Childhood obesity: The new guidelines recommend drugs at 12, surgery at 13

Children struggling with obesity should be diagnosed and treated early and aggressively, including medications for children as young as 12 and surgery for children as young as 13, according to new guidelines released last week. 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 that affects more than 14.4 million people. youth in the US 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 childhood obesity guidelines in 15 years from the American Academy of Pediatrics. “What we see is the persistence of weight gain and the likelihood that they will have (obesity) in adulthood.”

For the first time, the group’s guidance sets the ages at which children and adolescents should be offered medical treatments such as drugs and surgery – in addition to intensive diet, exercise and other behaviors and methods of life, said Eneli, director of the Center for Healthy Weight. and Nutrition at Nationwide Children’s Hospital.

In general, doctors should offer teens 12 and older with obesity access to appropriate medications and teens 13 and older with severe obesity. obesity referral for weight loss surgery, although situations may vary.

The guidelines aim to reset the inaccurate view of obesity as “a personal problem, perhaps a failure of human effort,” said Dr. Sandra Hassink, medical director for the AAP Institute for Healthy Childhood weight, and a co-author of the guidelines. .

“It’s no different than your asthma and now we have an inhaler for you,” Hassink said.

Youth with a body mass index that meets or exceeds the 95th percentile for children of the same age and gender are considered obese. Children who reach or exceed the 120th percentile are considered to have severe obesity. BMI is a body size measurement based on height and weight calculations.

Obesity affects about 20% of children and adolescents in the US and about 42% of adults, according to the Centers for Disease Control and Prevention.

The group’s guidelines take 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 problem in life. It’s not a lifestyle disease,” he said. “It usually stems from biological factors.”

The guidelines come as new drug treatments for childhood obesity emerge, including the approval late last month of Wegovy, a weekly injection, for use in child aged 12 and above. Different doses of the 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, produced by Novo Nordisk, helped teenagers reduce their BMI by about 16% on average, better than the results of adults.

Within days of approval on December 23, pediatrician Dr. Claudia fox prescribed the drug for one of his patients, a 12-year-old girl.

“What this offers patients is the possibility of having an almost normal body mass index,” said Fox, also a weight management specialist at the University of Minnesota. “It’s like a different level of development.”

The drug affects the way the pathways between the brain and the gut regulate energy, said Dr. Justin Ryder, an obesity researcher at Lurie Children’s Hospital in Chicago.

“It works with how your brain and stomach communicate with each other and helps you feel fuller than you otherwise would,” she says.

However, specific doses of semaglutide and other anti-obesity drugs are difficult to obtain due to recent shortages due to manufacturing problems and high demand, fueled in part by TikTok offers and others. more social media platforms boasting about enhanced weight loss.

In addition, many insurers will not pay for the drug, which costs about $1,300 a month. “I sent the prescription yesterday,” Fox said. “I’m not holding my breath that insurance will cover it.”

A pediatric obesity expert warned 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 unwanted use of drugs without addressing the cause of the problem.”

Lustig said that children should be evaluated individually to understand all the factors that contribute to obesity. He has long blamed excess sugar for the rise in obesity. He urges a sharp focus on food, especially ultraprocessed 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 wants more research on the drug’s effectiveness in a different group of children and on potential long-term side effects before she start prescribing it regularly.

“I’d like to see it applied on a little more consistent basis,” he said. “And I need the patient to come in regularly to be monitored.”

At the same time, he welcomed the group’s new emphasis on quick, intensive treatment for childhood obesity.

“I really think it’s a realization that diet and exercise isn’t going to do it for a lot of teenagers who struggle with it — probably the majority,” she said.

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The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group. AP is solely responsible for all content.

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