Early use of drugs and surgery for childhood obesity

Children suffering from obesity should be evaluated and treated early and aggressively, including medication for children as young as 12 and surgery for children as young as 13, according to new guidelines released Monday.

The long-standing practice of ‘waiting and waiting’ to delay treatment to see if children and teens will or will overcome obesity on their own exacerbates a problem that affects more than 14.4 million people. just let it. Young people Left untreated, obesity in the United States can lead to lifelong health problems, including: high blood pressureDiabetes, Depression.

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.”

For the first time, group guidance sets the age at which children and teens should be offered treatment Intensive diet, exercise, and other behavioral and lifestyle interventions, as well as medications and surgery, are included, said Eneri, director of the Center for Healthy Weight and Nutrition at Nationwide Children’s Hospital.

In general, physicians recommend that obese adolescents age 12 and older with access to appropriate medications and adolescents age 13 and older on referral for severe obesity: weight loss surgeryHowever, your situation may be different.

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 we 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 above the 120th percentile 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 University of Minnesota Pediatric Obesity Medical Center. Stated.

“Obesity is not a lifestyle problem. It is not a lifestyle disease,” he said. “It stems primarily 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 it offers patients is the possibility of even having a nearly normal condition. body mass index“It’s like a whole different level of improvement,” 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 the way your brain and stomach communicate with each other, helping you feel fuller than you actually are,” he said.

Still, getting 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 partly spurred by celebrities such as TikTok. social media platform Boasts enhanced weight loss.

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.”

Some experts in childhood obesity worry that obese children need early and intensive treatment, but some doctors may turn to drugs or surgery too soon.

“I’m not against drugs,” said Dr. Robert Lustig, a longtime expert in pediatric endocrinology at the University of California, San Francisco. “I am against the arbitrary 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, said more about the efficacy and potential long-term effects of the drug in a more diverse group of children before she began prescribing it regularly. He says he wants to do research.

“I’d like to see it used a little more consistently,” she said.

At the same time, she welcomed the group’s emphasis on rapid and intensive treatment. obesity as a child.

“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.

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