Children with obesity should be evaluated and treated early and aggressively, including medication for 12-year-olds and surgery for 13-year-olds, according to new guidelines released Monday.
The long-standing habit of “watching out” or delaying treatment to see if children and adolescents can overcome obesity on their own has only exacerbated a problem that affects more than 14.4 million young adults. years in the United States. If 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. continue to gain weight and the likelihood that they will become (obese) into adulthood.”
For the first time, the group’s guidelines set the age at which children and young people should be offered medical treatments such as drugs and surgery – in addition to an intensive diet, exercise and other interventions. other behavioral and lifestyle interventions, says Eneli, director of the Center for Healthy Weight. and Nutrition at National Children’s Hospital in Columbus, Ohio.
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In general, physicians should provide access to appropriate medications for adolescents 12 years of age and older with obesity, and adolescents 13 years of age and older with severe obesity to be referred for bariatric surgery, despite although situations may be different.
Dr Sandra Hassink, medical director of the AAP Institute for Healthy Childhood Weights and a co-author of the guidelines, said the guidelines aim to reframe the incorrect view of obesity as ” a personal matter, possibly due to the diligence of each person”. .
“It’s like having asthma and now we have an inhaler for you,” Hassink says.
Young adults 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 that 120% are considered severely obese. BMI is a measure of body size based on height and weight calculations.
According to the Centers for Disease Control and Prevention, obesity affects nearly 20 percent of children and adolescents in the United States and about 42 percent of adults.
The team’s guidelines consider that obesity is a biological problem and that the condition is a chronic, complex 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 mainly comes from biological factors.”
The guidelines come as new drug treatments for childhood obesity emerge, including last month’s approval of Wegovy, a weekly injection, for use in children. 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, conducted by Novo Nordisk, helped teenagers reduce their BMI by an average of about 16%, which is better than the results in adults.
Within days of December 23, pediatrician Dr Claudia Fox prescribed the drug to one of her patients, a 12-year-old girl.
“What it gives patients is the ability to even have a near-normal body mass index,” said Fox, who is also a weight management expert at the University of Minnesota. “It’s like a whole other level of improvement.”
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Justin Ryder, an obesity researcher at Lurie Children’s Hospital in Chicago, said the drug affects the way pathways between the brain and gut regulate energy.
“It works on how your brain and stomach communicate with each other and helps you feel fuller than usual,” he says.
However, it is difficult to get specific doses of semaglutide and other anti-obesity drugs due to recent shortages due to production problems and high demand, partly due to TikTok celebrities. and other social media platforms boasting about effective weight loss.
Also, many insurance companies won’t pay for about $1,300 worth of drugs a month. “I submitted the prescription yesterday,” Fox said. “I don’t hold my breath that insurance will cover it.”
A pediatric obesity expert warns that while obese children must be treated early and aggressively, he is concerned that some doctors may turn to medication or surgery too quickly.
“It’s not that I’m against these drugs,” said Dr. Robert Lustig, a longtime pediatric endocrinologist at the University of California, San Francisco. “I am against the arbitrary use of those drugs that do not address the cause of the problem.”
Lustig said children must be evaluated individually to understand all the factors that contribute to obesity. He has long blamed eating too much sugar for the rise in obesity. He called for a strong focus on the diet, especially on 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 wanted to do more research on the drug’s effectiveness for a wider range of children and about potential long-term effects before She began to prescribe the drug regularly.
“I would 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 monitored.”
At the same time, she welcomed the group’s new emphasis on rapid, intensive treatment for childhood obesity.
She said: “I definitely think this is a perception that diet and exercise won’t do the trick for some teenagers who are struggling with this – probably the majority. .
