Do kids need obesity drugs?
Aleading organization of pediatricians is recommending that teens with obesity be offered weight-loss medication as part of a comprehensive treatment plan. But unless barriers to access fall, it won’t move the needle on the U.S. childhood obesity epidemic — something that affects more than 1 in 5 kids in the country.
The American Academy of Pediatrics’ latest comprehensive childhood obesity guidelines are welcome acknowledgment that the old approach of “watchful waiting,” or putting off intervention to see if a child will grow out of or overcome obesity, too often doesn’t work. The recommendations also underscore that obesity is not a question of willpower, but a health condition with complex biological, socioeconomic and environmental drivers that deserves comprehensive treatment — and that behavioral and lifestyle changes alone do not work for everyone.
“Extra body weight often does follow kids into adulthood,” says Sarah Hampl, chair of the committee that devised the guidelines and a pediatric weight management specialist at University of Kansas School of Medicine. With 14 million kids in the U.S. affected by obesity, “it’s a very real and serious problem that poses health risks now and in the future for these kids.” Those long-term risks include diabetes, high cholesterol, sleep apnea and fatty liver disease.
These new guidelines are a marked — and needed — shift from the AAP’s previous position on managing obesity in children, made 15 years ago. The mantra at the time was “prevent, prevent, prevent” says Fatima Cody Stanford, an obesity doctor at Harvard Medical School and Massachusetts General Hospital. “With more than 20% of kids with obesity now, we would be very shortsighted if we did not recognize that we have to treat in addition to preventing obesity.”
The recommendations, which apply to kids 12 and older, arrive at a time when newer obesity drugs can offer more substantive and sustained weight loss than previous drugs. The treatments, including Novo Nordisk’s Wegovy, Eli Lilly & Co.’s Mounjaro, and several other closelywatched drugs in development, mimic natural hormones that help control appetite. For some people, the drugs can induce weight loss at a level that is comparable to bariatric surgery.
But getting the drugs has been a huge hassle for many adults — and teens’ families are likely to encounter the same challenges. Moreover, adults have struggled to get insurers to cover Wegovy, which has a list price of more than $1,600 per month. Patients will likely face similar challenges with Mounjaro after it receives an expected FDA approval as an obesity treatment later this year.
The patchwork insurance coverage could exacerbate existing inequities in access to treatment for kids with obesity. The AAP’s report notes that despite support from the United States Preventive Services Task Force, “the lack of payment by insurers remains a major barrier to childhood obesity treatment.”
This formal recommendation by AAP should be yet another wake-up call to insurers that treatment, including medications, ought to be covered as part of a comprehensive program that includes a whole-family approach to nutrition, fitness and behavior.
Pediatricians, meanwhile, need to get up to speed on obesity management. That includes not only how to use these drugs, but on a more basic level, how to appropriately talk to teens and their families about obesity.
Most family physicians have received little training in obesity medicine, and not all doctors are approaching conversations with families with empathetic language — and some aren’t comfortable discussing the topic of obesity at all out of a misplaced fear of stigmatizing a patient. When those conversations go wrong, the AAP previously noted, it can delay or even prevent a teen’s access to treatment.
None of this is to suggest that these drugs are a quick fix to the country’s obesity problem — or even the right answer for every teen.
Parents and teens considering medication should know that they might need to stay on it indefinitely. Studies show that people who stop taking obesity drugs typically gain back the weight. An open question — one that families will want to understand and companies need to do more to explore — is whether patients will need to remain on the same dose for life, or if they could eventually maintain their weight with a lower or less frequent dose.
Families will rightly want to know about the safety of longterm use of the drugs — and also any long-term health benefits. So far, such data is limited for both teens and adults.
Medication is just one tool in addressing the growing issue of childhood obesity. Prevention, of course, would be the preferred approach, but one that requires addressing complex structural inequities in the U.S.
But the childhood obesity epidemic is already here — and worsening. This step towards making weight loss drugs more readily available as part of a comprehensive treatment approach for teens is a good one.