Children struggling with obesity should be evaluated and treated early and aggressively, including with medication for children as young as 12 and surgery for those as young as 13, according to new guidelines released Monday.
The longstanding practice of “watchful waiting,” or delaying treatment to see if children and teens outgrow obesity or overcome it on their own, only exacerbates the problem that affects more than 14.4 million young people in the US. Left untreated, obesity can lead to lifelong health problems. , including high blood pressure, diabetes and depression.
“Waiting doesn’t work,” says Dr. Ihuoma Eneli, co-author of the first guidance on childhood obesity in 15 years from the American Academy of Pediatrics. “What we see is a continuation of weight gain and the likelihood that they will have (obesity) in adulthood.”
For the first time, the group’s guidance determines ages at which children and teenagers should be offered medical treatments such as drugs and surgery – in addition to intensive diet, exercise and other behavioral and lifestyle interventions, says Eneli, director of the Center for Healthy Weight. and Nutrition at Nationwide Children’s Hospital.
In general, doctors should offer adolescents 12 and older who have obesity access to appropriate drugs and teens 13 and older with severe obesity referrals for weight loss surgery, although situations may vary.
The guidelines aim to reverse the inaccurate view of obesity as “a personal problem, perhaps a failure of the person’s diligence,” says Dr. Sandra Hassink, medical director for the AAP Institute for Healthy Childhood Weight, and a co-author of the guidelines.
“It’s no different than you have asthma and now we have an inhaler for you,” Hassink said.
Young people who have a body mass index that meets or exceeds the 95th percentile for children of the same age and sex are considered obese. Children who reach or exceed the 120th percentile are considered severely obese. BMI is a measure of body size based on a calculation of height and weight.
Obesity affects nearly 20% of children and teens in the US and about 42% of adults, according to the Centers for Disease Control and Prevention.
The group’s guidance takes into account that obesity is a biological problem and that the condition is a complex, chronic disease, said Aaron Kelly, co-director of the Center for Pediatric Obesity Medicine at the University of Minnesota.
“Obesity is not a lifestyle problem. It is not a lifestyle disease,” he said. “It stems mainly from biological factors.”
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The guidelines come as new drug treatments for childhood obesity have emerged, including approval late last month of Wegovy, a weekly injection, for use in children 12 years and older. Different doses of the drug, called semaglutide, are also used under different names to treat diabetes. A recent study published in the New England Journal of Medicine found that Wegovy, made by Novo Nordisk, helped teenagers reduce their BMI by an average of about 16%, better than results in adults.
Within days of the December 23 approval, pediatrician dr. Claudia Fox prescribed the drug for one of her patients, a 12-year-old girl.
“What this offers patients is the possibility of even having a near-normal body mass index,” says Fox, also a weight management specialist at the University of Minnesota. “It’s like a whole other level of improvement.”
The drug affects how the pathways between the brain and the gut regulate energy, Dr. Justin Ryder, an obesity researcher at Lurie Children’s Hospital in Chicago, said.
“It works on how your brain and stomach communicate and helps you feel fuller than you would be,” he said.
Still, specific doses of semaglutide and other anti-obesity drugs have been hard to come by because of recent shortages caused by manufacturing problems and high demand, spurred in part by celebrities on TikTok and other social media platforms boasting about improved weight loss.
In addition, many insurers will not pay for the medication, which costs about $1,300 a month. “I sent the prescription yesterday,” Fox said. “I’m not holding my breath that insurance will cover it.”
One expert in pediatric obesity warned that while children with obesity should be treated early and intensively, he worries that some doctors may turn too quickly to drugs or surgery.
“It’s not that I’m against the medication,” says dr. Robert Lustig, a longtime specialist in pediatric endocrinology at the University of California, San Francisco. “I am against the willful use of that medication without addressing the cause of the problem.”
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Lustig said children should be evaluated individually to understand all the factors that contribute to obesity. He has long blamed too much sugar for the rise in obesity. He urges a sharp focus on diet, especially ultra-processed foods that are high in sugar and low in fiber.
Dr. Stephanie Byrne, a pediatrician at Cedars Sinai Medical Center in Los Angeles, said she wants more research on the drug’s effectiveness in a more diverse group of children and on potential long-term effects before she starts prescribing it routinely.
“I would like to see it used on a little more consistent basis,” she said. “And I’ll have to have that patient come in pretty regularly to be monitored.”
At the same time, she welcomed the group’s new emphasis on rapid, intensive treatment for childhood obesity.
“I definitely think it’s a realization that diet and exercise isn’t going to do it for a number of teenagers who struggle with this — maybe the majority,” she said.