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Indian Academy of Pediatrics Revised Guidelines on Evaluation, Prevention and Management of Childhood Obesity

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Abstract

Justification

The last guidelines for pediatric obesity were released in 2004 by Indian Academy of Pediatrics (IAP). Since then, there has been an alarming increase in prevalence and a significant shift in our understanding in the pathogenesis, risk factors, evaluation, and management of pediatric obesity and its complications. Thus, it was decided to revise and update the previous recommendations.

Objectives

To review the existing literature on the burden of childhood obesity and its underlying etiology and risk factors. To recommend evaluation of childhood obesity and suggest optimum prevention and management strategies of childhood obesity.

Process

The following IAP chapters (Pediatric and Adolescent Endocrinology, Infant and Young Child feeding, Nutrition, Non-Communicable Disease and Adolescent Health Academy) were invited to nominate members to become part of the writing committee. The Committee held discussions on various aspects of childhood obesity through online meetings between February and August, 2023. Recommendations were then formulated, which were analyzed, revised and approved by all members of the Committee.

Recommendations

Exogenous or primary obesity accounts for the majority of cases of childhood obesity. It is important to differentiate it from endogenous or secondary obesity as evaluation and management changes depending on the cause. In Indian, in children under 5 years of age, weight for length/height using WHO charts, and in children 5–18 years, BMI using IAP 2015 charts is used to diagnose overweight and obesity. Waist circumference should be routinely measured in all overweight and obese children and plotted on India specific charts, as it is a key measure of cardio-metabolic risk. Routine evaluation for endocrine causes is not recommended, except in short and obese children with additional diagnostic clues. All obese children more than ten years old should be evaluated for comorbidities like hypertension, dyslipidemia, hyperglycemia and non-alcoholic fatty liver disease/metabolic dysfunction associated steatotic liver disease (NAFLD/MASLD). Prevention and management of childhood obesity mainly involves healthy diet practices, daily moderate to vigorous physical activity and reduced screen time. Pharmacotherapy may be offered as an addition to lifestyle interventions only in cases of class 3 obesity or if there are any life-threatening comorbidities. Finally, surgical management may be offered in children older than 12 years of age with class 2 obesity and associated comorbidities or class 3 obesity with/without comorbidities, only after failure of a proper trial of intense lifestyle modifications and pharmacotherapy for at least 6 months.

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Authors and Affiliations

  1. Growth and Pediatric Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, 32, Sassoon Rd, Opposite Pune Railway Station, Sangamvadi, Pune, Maharashtra, India

    Vaman Khadilkar

  2. Division of Pediatric Endocrinology, Department of Pediatrics, Surya Mother and Child Superspecialty Hospital, Chembur, Mumbai, Maharashtra, India

    Nikhil Shah

  3. Department of Pediatrics, Hamdard Institute of Medical Sciences and Research, New Delhi, India

    Rekha Harish

  4. Department of Pediatrics, G. Kuppuswamy Naidu Memorial Hospital, Coimbatore, Tamil Nadu, India

    Ahila Ayyavoo

  5. Department Of Pediatrics, All India Institute of Medical Sciences, Nagpur, Maharashtra, India

    Akash Bang

  6. Department of Pediatrics, Lady Hardinge Medical College, and Kalawati Saran Children’s Hospital, New Delhi, India

    Srikanta Basu & Preeti Singh

  7. Department of Pediatrics, Medical College, Kolkata, West Bengal, India

    Sukanta Chatterjee

  8. Department of Pediatrics, Kalpana Chawla Government Medical College, Karnal, Haryana, India

    Jugesh Chhatwal

  9. Departement of Pediatrics, Sree Mookambika Institute of Medical Sciences, Kulasekharam, Kamyakumari, Tamil Nadu, India

    K. E. Elizabeth

  10. Babylon’s Newton Institute of Child and Adolescent Development, Jaipur, Rajasthan, India

    Swati Ghate

  11. Division of Pediatric Endocrinology, Institute of Child Health, Sir Ganga Ram Hospital, New Delhi, India

    Aayush Gupta

  12. Kamalesh Mother and Child Hospital, Nerul, Navi Mumbai, Maharashtra, India

    Upendra Kinjawadekar

  13. Pediatric Endocrinology and Diabetes Unit, Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India

    Rakesh Kumar

  14. Ex Head of Department of Pediatrics, Tata Main Hospital and Manipal Tata Medical College, Jamshedpur, Jharkhand, India

    Sudhir Mishra

  15. Department of Pediatric and Adolescent Endocrinology, Rainbow Children’s Hospital, Hyderabad, Telangana, India

    Kavitha Sakamuri

  16. Department of Pediatrics and Neonatology, Anand Hospital, Meerut, Uttar Pradesh, India

    Vineet Saxena

  17. Bhagat Clinic, Ludhiana, Punjab, India

    Harinder Singh

  18. Sud Children Hospital, Jalandhar, Punjab, India

    Anil Sud

  19. Department of Pediatrics, Dr. Panjabrao Deshmukh Memorial Medical College, Amravati, Maharashtra, India

    Satish Tiwari

Authors
  1. Vaman Khadilkar
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  2. Nikhil Shah
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  3. Rekha Harish
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  6. Srikanta Basu
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  16. Vineet Saxena
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  17. Harinder Singh
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  18. Preeti Singh
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  19. Anil Sud
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  20. Satish Tiwari
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Contributions

Contributors: All authors were part of the National Consultative Committee that formulated these guidelines. VK, NS and UK conceived the design and prepared the agenda. AB, SG, AG, KS and PS reviewed the literature for each section in detail and wrote the first draft ofthe respective sections. AA, SB, SC, JC, KE, RK, SM, HS, AS and ST moderated the draft recommendations of each respective section and provided critical inputs. RH was the invited expert who provided critical inputs for revision and participated in discussions VK, NS, UK and VS provided their inputs in the guidelines, participated in discussions and manuscript editing. All authors approved the final version

Corresponding author

Correspondence to Vaman Khadilkar.

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Competing interests: None stated.

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Khadilkar, V., Shah, N., Harish, R. et al. Indian Academy of Pediatrics Revised Guidelines on Evaluation, Prevention and Management of Childhood Obesity. Indian Pediatr 60, 1013–1031 (2023). https://doi.org/10.1007/s13312-023-3066-z

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  • DOI: https://doi.org/10.1007/s13312-023-3066-z

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