Overcoming pediatric obesity: Behavioral strategies and GLP-1 support

Kay Rhee, MD | Image credit: Author provided

In this Q&A, Kay Rhee, MD, medical director of the Medical Behavioral Unit and research director in the Division of Pediatric Hospital Medicine at the University of California San Diego School of Medicine; and medical director of the Behavioral Unit at Rady Children's, shares insights on the challenges of treating pediatric obesity. Rhee discusses the impact of biological and environmental factors, the role of behavioral interventions, and how medications like GLP-1 agonists can complement weight management strategies for children and teens.

Contemporary Pediatrics:

What are some obstacles that can make treating pediatric obesity difficult to tackle?

Kay Rhee, MD:

Pediatric obesity can be really hard to treat because you are not just dealing with the child’s eating and activity behaviors, but also their genetic predisposition or risk of developing obesity and its comorbidities (like type 2 diabetes or hypertension) and other factors like their internal drive to eat or to be stimulated by food to the point that they are constantly thinking about their next meal or snack. These biologic drives can be really hard to overcome for some children.

Then we also have the external environment to think about – the neighborhood in which the child lives, what resources and supports the child has, what kind of access they have to healthy foods or greenspace to be physically active in, and the safety of their neighborhood.

Contemporary Pediatrics:

How can behavioral interventions help teens and children with weight loss? How can this patient population use these alongside GLP-1s?

Rhee:

Behavioral weight programs can really help teens/children learn to develop new healthy eating and activity habits. These programs usually involve the parent or caregivers too, so they help the whole family develop new routines and patterns with the hope that these behaviors become second nature to them. Learning these new skills alongside the use of medications like GLP-1 agonists can be helpful because the medicines can decrease the cravings or decrease appetite to the point where children and youth can focus on learning the new behaviors. Then if they start to be successful in their weight loss efforts, they feel proud and energized because they have successfully learned a new skill that can be linked to these positive outcomes. This sense of pride and accomplishment can really reinforce the new behaviors, and it becomes a great positive feedback loop.

Contemporary Pediatrics:

What are some behavioral intervention examples that physicians can suggest to their patients?

Rhee:

One thing we try to tell parents to do is to remove the tempting foods in the house. The things like salty snack foods, sweets, soda, etc. If these foods are not in the house, and their child is hungry, they will naturally have to eat the other, more healthy options that are available in the house, such as fruit.

Contemporary Pediatrics:

What is the best way providers can approach the topic of weight with their patients?

Rhee:

This is a hard question because not every person who is “overweight” has a metabolic consequence of excess fat (like diabetes, fatty liver disease, high cholesterol, or high blood pressure). So, for some families, talking about weight seems like we are focused on more of a cosmetic issue, or that we are bending to the social norms of what a healthy body should look like. So one thing providers should remember is that the BMI growth charts are just a screening tool for the potential metabolic issues that are tied to excess fat mass, especially when a child has a BMI greater than or equal to the 95th percentile.

When broaching this topic, providers could say that they are bringing this up because of the high correlation between obesity and metabolic issues. And if the child’s family history is full of other people with metabolic conditions or cardiovascular disease (CVD), then it might be worth doing some lab tests to see if they should be concerned about these conditions developing in their child. Talking about the potential risks of developing metabolic conditions or CVD as a young adult might help the families understand why we are talking about weight and using BMI as a screening tool to do this.