Children struggling with obesity should be evaluated and treated early and aggressively, including medications for children as young as 12 and surgery for children 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 or overcome excess weight 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,” said Dr. Ihuoma Eneli, co-author of the first guideline on childhood obesity in 15 years from the American Academy of Pediatrics. “What we are seeing is a continuation of weight gain and the likelihood that they will (obesity) develop into adulthood.”
For the first time, the group’s guidance identifies ages at which children and teens should receive medical treatments such as medications and surgery — in addition to intensive nutrition, exercise and other behavioral and lifestyle interventions, said Eneli, director of the Center for Healthy Weight and Nutrition at the National Institute of Health. National Children’s Hospital.
In general, physicians should provide obese adolescents 12 years and older with access to appropriate medications and refer severely obese teens 13 and older for weight loss surgery, although situations may vary.
The guidelines aim to reset the inaccurate view of obesity as “a personal problem, perhaps a failure of the person’s diligence,” said Dr. Sandra Hassink, medical director of the AAP Institute for Healthy Childhood weight, and a co-author of the guidelines.
“This is no different than you have asthma and now we have an inhaler for you,” Hassink said.
Youth with 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’s not a lifestyle disease,” he said. “It mainly stems from biological factors.”
The guidelines come as new drug treatments for childhood obesity have emerged, including the approval late last month of Wegovy, a weekly injection, for use in children ages 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 teens reduce their BMI by about 16% on average, better than the results seen in adults.
Within days of the Dec. 23 approval, pediatrician Dr. Claudia Fox prescribed the drug to one of her patients, a 12-year-old girl.
“What it offers patients is the opportunity to even have 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 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 hard to come by due 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.
In addition, many insurers don’t 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.”
An expert on childhood obesity warned that while children with obesity should be treated early and intensively, he is concerned that some doctors are too quick to turn to drugs or surgery.
“It’s not that I’m against the drugs,” says Dr. Robert Lustig, a longtime specialist in pediatric endocrinology at the University of California, San Francisco. “I am against knowingly using those drugs without addressing the root of the problem.”
Lustig said children need to 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 nutrition, especially ultra-processed, high-sugar, low-fiber foods.
Dr. Stephanie Byrne, a pediatrician at Cedars Sinai Medical Center in Los Angeles, said she would like more research into the drug’s effectiveness in a more diverse group of children and into possible long-term effects before prescribing it on a regular basis.
“I’d like to see it used on a slightly more consistent basis,” she said. “And I would have to have that patient come in quite often to be checked.”
At the same time, she welcomed the group’s new emphasis on rapid, intensive treatment of childhood obesity.
“I definitely think this is a realization that diet and exercise aren’t going to do it for some of the teens who struggle with this — maybe the majority,” she said.