Prevalence and Predictors of Guideline Concordant Pediatric Obesity Care: A Narrative Review

To summarize the current state of adoption of the 2023 American Academy of Pediatrics (AAP) Clinical Practice Guideline (CPG) for the evaluation and treatment of childhood obesity, identify barriers and facilitators to guideline-concordant care, and highlight gaps in research and clinical practice. The AAP CPG outlines 13 Key Action Statements (KASs) for the screening, diagnosis, and treatment of pediatric obesity. Evidence suggests variable uptake across KASs. For example, BMI measurement (KAS 1) is limited by missed well-child visits and insurance disparities, while comprehensive evaluation (KAS 2) faces challenges in mental health and social needs screening. Screening for comorbidities such as dyslipidemia, diabetes, and metabolic dysfunction-associated steatoic liver disease (MASLD) remains low despite longstanding recommendations. Treatment-related KASs (11–13) show significant gaps: referrals to intensive health behavior and lifestyle interventions are infrequent, pharmacotherapy use is < 2% among eligible adolescents, and bariatric surgery referrals remain rare. Barriers include provider hesitancy, resource limitations, and systemic inequities; facilitators include electronic health record integration, multidisciplinary teams, and expanded insurance coverage. Despite strong evidence supporting early and intensive treatment of pediatric obesity, guideline adoption remains inconsistent. Addressing structural barriers, improving provider education, and leveraging health system innovations are critical for implementation. Future research should evaluate effective implementation strategies, long-term outcomes of pharmacotherapy, and approaches to adapt guidelines to local contexts.