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Experts recommend medication, surgery for teenage obesity in new directions

Experts recommend medication, surgery for teenage obesity in new directions

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For the first time, experts with The American Academy of Pediatrics recommends proactive medical intervention against childhood obesity. The organization’s new guidelines will no longer require doctors to simply monitor or delay treatment in children with obesity, defined as a body mass index above 30. Instead, they now emphasize a range of options, such as dietary and lifestyle advice for more young children, as well as medicines and/or surgeries for children 12 years of age and older.

Previous standards for treating childhood obesity called for “watchful waiting,” with the hope that a child’s BMI (a measure of both weight and height) would naturally decrease over time as they grow. In 2007, the AAP previous recommendations encouraged a step-based approach in which physicians can slowly escalate from observation to treatment. But these new recommendations –released Monday – are the first clinical practice guidelines to put obesity treatment at the fore.

“There is no evidence that ‘watchful waiting’ or delayed treatment is appropriate for obese children,” said Sandra Hassink, one of the authors behind the guidelines and vice chair of the AAP’s Clinical Practice Guidelines Subcommittee on Obesity, in statement released by the organization. “The goal is to help patients make lifestyle, behavioral or environmental changes in a way that is sustainable and involves families in decision-making every step of the way.”

The lengthy guidelines outline multiple treatments available depending on the child’s age and other circumstances (children under 2 are not considered suitable for the treatment of obesity).

For younger children, these options may include intensive health behavior and lifestyle treatment, which may include regular counseling sessions with the child and family over 3- up to a 12-month period. For children 12 years and older, doctors are now advised to consider drugs as first line. And teens 13 and older may also be evaluated for bariatric surgery as a potential treatment.

In making it recommendations, the AAP cites many studies that suggest the benefits of these treatments outweigh any potential risks they may carry. Patients who have undergone bariatric surgery appear to have a lower risk of developing obesity-related complications such as type 2 diabetes and there is a longer life expectancy compared to non-surgical patients matched for age and baseline BMI, for example. long-term health benefits were also observed especially in teenagers with bariatric patients.

A new class of drugs called incretins is also available greatly changed the landscape of obesity treatment in recent years. These drugs combined with diet and exercise, have produced much greater weight loss on average than most other treatments and approach the typical results seen with bariatric surgery.

Last month, the Food and Drug Administration extended the approval of Novo Nordisk’s Wegovy, the first drug of this new generation, for children over 12 years of age, following clinical trial data showing that teenagers saw similar improvements in BMI as adults. The shortage that has hampered Wegovy’s deployment since its approval in June 2021 may finally end as well, with the company recently announcement that its supply should now be stable. Without insurance coverage, which is often limited, the drug can still cost more than $1,000 a month.

The AAP’s guidelines come at a time when obesity rates in the U.S. are rising, including among childrenit has only accelerated, possibly in part due to the covid-19 pandemic. The new recommendations specifically do not cover how best to prevent obesity in children, although the organization has promised to publish separate recommendations on this in the near future.

“The medical costs of obesity on children, families, and our society as a whole are well documented and require urgent action,” lead author Sarah Hample said in a statement. “This is a complex issue, but there are many ways we can take steps to intervene now and help children and teens build the foundation for long, healthy lives.”


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