Pediatricians are now recommending drugs and surgery for obese children

Pediatricians are now recommending drugs and surgery for obese children

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Obese 12-year-olds should now consider weight-loss medication, and 13-year-olds with severe obesity should consider metabolic or bariatric surgery, according to new aggressive directions published Monday by the American Academy of Pediatrics.

The new guidance marks the first time the AAP has recommended weight loss medications for childhood obesity. Overall, the medical group is urging immediate, intensive action to prevent childhood obesity and overweight before the complex conditions lead to long-term health problems, such as cardiovascular disease and diabetes.

“There is no evidence that ‘watchful waiting’ or delayed treatment is appropriate for obese children,” Sandra Hassink, author of the guidelines and vice chair of the AAP’s Clinical Practice Guidelines Subcommittee on Obesity, said in a statement. “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.”

Obesity and overweight have long been stigmatized as simple conditions driven by personal choice. But in reality, the AAP points out, they are complex medical conditions that involve combinations of genetic, physiological, socioeconomic, and environmental factors.

“Weight is a sensitive topic for most of us, and children and teenagers are particularly aware of the heavy and unfair stigma that comes with being affected by it,” Dr Sarah Hample, lead author of the guidelines, said in a statement . “Research tells us that we need to look closely at families—where they live, their access to nutritious food, health care, and physical activity opportunities—as well as other factors that are associated with health, quality of life outcomes, and risks.”

The AAP defines overweight as having a body mass index (BMI) at or above the 85th to 95th percentile. Obesity is defined as a BMI at or above the 95th percentile, and severe obesity is defined as a BMI at or above 120 percent of the 95th percentile for age and sex.

In addition to recommendations related to weight-loss medications for obesity and surgery for severe obesity, the guidelines include recommendations for motivational interviewing and intensive treatment of healthy behaviors and lifestyles. The AAP also recommends that pediatricians evaluate overweight, obese, and severely obese children for lipid abnormalities, high blood pressure, signs of prediabetes or diabetes, and mental illness. The guidelines discuss the increased risk children face due to special health needs, low socioeconomic status, and structural racism.

Last month, the US Centers for Disease Control and Prevention expanded the Child and Adolescent Growth Charts (ages 2 to 19) to track the growth and treatment of severely obese children.

“Childhood obesity is a serious and growing problem in the United States,” said Karen Hacker, director of CDC’s National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP) in statement at the time. “The Advanced BMI-for-Age Growth Charts allow clinicians to track growth and visualize high BMI percentiles with families.”

Before the pandemic, obesity took its toll about 14.7 million children and adolescents. The pandemic made things worse. According to CDC study published in 2021, the rate of increase in BMI in children and adolescents doubled during the pandemic compared to pre-pandemic years. Most affected by the increase are children and teenagers who are overweight or obese, and younger school-age children.

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