The Expert Panel Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents: Summary Report released in December 2011 makes many useful recommendations for decreasing the risk for future cardiovascular disease in children and adolescents.1 However, some have criticized the recommendations for being “overly aggressive” and potentially “biased,” because several panel experts disclosed that pharmaceutical companies helped fund their research.2
As a primary care provider involved in academics, I understand the challenges of trying to secure finances to perform necessary research. Although I agree that there can be problems with research performed with financial backing from pharmaceutical companies, suggesting that pediatric experts who are part of a group process have skewed guidelines to sell more drugs is disrespectful to those who have dedicated many years of their lives to advancing knowledge in a particular area.
Pediatric research is scarce on most health conditions, so we often have to rely on expert opinion. However experts may disagree and that is what seems to be the trouble here.
If obesity was not a problem for at least one-third of U.S. children, and if the families we counsel about making necessary lifestyle changes actually acted on the advice of their health-care providers, we would not need guidelines to recommend that we perform universal obesity screening among 9- to 11-year-old children in the first place.
But the sad reality is that most families turn a deaf ear to the advice of their primary care provider. They prefer to believe that their son or daughter will outgrow being overweight or that it is just their child’s lot in life because the whole family is “big boned.”
As obesity rates climb, the problem of increased cardiovascular risk among the pediatric and adolescent population, makes it an important patient care issue. Primary care providers should not lose sight of the fact that promoting behavioral change during childhood is an effective prevention tool that is much cheaper than treating adults who are suffering the health consequences of obesity.
Those who don’t agree with newer pediatric CVD risk reduction guidelines express the worry that children diagnosed with high cholesterol will develop anxiety, or that referral to a registered dietitian early in life may result in the child developing an eating disorder later. But I have yet to see this happen. In my experience, visiting an RD increases the child’s knowledge about nutrition and harms no one.
I agree that universal recommendations for cholesterol screening automatically increases the cost of healthcare and may potentially result in more children on statin medication, but unless cholesterol levels are seriously elevated, the guidelines recommend a long period of trying lifestyle changes first. Although not ideal, receiving the news that a child’s cholesterol levels are elevated has in my experience been the one factor that convinces families that they need to make a change after years of counseling at well visits have failed.
Julee B. Waldrop, DNP, FNP, PNP, is the Director of the MSN-DNP Program and an associate professor at the University of Central Florida. She provides health care to children at a local community health center.
- American Academy of Pediatrics. “Expert panel on integrated guidelines for cardiovascular health and risk reduction in children and adolescents: summary report.” Pediatrics. 2011; 128(S5): S213 -S256.
- Newman T et al. “Overly aggressive new guidelines for lipid screening in children: Evidence of a broken process.” Pediatrics. 2012:130(2):349-352.