New Guidelines for Kids With Obesity: What Parents Should Know

Jan. 13, 2023 — The American Academy of Pediatrics last week issued their first new guidelines in 15 years for evaluating and treating kids and adolescents with overweight or obesity. 

If you only saw the headlines, you might think that when a youngster is a few pounds overweight, their pediatrician will prescribe a weight loss drug or bariatric surgery. The reality is much less alarming. The guidelines take a deep dive into evidence-based treatments at various levels.

“It’s a misunderstanding, it’s being sensationalized,” says Lori Fishman, PsyD, a child psychologist who specializes in pediatric weight management. “There’s so much more to the process. It’ll be a small percentage of kids who’ll even qualify for these treatments.” 

Treating the Whole Child

Before writing the guidelines, the AAP’s Subcommittee on Obesity spent years analyzing and synthesizing information from nearly 400 studies. 

“We now have more information than ever that supports that obesity is a chronic, complex disease that requires a whole-child approach,” says Sarah Hampl, MD, one of two lead authors of the guidelines. “And many kids will not outgrow it, so it’s important to identify children with obesity early and offer them evidence-based treatments.”

The Rise of Childhood Obesity

For kids 2-18, obesity is defined as having a BMI at or above the 95th percentile for a child’s age and sex. Rates of pediatric obesity have more than tripled since the 1960s, from 5% to nearly 20%. Just last month, the CDC released updated growth charts to take into account how many more children and adolescents now have severe obesity, well beyond the 95th percentile. By 2018, more than 4.5 million kids qualified, but the old charts didn’t go high enough.

If these trends continue, researchers estimate that 57% of children aged 2 to 19 will have obesity by the time they hit 35. And the pandemic has only made things worse.

“It’s about much more than what we eat and drink or how physically active we are,” Hampl says. Risk factors for obesity include genetics, socioeconomics, race and ethnicity, government policies, a child’s environment, neighborhood, and school, and even their exposure to unhealthy food marketing. Because each child is so different, these factors combine in unique ways.

By guiding children and their families to adopt healthier habits early, it may help to reduce some of the weight-related health issues that have also increased in the last few decades. Just within the 21st century, diabetes rates for children and teenagers have skyrocketed — between 2001 and 2017, the number of kids with type 2 went up an astonishing 95%.

“Now we understand the consequences of untreated obesity, especially severe obesity,” says Mary Ellen Vajravelu, MD, a doctor-scientist at the Center for Pediatric Research in Obesity and Metabolism in Pittsburgh. “That includes type 2 diabetes, fatty liver disease, high blood pressure, high cholesterol. It’s important to treat obesity in childhood to avoid the complications we’re seeing in young adults.”

Also important: Reversing the trend while a child is young can help them avoid the emotional impact of growing up with obesity. 

“I saw the recommendations and thought, ‘How different would my life have been for the past 35 years if they had treated my obesity when I was a child?” says Heather, the mother of a 10-year-old in Florida. She’s been carrying shame and limiting herself since childhood, for instance by avoiding activities where her size might prove embarrassing. “For kids who are struggling, I think it’ll be life-changing.”

Medication and Surgery

Those last two recommendations have garnered most of the headlines, and it’s understandable. Medicating a child — or performing an operation that would permanently change their body — might seem extreme. But the research shows that for children with obesity and severe obesity, these treatments work.

“This isn’t for a kid who’s a little overweight,” says Fishman. “It’s obesity that’s limiting this child’s ability to function. When we face something this disabling, we want to attack it from every direction we can.”

Right now, only a handful of medications are approved to treat obesity in adolescents. Some are taken orally, while others, like the recently approved Wegovy, are injected. 

Jill, the New Jersey mom, is using Wegovy herself. 

“The fact that I’ve had success with it makes me more comfortable about approaching it as an option for my son,” she says. “And ultimately, it’s his choice. If he wants to see if he can just do things differently first, we’ll try that. A nutritionist’s guidance will be part of this for him regardless, so he can understand what’s involved. It’s not like he’ll get the shot and all of a sudden magic happens.”

Weight loss surgery for adolescents does have certain drawbacks. Any surgery has the risk of complications, and some surgical patients do gain back a significant amount of weight. Some research suggests that adolescents who have the surgery are more likely to have alcohol problems later in life.

Even with those risks, for some teens surgery may prove life-saving.

“We know much more about the complications of obesity in adults, we know those are devastating,” says Hampl. “If we can prevent heart attacks, stroke, sleep apnea, diabetes, and other really serious medical complications, that in itself is a huge benefit to the person’s health.”

The Question of Equity

The guidelines point out that obesity has inequities baked into the condition. Risk factors increase depending on your economic status and your race. Access to treatment is lopsided. Some of the most effective treatments, like intensive health behavior and lifestyle treatment, aren’t available everywhere. Providers may not be in-network or even accept insurance. 

If the family of a child with overweight can’t access effective programs to help them build healthy habits, the child’s odds for developing obesity grow. As they get older and their BMI reaches the level of obesity or severe obesity, treatments like medication and surgery become an option. But they’re even more costly, which leaves many families with no help at all.

That’s why the guidelines also include policy recommendations aimed at covering comprehensive obesity prevention, evaluation, and treatment. They call attention to the ways unhealthy food is marketed, the effects of limited resources on a community, how socioeconomic and immigration status factor in, and the challenges posed by food insecurity.

“We hope the guidelines will serve as impetus to help improve access to care for all children with obesity,” Hampl says. “That includes everything from infrastructure and policy to systems change as well.”

For parents who struggle to help their children with overweight and obesity, having such an authoritative resource can pave the way to getting real help.

“It’s good that they issued these guidelines. I’m hoping, for my son and all the kids out there who are struggling, that it will help to have it recognized as something worthy of clinical, medical management,” Jill says. “It’s validating.”