New guidelines: early drug use and surgery for childhood obesity

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

The practice of “watchful waiting” or delaying treatment to see if children and teens outgrow obesity or outgrow it on their own only exacerbates the problem that affects more than 14.4 million young people in the United States. If left untreated, obesity can lead to health problems. for life, including high blood pressure, diabetes, and depression.

“Waiting doesn’t work. What we’re seeing is a continuation of weight gain and the likelihood that I’ll have (obesity) in adulthood,” said Dr. Ihuoma Eneli, co-author of the first Handbook on Childhood Obesity 15 years ago from the American Academy of Pediatrics.

For the first time, the group’s guidelines outline the ages at which children and teens should be offered medical treatments such as medication and surgery — in addition to intensive diet, exercise and other behavioral and lifestyle interventions, said Enley, director of the Wellness Center. Weight and Nutrition at Nationwide Children’s Hospital.

In general, adolescents 12 years of age or older who are obese should have access to appropriate medications and adolescents 13 years of age or older who are obese to have weight-loss surgery, although situations are different.

The guidelines aim to reset the inaccurate view of obesity as “a personal problem, perhaps a failure of a person’s diligence,” said Dr. Sandra Hasink, MD, medical director of the AAP’s Institute for Healthy Childhood Weight and co-author of the guidelines. .

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

Young adults with a BMI 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 obese. BMI is a measure of body size based on weight and height.

Obesity affects nearly 20% of children and teens in the United States and about 42% of adults, according to the Centers for Disease Control and Prevention.

Aaron Kelly, co-director of the University of Minnesota Pediatric Obesity Center, said the group’s guidelines take into account that obesity is a biological problem and that the condition is a chronic, complex disease.

“Obesity is not a lifestyle problem. It is not a lifestyle disease. It mostly arises from biological factors.”

The guidelines come as new drug treatments for childhood obesity emerge, including the approval late last month of Wegovy’s weekly injection, for use in children 12 and older. Different doses of the drug, called semaglutide, are also used by 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 results in adults.

Within days of permission on December 23, pediatrician Dr. Claudia Fox prescribed the drug to one of her patients, a 12-year-old girl.

“What it offers patients is the possibility of having a near-normal BMI,” said Fox, who is also a weight management specialist at the University of Minnesota. “It’s like a whole different level of refinement.”

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

“It works on how your brain and stomach communicate with each other and helps you feel fuller than you otherwise would,” he said.

However, exact 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, prompted in part by celebrities on TikTok and other social media platforms boasting of improved weight loss.

In addition, many insurance companies do not pay for the drug, which costs about $1,300 per month. “I sent the prescription in yesterday,” said Fox. “I’m not holding my breath that insurance will cover it.”

An expert on childhood obesity warned that while obese children should be treated early and intensively, he worries that some doctors may switch too quickly to medication or surgery.

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

Lustig said children should be evaluated individually to understand all of the factors that contribute to obesity. Too much sugar has long been blamed for obesity. He urges a heavy focus on the diet, especially 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’d like to do more research on the drug’s effectiveness in a more diverse group of children and on potential long-term effects before she begins prescribing it regularly.

“I’d like to see it used on a more consistent basis,” she said. “And I’m going to have to have this patient come in a lot to be monitored.”

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

“I definitely think that’s a realization that diet and exercise aren’t going to do it for a number of teens who have this — probably the majority,” she said.

—- The Health and Science division of the Associated Press receives support from the Science and Education Media Group of the Howard Hughes Medical Institute. AP is solely responsible for all content.

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