Providing Team-Based Care for Children and Adolescents With Obesity

Obesity in children and adolescents is a growing health concern. Pediatric endocrinologists are uniquely positioned to address not only obesity but also many of its complications and comorbidities, such as prediabetes, type 2 diabetes and polycystic ovarian syndrome.

The pediatric endocrinology team at Lehigh Valley Reilly Children’s Hospital offers comprehensive care for children with endocrine conditions.

The team includes:

• Four board-certified pediatric endocrinologists
• Nurse practitioner
• Registered dietitian
• Diabetes educator
• Social worker

“Childhood and adolescence are periods of rapid growth and development,” says pediatric endocrinologist Stacey Beckford, MD. “The physical and hormonal changes that young people are experiencing during this time can bring forward health challenges, including obesity

The evaluation of obesity by the pediatric endocrinology team is guided, in part, by a child’s age and stage of development. When obesity begins before age 5, it is important to rule out potential genetic causes, such as Prader-Willi syndrome. In older children, it is important to rule out any primary hormonal disturbances that could be contributing to their weight gain.

The team also focuses on identifying and treating any complications of obesity before they progress and worsen. “For example, insulin resistance and prediabetes are reversible if we address them early,” says pediatric endocrinologist Resmy Gopi, MD. “But if we don’t address them, they could lead to type 2 diabetes.”

Helping young individuals with obesity adopt healthier eating and physical activity habits is a priority. Yet, this is quite different from working with adults. Children and adolescents are often dependent on others to buy and prepare their food as well as provide opportunities to be physically active. Family support is crucial.

However, parents often find it challenging to implement many of the recommended lifestyle changes. The care team, including a dedicated dietitian, devotes considerable time to educating not only young individuals, but also their caregivers. “We are trying to instill healthy habits that our patients can continue into adulthood so they can lead long, fruitful lives,” Dr. Beckford says.

Anti-obesity medications are another treatment option offered by the pediatric endocrinology team. Since 2020, the FDA has approved three medications for treating obesity in adolescents ages 12 and older:

• Semaglutide (Wegovy), once-weekly injections – approved in December 2022
• Liraglutide (Saxenda), once-daily injections
• Phentermine and topiramate (Qsymia), extended release capsules

“We recommend that primary care doctors and clinicians consider referring pediatric patients who have comorbidities or BMI ≥ 99th percentile, failed lifestyle modifications and desire medication management,” Dr. Beckford says. “Also, don’t be shy about using the eConsult function on Epic to ask us questions prior to making a referral.”