New guideline: Use of medication, surgery for obesity in children


Children struggling with obesity should be evaluated and treated early and aggressively, including medication for children under 12 and surgery for those under 13, according to new guidelines released Monday.

The long-standing practice of “watchful waiting,” or delaying treatment, to see if children and teens will outgrow or overcome obesity on their own exacerbates a problem that affects more than 14.4 million youth in the United States. 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 book. childhood obesity guidelines in 15 years from the American Academy of Pediatrics. “What we’re seeing is the continuation of weight gain and the likelihood of them becoming (obese) in adulthood.”

For the first time, the group’s guidelines specify an age at which medical treatments such as drugs and surgery should be offered to children and adolescents in addition to intensive nutrition, exercise and other behavioral and lifestyle interventions, said Eneli, of Healthy Weight. director of the center. and meals at Nationwide Children’s Hospital.

For children of the same age and sex, youth with a body mass index corresponding to or above the 95th percentile are considered obese.
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In general, doctors should refer adolescents age 12 and older who are able to take appropriate medications and adolescents age 13 and older for major weight loss surgery. , but situations may vary.

The guidelines aim to reframe the misconception of obesity as “a personal problem, perhaps a failure of a person’s hard work,” said Dr. Sandra Hassink, medical director of the AAP’s Healthy Childhood Weight Institute and co-author of the guidelines. .

“It’s no different than if you have asthma and now we have an inhaler for you,” Hasink said.

For children of the same age and sex, youth with a body mass index corresponding to or above the 95th percentile are considered obese. Children who reach 120 percent or higher are considered severely obese. BMI a 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 and about 42 percent of adults in the United States.

The group’s guidelines recognize that obesity is a biological problem and that the condition is a complex, chronic disease, said Aaron Kelly, director of the Center for Pediatric Obesity Medicine at the University of Minnesota.

“Obesity is not a lifestyle problem. This is not a lifestyle disease,” he said. “It’s mostly caused by biological factors.”

An obese boy reaches for donuts
According to the Centers for Disease Control and Prevention, obesity affects nearly 20 percent of children and adolescents and about 42 percent of adults in the United States.
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The guidelines follow the introduction of new drugs to treat obesity in children, including late last month Wegovy, a weekly injection approved for use in children 12 and older. Different doses of a drug called semaglutide are also used under different names to treat diabetes. A recent study Published in the New England Journal of Medicine, Novo Nordisk’s Wegovy helped teenagers reduce their BMI by an average of 16%, better than adults.

A few days after the Dec. 23 approval, pediatrician Dr. Claudia Fox prescribed the drug to one of her patients, a 12-year-old girl.

“It offers patients the opportunity to have a near-normal body mass index,” says Fox, a weight management expert at the University of Minnesota. “It’s like a whole other level of improvement.”

Dr. Justin Ryder, an obesity researcher at Lurie Children’s Hospital in Chicago, said the drug affects how pathways between the brain and gut regulate energy.

“It works on how your brain and stomach communicate and helps you feel full,” she said.

However, specific doses of semaglutide and other anti-obesity drugs have been difficult to obtain due to manufacturing issues and high demand, in part because celebrities have boasted about their weight loss on TikTok and other social media platforms.

Also, many insurers won’t pay for the drug, which costs about $1,300 a month. “I sent the recipe yesterday,” Fox said. “I’m not holding my breath so insurance will cover it.”

One pediatric obesity expert says that while obese children should be treated early and intensively, some doctors are concerned that they may be turning too quickly to drugs or surgery.

“It’s not that I’m against drugs,” said Dr. Robert Lustig, a longtime specialist in pediatric endocrinology at the University of California, San Francisco. “I am against using these drugs without addressing the cause of the problem.”

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 calls for a sharp focus on diet, especially 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 to do more research on the drug’s effectiveness and possible long-term effects in a diverse group of children before starting to routinely prescribe the drug.

“I would like to see it used a little more sustainably,” he said. “And I had to come in more often to keep an eye on that patient.”

At the same time, he welcomed the group’s new focus on rapid and intensive treatment of childhood obesity.

“I think it’s a realization that diet and exercise isn’t going to do it for a number of teenagers who are struggling with this — probably for many,” she said.

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