‘WAITING DOESN’T WORK’
The long-standing practice of delaying treatment to see whether children and teens outgrow or overcome obesity on their own only worsens the problem, American Academy of Pediatricians says
Children struggling with obesity should be evaluated and treated early and aggressively, including with medications for kids as young as 12 and surgery for those as young as 13, according to new guidelines.
The long-standing practice of watchful waiting — delaying treatment to see whether children and teenagers will outgrow or overcome obesity on their own — only worsens the problem that affects more than 14.4 million young people 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, coauthor of the first guidance on childhood obesity in 15 years from the American Academy of Pediatrics. “What we see is a continuation of weight gain and the likelihood that they’ll have [obesity] in adulthood.”
For the first time, the Itasca-based pediatricians organization’s guidance sets ages at which kids and teenagers should be offered medical treatments such as drugs and surgery — in addition to intensive diet, exercise and other behavior and lifestyle interventions, according to Eneli, who is the director of the Center for Healthy Weight and Nutrition at Nationwide Children’s Hospital in Columbus, Ohio.
According to the new guidelines, doctors, in general, should offer access to appropriate drugs to adolescents 12 and older who are faced with obesity and offer referrals for weight-loss surgery to those 13 and older with severe obesity.
The guidelines aim to reset the inaccu
rate view of obesity as “a personal problem, maybe a failure of the person’s diligence,” said Dr. Sandra Hassink, medical director for the academy’s Institute for Healthy Childhood Weight, who was a co-author of the guidelines.
“This is not different than 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 kids of the same age and gender are considered obese. Kids who reach or exceed that level by 120% are considered to have severe obesity. BMI is a measure of body size based on a calculation of height and weight.
Obesity affects nearly 20% of kids and teens in the United States and about 42% of adults, according to the federal Centers for Disease Control and Prevention.
The academy’s guidance takes into consideration that obesity is a biological problem and that the condition is a complex, chronic disease, said Aaron Kelly, codirector of the Center for Pediatric Obesity Medicine at the University of Minnesota.
“Obesity is not a lifestyle problem,” he said. “It is not a lifestyle disease. It predominately emerges from biological factors.”
The guidelines come as new drug treatments for obesity in kids have emerged, including approval late last month of Wegovy, a weekly injection, for use in children 12 and older. Different doses of the drug, called semaglutide, are 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 in adults.
Within days of the Dec. 23 authorization, Dr. Claudia Fox prescribed the drug for a 12-year-old girl.
“What it offers patients is the possibility of even having an almost normal body mass index,” said Fox, a pediatrician and 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 the gut regulate energy, said Dr. Justin Ryder, an obesity researcher at Lurie Children’s Hospital.
“It works on how your brain and stomach communicate with one another and helps you feel more full than you would be,” Ryder said.
Still, specific doses of semaglutide and other anti-obesity drugs have been hard to get because of recent shortages caused by manufacturing problems and high demand, spurred in part by celebrities on TikTok and other social media platforms boasting about enhanced weight loss.
And many insurers won’t pay for the medication, which costs about $1,300 a month.
“I sent the prescription yesterday,” Fox
“IT WORKS ON HOW YOUR BRAIN AND STOMACH COMMUNICATE WITH ONE ANOTHER AND HELPS YOU FEEL MORE FULL THAN YOU WOULD BE.” DR. JUSTIN RYDER, obesity researcher, about the drug Wegovy
said. “I’m not holding my breath that insurance will cover it.”
One expert in pediatric obesity cautioned that while kids with obesity must be treated early and intensively, he worries that some doctors may turn too quickly to drugs or surgery.
“It’s not that I’m against the medications,” said Dr. Robert Lustig, a specialist in pediatric endocrinology at the University of California-San Francisco. “I’m against the willy-nilly use of those medications without addressing the cause of the problem.”
Lustig said children should be evaluated to understand all of the factors that contribute to obesity. He has long blamed too much sugar for the rise in obesity. He urges a sharp focus on diet, particularly ultraprocessed 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’d like more research about the drug’s efficacy in a more diverse group of children and about potential long-term effects before she begins prescribing it regularly.
“I would want to see it be used on a little more consistent basis,” Byrne said. “And I would have to have that patient come in pretty frequently to be monitored.”
But she said she welcomes the academy’s new emphasis on prompt, intensive treatment for obesity in kids.
“I definitely think this is a realization that diet and exercise is not going to do it for a number of teens who are struggling with this — maybe the majority,” she said.