Children struggling with obesity should be evaluated and treated early and aggressively, including medication for children as young as 12 and surgery for children as young as 13, according to new guidelines released Monday.
The long-term practice of “watchful waiting,” or delaying treatment to see if children and teens will outgrow or overcome obesity on their own, only exacerbates the problem, which affects more than 14.4 million young people in the U.S. Left untreated, obesity can lead to lifelong health problems. problems. including high blood pressure, diabetes and depression.
“Waiting doesn’t work,” said Dr. Ihuoma Eneli, co-author of the first guideline on childhood obesity in 15 years from the American Academy of Pediatrics. As an adult, I will be (obese).
For the first time, the group’s guidelines set an age at which children and adolescents should be offered medical care such as drugs 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 a nationwide children’s hospital.
In general, doctors should offer adolescents 12 years of age and older who are obese access to appropriate medications and adolescents 13 years of age and older with severe obesity a referral for weight loss surgery, although situations may vary.
The guidelines aim to restore an inaccurate view of obesity as “a personal problem, perhaps a failure of human care,” 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 if 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 the calculation of height and weight.
Obesity affects nearly 20% of children and adolescents in the U.S. and about 42% of adults, according to the Centers for Disease Control and Prevention.
The group’s guidelines take 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. “This is largely due to biological factors.”
The guidance comes as new drugs to treat childhood obesity have emerged, including the approval late last month of Wego, a weekly injection, for use in children 12 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 about 16% on average, better than adults.
Within days of the December 23 authorization, pediatrician Dr. Claudia Fox cures one of her patients, a 12-year-old girl.
“It offers patients 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 other level of improvement.
The drug affects how pathways between the brain and gut regulate energy, said Dr. Justin Ryder, an obesity researcher at Lurie Children’s Hospital in Chicago.
“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 difficult to obtain because of recent shortages caused by manufacturing problems and high demand, fueled in part by celebrities on TikTok and other social media platforms touting improved weight loss.
Plus, many insurance companies won’t pay for drugs that cost about $1,300 a month. “I sent the prescription yesterday,” Fox said. “I’m not holding my breath that insurance will cover it.
One childhood obesity expert warned that while obese children must be treated early and intensively, he worries that some doctors may be too quick to turn to drugs or surgery.
“It’s not that I’m against medication,” said Dr. Robert Lustig, a longtime specialist in pediatric endocrinology at the University of California, San Francisco. “I’m against taking these drugs willy-nilly without addressing the cause of the problem.”
Lustig said children need to be evaluated individually to understand all the factors that contribute to obesity. Too much sugar has long been blamed for the rise in obesity. It encourages a sharp focus on diet, especially 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 would like to do more research on the drug’s effectiveness in a more diverse group of children and potential long-term effects before prescribing it regularly.
“I would like to see it used on a little more consistent basis,” she said. “And I would have to have that patient come in often enough to be monitored.
At the same time, she welcomed the group’s new emphasis on rapid and intensive treatment of obesity in children.
“I definitely think it’s a realization that diet and exercise isn’t going to do it for a lot of teens who are struggling — maybe most,” she said.
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