help on this issue, and we are eager to share insights and effective strategies to help pediatric providers address the challenge in a culturally respectful manner,” said Gabriela M. Maradiaga Panayotti, M.D., IBCLC, FAAP, a member of the AAP Council on Immigrant Child and Family Health Executive Committee and associate professor of pediatrics at Duke University School of Medicine in Durham, N.C.

Dr. Maradiaga Panayotti will present the session with Dra. Ana B. Rosas-Sumano, professor of pediatrics at the Benito Juarez Autonomous University of Oaxaca and president of the National Confederation of Pediatrics of Mexico. It will be presented in English and translated into Spanish.

It is important to identify the nonmedical and systemic barriers to improve the health, nutrition and activity of Hispanic/Latino children with obesity, Dr. Maradiaga Panayotti said.

“The pediatric medical home can be a champion to support families through these challenges,” she said. 

Dra. Rosas-Sumano agreed this is an important issue for pediatricians due to the frequency with which they are faced with Hispanic American children with obesity. 

“Pediatricians must understand … the complexity of Hispanic family members living in the United States and help them prevent eating disorders in themselves and their children, such as overweight and obesity,” she said.

Culinary Medicine: Using Food for Physical, Mental, and Environmental Health
(S2110) from 7:30-8:30 a.m. EDT Saturday, Oct. 21 in room 207B of the convention center

Eating healthy foods not only can prevent disease and improve physical health, it also can enhance mental health and is good for the environment.

Michelle H. Loy, M.D., FAAP, and Maria R. Mascarenhas, M.B.B.S., will discuss a new evidence-based field called culinary medicine, which combines the art of cooking with the science of medicine.

“Culinary medicine is a powerful, fun and environmentally friendly modality easily applied to various populations and settings with physical and mental health benefits to patients, trainees and pediatricians,” said Dr. Loy, a member of the AAP Section on Integrative Medicine Executive Committee and assistant professor of pediatrics in clinical medicine at Weill Cornell Medicine and assistant attending at New York Presbyterian Hospital.

The session will cover:

  • the role of culinary medicine in medical education, patient care and clinician well-being;
  • the physical and mental health benefits of a whole food, anti-inflammatory diet, including herbs and spices, grains, vegetables, fruits, beans, lentils, nuts, seeds, mushrooms, and prebiotic- and probiotic-rich foods; and
  • principles to create delicious, healthy, inexpensive, easy-to-prepare and climate-friendly (low-carbon) food.

“Whether the time-starved pediatrician is seeking fresh approaches to bring nutrition to patients to reduce diet-related chronic disease, meaningful nutrition education to trainees, or practical, timesaving, cost-effective and environmentally friendly tips for self-care/family meal-planning, this evidence-based and practical session should be professionally and personally enriching,” Dr. Loy said.

Section on Obesity Program: Pharmacological Management of Pediatric Obesity: A Hands-on Workshop
(H2019) from 8 a.m.-4 p.m. EDT Saturday, Oct. 21 at the Marriott Marquis Washington, D.C., Marquis Ballroom Salons 7 and 8

If you want to learn about the new obesity medications and how to integrate them into your practice, block out time for the Section on Obesity’s daylong program.

“The newly approved medications for treatment of obesity in teens have shown significant promise to help those whose health is at risk and for whom lifestyle efforts have not been enough,” said Sarah C. Armstrong, M.D., FAAP, chair of the AAP Section on Obesity and professor of pediatrics at Duke University in Durham, N.C. “However, the medications are unfamiliar to pediatricians in many ways.”

The program will include sessions on how new medications work, indications, side effects, how to prescribe and strategies to overcome insurance coverage barriers. In addition, participants will have the opportunity to try out demonstration devices to improve their comfort with prescribing injectable medications.

Experts also will discuss how to offer medication for obesity care in a nonstigmatizing and patient-centered way, appropriate patient selection for treatment, and the importance of screening for disordered eating patterns to ensure these behaviors are identified and managed appropriately, Dr. Armstrong said. 

“Maybe even more important than the logistics of prescribing is the ‘who, what, when, where and how’ of prescribing to ensure we treat every patient with dignity and respect and also to offer them all options available to them,” Dr. Armstrong said. “It’s a steep learning curve, but patients and families are asking for these treatments, and we need to be prepared to integrate them into our care.”

Pediatric Obesity and Food Insecurity: Next Steps Beyond Screening
(S2509) from 2-3 p.m. EDT Saturday, Oct. 21 in room 146A of the convention center and livestreamed

Pediatricians are becoming more and more comfortable with identifying food insecurity and obesity in clinical settings, said Kofi Essel, M.D., M.P.H., FAAP, a member of the AAP Section on Obesity Executive Committee and director of the Food as Medicine Program at Elevance Health in Atlanta. But what happens next?

During the session, Dr. Essel will explore the origins of the paradoxical relationship with increased weight gain and food hardship and the stigma that underlies these conditions. He will be joined by Alexandra Ashbrook, JD, LLM, director of root causes and specific populations at the Food Research & Action Center in Washington, D.C.

Although the data linking obesity and food insecurity are limited in children, it is essential for pediatricians to understand the overlap and be equipped with meaningful and evidenced-based solutions to ensure that all children get the nutrition they need to thrive, Dr. Essel said.

“We will share effective strategies pediatricians can take — both inside and outside the clinic walls — to decrease stress and optimize health while centering dignity and the humanity of patients and families,” he said.

Clinical Practice Guideline for the Assessment and Treatment of Pediatric Obesity
from 9-10 a.m. EDT Sunday, Oct. 22 in room 146A in the convention center (S3309) and livestreamed; repeats from 5-6 p.m. EDT Sunday, Oct. 22 in room 145 and translated into Spanish (S3805)

This session will focus on practical applications of the 2023 Clinical Practice Guideline for the Evaluation and Treatment of Children and Adolescents With Obesity.

Since expert committee recommendations were published and endorsed by the AAP in 2007, many changes have occurred in the evidence-based assessment and treatment of pediatric obesity, said Mahnoosh “Mona” Sharifi, M.D., M.P.H., FAAP, co-author of the 2023 AAP clinical practice guideline (CPG) and associate professor of pediatrics at Yale University School of Medicine in New Haven, Conn.

“Primary care clinicians will benefit from a session highlighting the important aspects of the CPG and providing opportunities for questions and feedback,” Dr. Sharifi said.

Dr. Sharifi will

  • discuss pediatric obesity as a complex, chronic disease,
  • address weight bias and the barriers to treatment it represents for patients with obesity,
  • review recommended evaluation of obesity-related co-occurring conditions,
  • review clinic-based, effective treatments for pediatric obesity and
  • discuss remaining gaps in evidence.

“We are at a critical point in the field of pediatrics where clinicians are increasingly aware and appropriately concerned about the potential for causing harm in the way in which they address obesity with patients and families,” Dr. Sharifi said. “This fear of violating the ‘first do no harm principle’ puts us at a crossroads. We can avoid and defer care for the more than one in five U.S. children already affected by obesity, or we can root out the bias in our care delivery; strengthen our capacity for high-quality, nonstigmatizing, family-centered care; and advocate for policies that facilitate both evidence-based prevention and treatment. The goal of the CPG, this session and the many resources available through the AAP Institute for Healthy Childhood Weight are to facilitate the latter path.”

Weight Bias and the Lurking Land Mines Threatening Effective Engagement
(S4308) from 9-10 a.m. EDT Monday, Oct. 23 in room 206 of the convention center

When discussing weight with patients and families, pediatricians need to make sure they engage in compassionate and supportive communication, said Rebecca Puhl, Ph.D., professor of human development and family sciences at the University of Connecticut.

During the session, Dr. Puhl will discuss the nature and impact of weight stigma on children and adolescents with obesity.

“I'll also be discussing stigma-related barriers that interfere with effective provider-patient communication and strategies to reduce weight bias in patient care,” she said.

Weight stigma is the societal devaluation people experience because of their body weight or size, Dr. Puhl explained. Common weight-based stereotypes (e.g., people with higher weight are lazy or unmotivated) can lead to victimization, bullying and unfair treatment.

Youths who are teased or bullied about their weight are at increased risk of depressive symptoms, anxiety and poor body image as well as disordered eating behaviors, lower physical activity and weight gain.

“The harmful health consequences of weight stigma for youth underscore the importance that pediatricians are equipped with tools to promote respectful, supportive and patient-centered care for children and adolescents of all body sizes,” she said.

These tools include using patient-centered language when discussing weight with youths and families.

“In my session, I'll give examples of how to approach these conversations in respectful and supportive ways, using language and terminology that youth feel comfortable with,” Dr. Puhl said.

The Intersection of Obesity and Eating Disorders: Moving Forward Together
(S4606) from 3:30-4:30 p.m. EDT Monday, Oct. 23 in room 207B of the convention center

Faculty: Ellen S. Rome, M.D., M.P.H., FAAP, a member of the AAP Section on Adolescent Health, former member of Committee on Nutrition and head of the Center for Adolescent Medicine at Cleveland Clinic Children's

Dr. Rome will discuss the importance of addressing eating disorders and obesity as serious chronic health conditions. She will focus on the increased incidence of both conditions and discuss their commonalities, including the role of weight bias/stigma, risk and protective factors, importance of early detection and similarities in treatment approaches.

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