Childhood obesity, new guidelines suggest medication and surgery to treat

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 ‘wait and see’, where children and teens delay treatment to see if they will or will overcome obesity on their own, affects more than 14.4 million young people in the United States It only makes the problem worse. Left untreated, obesity can lead to lifelong health problems, such as high blood pressure, diabetes, and depression.

“Waiting doesn’t work,” says Dr. Ihuoma Eneli, who co-authored the American Academy of Pediatrics’ first guidance on childhood obesity in 15 years. “What we’re seeing is continued weight gain and the potential they have. [obesity] into adulthood. “

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

In general, physicians should provide obese adolescents age 12 and older with access to appropriate medications and severely obese teenagers age 13 and older with referrals for weight-loss surgery, but the situation may vary.

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

“It’s like you have asthma. 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 who reach that level or exceed 120% are considered severely obese. BMI is a measure of body size based on calculations of height and weight.

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

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

“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. A recent study published in the New England Journal of Medicine found that her Wegovy, made by Novo Nordisk, lowered her BMI in her teens by an average of about 16%, better than results in adults. I understand.

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, spurred in part by celebrities who boast about promoting weight loss on TikTok and other social media platforms.

Also, 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, 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 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 Academy’s new 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.