New guidance: early use of drugs and surgery for childhood obesity

Dr. Ifoma Eneri, co-author of the first paper, said: childhood obesity guidance 15 years from the American Academy of Pediatrics. “What we are seeing is continued weight gain and the potential for[obesity]in adulthood.”

According to Eneri, director of the Center for Healthy Weight, the group’s guidance includes treatments such as drugs and surgery, in addition to intensive diet, exercise, and other behavioral and lifestyle interventions. For the first time, the age offered to teens and young people has been set. Nutrition at Nationwide Children’s Hospital in Columbus, Ohio.

In general, physicians should offer referrals for weight-loss surgery to adolescents age 12 and older with access to appropriate medications and teenagers age 13 and older who are severely obese. There are cases.

The guidelines aim to reset the inaccurate view of obesity as ‘a personal problem, perhaps a failure of one’s diligence’.

“This is no different than you have asthma and now you have an inhaler for you,” Hasink said.

Adolescents with a body mass index above the 95th percentile for children of the same age and sex are considered obese. Children who reach that level or exceed 120% are considered to have. severe obesity. BMI is Approximate body size Based on height and weight calculations.

According to the Centers for Disease Control and Prevention, obesity affects nearly 20% of US children and adolescents and about 42% of adults.

The group’s guidance takes into account that obesity is a biological problem and that the condition is a complex chronic disease, said Aaron Kelly, co-director of the Center for Pediatric Obesity Medicine at the University of Minnesota. said.

“Obesity is not a lifestyle problem. It is not a lifestyle disease,” he said. “It arises mainly from biological factors.”

The guidelines were created as new drug treatments for childhood obesity emerged, including the approval late last month of Wegovy, a weekly injection for use in children aged 12 and older. Different doses of a drug called semaglutide are also used under different names to treat diabetes. Recent research A paper published in the New England Journal of Medicine found that Novo Nordisk’s Wegovy lowered teens’ BMI by an average of about 16%, better than the results for adults.

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

“What’s offered to a patient may even have a near-normal body mass index,” said Fox, who is also a weight management expert at the University of Minnesota.

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

“It works with how the brain and stomach communicate with each other, making it easier to feel fuller than it actually is,” he said.

Still, obtaining specific doses of semaglutide and other anti-obesity drugs has been difficult. This is due to manufacturing issues and recent shortages caused by high demand, fueled in part by celebrities on TikTok and other social media platforms boasting of improved weight loss benefits. am.

Plus, many insurance companies won’t cover the cost of the drug, which costs about $1,300 a month. “I sent the prescription yesterday,” said Fox. “I’m not going to hold my breath that insurance will cover it.”

One pediatric obesity expert says obese children need early and intensive treatment, but some doctors worry they may quickly resort to drugs or surgery.

“I’m not against drugs,” says Dr. Robert Lustig, a longtime expert in pediatric endocrinology at the University of California, San Francisco. “I am against the blind use of these drugs without addressing the cause of the problem.”

Lustig said children need to be evaluated individually to understand all the factors that contribute to obesity. He has long attributed the rise in obesity to excessive sugar consumption. He urges you to focus on your diet, especially ultra-processed foods that are high in sugar and low in fiber.

Stephanie Byrne, Ph.D., a pediatrician at Cedars-Sinai Medical Center in Los Angeles, consulted the drug about its efficacy and potential long-term effects in a more diverse group of children before beginning regular prescribing. He said he would like to study further.

“I wish it was used a little more consistently,” she said. “And we need to have them come in fairly frequently to monitor the patient.”

At the same time, she welcomed the group’s focus on rapid and intensive treatment for childhood obesity.

“I’m sure it’s a perception that diet and exercise don’t work for many, perhaps the majority, of teens who struggle with this,” she said.