in the United States, Centers for Disease Control and Prevention estimates that nearly 1 in 5 children are obese. Since the 1980s, the number of obese children has increased, reaching higher rates and greater weight at earlier ages in each generation. The number of diagnoses of obesity and severe obesity continues to grow, despite the tremendous efforts by parents, clinicians, educators, and policy makers to limit excessive weight gain in children.
Liliana Aguayo, PhD, MPH
In response to this significant public health challenge, the American Academy of Pediatrics (AAP) new practice guidelines For the assessment and management of obesity in children and adolescents. The new His AAP Guidelines, prepared by a panel of experts, represent a new starting point in the conceptualization of obesity, recognizing the role played by social determinants of health that contribute to excessive weight gain.
As a community health researcher investigating disparities in childhood obesity, I applaud the paradigm shift from the AAP. I especially support the perception that obesity is a very serious metabolic disease that will not go away without the introduction of systemic changes and effective treatments.
However, like many of my colleagues and everyone who recognizes barriers to access to recommended treatments, I am concerned about the consequences of new guidelines in the context of current and future health disparities. increase.
a Recent research was announced in Pediatrics We showed that the disparity in childhood obesity is widening. Younger children are reaching higher weights at a younger age. These alarming trends are even greater among black children and those who grow up in the most socioeconomically disadvantaged backgrounds. The new AAP guidelines, even if well-intentioned, exacerbate these differences, leaving children at disproportionate risk of obesity who do not receive AAP-recommended treatments and those who are able to lead healthy lives. may pull further apart.
Instead of “waiting patiently” to see if a child will outgrow obesity, the new guidelines sayaggressive treatmentAt least 26 hours of intensive face-to-face health behavior and lifestyle counseling and treatment is recommended for children 2 years and older who meet obesity criteria.For children 12 years and older, the AAP recommends: This breakthrough is a promising anti-obesity drug (e.g., orlistat, Wegs [semaglutide]Saxenda [liraglutide], Qsymia (phentermine and topiramate) is approved by the U.S. Food and Drug Administration for long-term use in children 12 years and older. Bariatric surgery should be considered for severely obese children over the age of 13.
Will cost barriers continue to widen inequality?
very promising Semaglutide (Wegovy) is a GLP-1-based drug currently offered for approximately $1000 per month. As with any chronic disease, children should be prepared to take anti-obesity drugs long-term.a study A study conducted in adults found that the weight lost could be regained when the medication was discontinued. Bariatric surgery costs total him over $20,000.
At current prices, the U.S. health care system has access to few of the children in need of drugs or surgical interventions. Most private health insurance companies and Medicaid deny coverage for childhood obesity treatments. are also more likely to develop obesity at an early age, increasing barriers to access to treatment.
The AAP recognized that following new treatment recommendations will require significant time and financial commitment. Members of her AAP expert panel that developed the guidelines say they are “recognizing the many barriers to treatment that patients and their families face.”
Nevertheless, recognition of the role of social determinants of health in the development of childhood obesity has not motivated the introduction of treatment options that are not unattainable for most US families.
Due to the high price, it is important to move away from the conclusion that the new AAP guidelines are irrelevant at the population level. This conclusion does not recognize the potential harm the guidelines pose. In relation to the disparities in childhood obesity, new treatment recommendations are likely to suggest that those who have will benefit from available options to reduce childhood obesity and those who will have obesity rates will continue with growth. would widen the gap in childhood obesity prevalence between
We live in a world of haves and have-nots. This applies not only to financial resources but also to obesity rates. In the long term, optimists believe that GLP-1 therapeutics will become ubiquitous, generics will be developed, insurance companies will expand coverage, and most children who need effective obesity treatment options will be able to do so. Until this happens, the inequality in childhood obesity will continue to widen unless deliberate policies are swiftly put in place.
Brave and purposeful action is needed to avoid increasing inequality. Failure to heed this known issue is a lost opportunity for the AAP, lawmakers, and others in a position to help America’s children.
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