According to new guidelines announced on Monday, children battling with obesity should be examined and treated early and aggressively, including with drugs for children as young as 12 and surgery for those as young as 13.
According to studies, the practice of “watchful waiting,” or delaying therapy to see if children and adolescents outgrow or overcome obesity on their own, exacerbates the problem that affects more than 14.4 million young people in the United States. Obesity can lead to lifelong health issues, including high blood pressure, diabetes, and depression, if left untreated.
“Waiting doesn’t work,” said Dr. Ihuoma Eneli, co-author of the American Academy of Pediatrics’ first recommendations on childhood obesity in 15 years. We observe a continuance of weight gain and an increased likelihood of (obesity) in adulthood.
Eneli, director of the Center for Healthy Weight and Nutrition at Nationwide Children’s Hospital, explained that for the first time, the group’s guidance specifies the ages at which medical treatments such as drugs and surgery should be offered to children and adolescents, in addition to intensive diet, exercise, and other behavior and lifestyle interventions.
In general, doctors should provide obese adolescents ages 12 and older with access to appropriate medications, and obese adolescents ages 13 and older with referrals for weight-loss surgery, however circumstances may vary.
Dr. Sandra Hassink, medical director of the AAP Institute for Healthy Childhood Weight and a co-author of the guidelines, stated that the guidelines aim to change the erroneous perception of obesity as “a personal problem, maybe a failure of the person’s diligence,”
“This is not different than you have asthma and now we have an inhaler for you,” Hassink explained.
Young persons are termed obese if their body mass index meets or surpasses the 95th percentile for their age and gender. Children who reach or above the 120th percentile are considered to be morbidly obese. The body mass index (BMI) is a computation of height and weight used to determine body size.
According to the Centers for Disease Control and Prevention, nearly 20% of children and adolescents and 42% of adults in the United States are obese.
According to Aaron Kelly, co-director of the Center for Pediatric Obesity Medicine at the University of Minnesota, the group’s recommendations take into account the fact that obesity is a biological problem and a complicated, chronic disease.
“Obesity is not a problem of lifestyle. It is not a disease of lifestyle “he said. It is primarily caused by biological reasons.
New medication therapies for childhood obesity have emerged, including the approval late last month of Wegovy, a weekly injectable for youngsters 12 years and older. Different dosages of the medication semaglutide are used to treat diabetes under different names. A recent study published in the New England Journal of Medicine revealed that Wegovy, manufactured by Novo Nordisk, assisted adolescents in reducing their BMI by an average of 16%, which was superior than the results shown in adults.
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Within days of the authorisation on December 23, physician Dr. Claudia Fox prescribed the medication to one of her patients, a 12-year-old girl.
“What it offers patients is the possibility of even having an almost normal body mass index,” said Fox, a University of Minnesota weight management specialist. It represents a whole new degree of advancement.
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 in Chicago.
“It works on how your brain and stomach communicate with one another and helps you feel more full than you would be,” he explained.
Nonetheless, specific doses of semaglutide and other anti-obesity drugs have been difficult to obtain due to recent shortages caused by manufacturing problems and high demand, which have been fueled in part by celebrities boasting about enhanced weight loss on TikTok and other social media platforms.
In addition, many insurers will not cover the monthly $1,300 cost of the drug. Fox stated, “I sent the prescription yesterday,” I am not optimistic 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 longtime 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 must be evaluated individually 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,” she said. “And I would have to have that patient come in pretty frequently to be monitored.”
At the same time, she welcomed the group’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.
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