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Children struggling with obesity should be evaluated and treated early and aggressively, including with medication for children as young as 12 and surgery for those as young as 13, according to new guidelines released Monday.
The long-standing practice of “watchful waiting,” or delaying treatment to see if children and teens outgrow or overcome obesity on their own, only exacerbates the problem, which affects more than 14.4 million young people in the US. If left untreated, obesity can lead to lifelong health problems, including high blood pressure, diabetes and depression.
“Waiting doesn’t work,” said Dr. Ihuoma Eneli, co-author of the first a guide to childhood obesity after 15 years from the American Academy of Pediatrics. “What we’re seeing is continued weight gain and the likelihood that they will have (obesity) in adulthood.”
For the first time, the group’s guidelines specify ages at which children and teens should be offered medical treatments such as drugs and surgery — in addition to intensive diet, exercise and other behavioral and lifestyle interventions, said Enelli, director of the Center for healthy weight and nutrition at Nationwide Children’s Hospital in Columbus, Ohio.
In general, doctors should offer adolescents 12 and older who are obese access to appropriate medication, and severely obese teens 13 and older recommended for weight loss surgery, although situations may vary.
The guidelines aim to restore the inaccurate view of obesity as “a personal problem, perhaps a failure of a person’s diligence,” said Dr. Sandra Hassink, medical director of the AAP Institute for Healthy Childhood Weight and co-author of the guidelines.
“It’s no different than if you have asthma and now we have an inhaler for you,” Hassink said.
Young people who have a body mass index that meets or exceeds the 95th percentile for children of the same age and sex are considered obese. They are considered to have children who reach or exceed this level by 120%. severe obesity. BMI is a a measure of body size based on height and weight calculation.
Obesity affects nearly 20 percent of children and teens in the U.S. and about 42 percent of adults, according to the Centers for Disease Control and Prevention.
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 Center for Pediatric Obesity Medicine at the University of Minnesota.
“Obesity is not a lifestyle problem. It’s not a lifestyle disease,” he said. “It’s mostly biological.”
The guidelines come as new drugs to treat childhood obesity have emerged, including approval late last month of Wegovy, a weekly injection, for use in children 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 Wegovy, made by Novo Nordisk, helped teenagers reduce their BMI by an average of about 16%, better than results in adults.
Within days of the Dec. 23 authorization, pediatrician Dr. Claudia Fox prescribed the drug to one of her patients, a 12-year-old girl.
“What it offers patients is the ability to even have a near-normal body mass index,” said Fox, also a weight management specialist at the University of Minnesota. “It’s like a whole different level of improvement.”
The drug affects the way pathways between the brain and gut regulate energy, said Dr. Justin Ryder, an obesity researcher at Lurie Children’s Hospital in Chicago.
“It works on how your brain and stomach communicate with each other and helps you feel fuller than you would be,” he said.
Still, specific doses of semaglutide and other anti-obesity drugs have been difficult to obtain because of recent shortages caused by manufacturing problems and high demand, fueled in part by celebrities on TikTok and other social media platforms boasting about increased weight loss.
Also, many insurers won’t pay for the drug, which costs about $1,300 a month. “I sent the recipe yesterday,” Fox said. “I’m not holding my breath that insurance will cover it.”
One pediatric obesity expert cautioned that while obese children should be treated early and intensively, he worries that some doctors may turn too quickly to drugs or surgery.
“It’s not that I’m against drugs,” said Dr. Robert Lustig, a longtime specialist in pediatric endocrinology at the University of California, San Francisco. “I am against the willy-nilly 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 blamed too much sugar for the rise in obesity. He urges a sharp focus on diet, especially ultra-processed foods that are high in sugar and low in fiber.
Dr. Stephanie Byrne, a pediatrician at Cedars Sinai Medical Center in Los Angeles, said she would like more research on the drug’s efficacy in a more diverse group of children and the potential long-term effects before she starts prescribing it regularly.
“I would like to see it used on a little more consistent basis,” she said. “And I’m going to have to have this patient come in quite often to be monitored.”
At the same time, she welcomed the group’s new emphasis on rapid, intensive treatment of childhood obesity.
“I definitely think it’s a realization that diet and exercise isn’t going to do it for a number of teenagers who struggle with this — maybe the majority,” she said.
The Associated Press Health and Science Division is supported by the Science and Education Media Group of the Howard Hughes Medical Institute. AP is solely responsible for all content.
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