Children struggling with obesity should receive early and aggressive evaluation and treatment, including medication for children 12 and older and surgery for children 13 and older, according to new guidelines released Monday.
The longstanding practice of “watchful waiting,” or delaying treatment to see if children and adolescents grow out of obesity or overcome it on their own, is compounding the problem, which affects more than 14.4 million young people in the United States , only, researchers say. Left untreated, obesity can lead to lifelong health problems, including high blood pressure, diabetes and depression.
“Waiting doesn’t work,” said Dr. Ihuoma Eneli, co-author of the first guide to childhood obesity in 15 years from the American Academy of Pediatrics. “What we are seeing is continued weight gain and the likelihood that they will have (obesity) in adulthood.”
For the first time, the group’s guidelines specify the age at which children and adolescents should be offered medical treatments, such as medication and surgery — in addition to intensive diet, exercise and other behavioral and lifestyle interventions, said Eneli, director of the Center for Healthy Weight and Nutrition at Nationwide Children’s Hospital.
In general, physicians should provide access to appropriate medication for adolescents 12 years and older with obesity and referrals for weight-loss surgery for adolescents 13 and older with severe obesity, although situations may vary.
The guidelines aim to reset the inaccurate view of obesity as “a personal issue, perhaps a failure of care on the part of the person,” said Dr. Sandra Hassink, medical director of the AAP Institute for Healthy Childhood Weight and co-author of the guidelines.
“It’s no different than when you have asthma and now we have an inhaler for you,” Hassink said.
Young people with a body mass index at or above the 95th percentile for children of the same age and sex are considered obese. Children who are at or above the 120th percentile are considered severely obese. BMI is a measure of height based on a calculation of height and weight.
According to the Centers for Disease Control and Prevention, obesity affects nearly 20% of children and adolescents in the United States and about 42% of adults.
The group’s guidelines recognize that obesity is a biological problem and 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 issue. It’s not a lifestyle disease,” he said. “It arises predominantly from biological factors.”
The guidelines come as new drug treatments for childhood obesity have emerged, including the approval of Wegovy, a weekly injection, for use in children as young as 12 late last month. Different doses of the drug called semaglutide are also used under different names to treat diabetes. That’s according to a study recently published in the New England Journal of Medicineby an average of about 16%, better than the adult results.
Within days of being approved on December 23, pediatrician Dr. Claudia Fox prescribed the drug to one of her patients, a 12-year-old girl.
“What it offers patients is the ability to even have a near-normal body mass index,” said Fox, also a weight management specialist at the University of Minnesota. “It’s like a whole different level of improvement.”
The drug affects how the pathways between the brain and gut regulate energy, said Dr. Justin Ryder, an obesity researcher at Lurie Children’s Hospital in Chicago.
“It affects how your brain and stomach communicate with each other and helps you feel fuller than you would be,” he said.
Still, specific doses of semaglutide and other anti-obesity drugsdue to recent shortages caused by manufacturing issues and high demand, spurred in part by celebrities on TikTok and other social media platforms boasting improved weight loss.
Additionally, many insurers don’t pay for the drugs, which cost about $1,300 a month. “I sent the prescription yesterday,” Fox said. “I’m not holding my breath that insurance is going to cover it.”
A pediatric obesity expert warned that while children with obesity need early and intensive treatment, he worries some doctors may switch to drugs or surgery too quickly.
“It’s not that I’m against the drugs,” said Dr. Robert Lustig, a longtime specialist in pediatric endocrinology at the University of California, San Francisco. “I am against the indiscriminate use of these drugs without addressing the root cause of the problem.”
Lustig said that to understand all the factors that contribute to obesity, children need to be examined one at a time. He has long blamed too much sugar for the rise in obesity. He calls for a sharp focus on nutrition, particularly ultra-processed foods high in sugar and low in fiber.
dr Stephanie Byrne, a pediatrician at Cedars Sinai Medical Center in Los Angeles, said she’d like to do more research on the drug’s effectiveness in a more diverse group of children and possible long-term effects before she starts prescribing it regularly.
“I wish it was used a little more consistently,” she said. “And I would have to have this patient come in for monitoring fairly frequently.”
At the same time, she welcomed the group’s new focus on rapid and intensive treatment of childhood obesity.
“I definitely think this is a realization that diet and exercise aren’t going to be enough for a number of teens who are struggling with this — maybe for the majority,” she said.