For the first time, experts from the American Academy of Pediatrics recommends proactive medical intervention against childhood obesity. The organisation’s new guidelines will no longer ask doctors to simply observe or delay treatment for obese children, defined as a body mass index above 30. They now emphasize a range of options, such as diet and lifestyle advice for young children and medication and/or surgery for children 12 years and older.
Past standards for the treatment of childhood obesity called for “watchful waiting”, with the hope that a child’s BMI (a measure of weight and height) would naturally decline over time as he was growing. In 2007, the AAP previous recommendations promoted a staged approach, where physicians could move slowly from observation to treatment. But these new recommendations…released Monday – are the first clinical practice guidelines to bring obesity treatments to the fore.
“There is no evidence that ‘watchful waiting’ or delayed treatment is appropriate for obese children,” said Sandra Hassink, one of the guideline authors and vice-chair of the guidelines subcommittee. AAP Clinical Practice Guidelines on Obesity, in a statement published by the organization. “The goal is to help patients change their lifestyle, behaviors or environment in a lasting way and to involve families in decision-making every step of the way.”
The long guidelines describe a multitude of treatments available, depending on the age of the child and other circumstances (children under 2 are not considered eligible for the treatment of obesity).
For younger children, these options may include intensive health behavior and lifestyle treatment, which may involve regular counseling sessions with the child and family over a period of 3 to over a period of 12 months. For children 12 and older, doctors are now advised to consider medication as a first-line option. And adolescents 13 and older may also be evaluated for bariatric surgery as a potential treatment.
In developing his recommendations, the AAP cites numerous studies suggesting that 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 have a longer life expectancy compared to non-surgical patients matched in age and baseline BMI, for example. Long-term health benefits have also been observed in adolescent bariatric patients.
A new class of drugs, the incretins, has also greatly changed landscape of obesity treatment in recent years. These drugs, combined with diet and exercise, have resulted in significantly 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 widened the approval of Novo Nordisk’s Wegovy, the first drug of this new generation, for children over 12, following clinical trial data showing that adolescents saw an improvement in BMI similar to that of adults. The shortages that have plagued Wegovy’s rollout since its approval in June 2021 may finally be over as well, with the company recently announcing that its supply should now be stable. Without insurance coverage, which is often limited, however, the drug can cost upwards of $1,000 per month.
The AAP guidelines come at a time of rising obesity rates in the United States, including among the childrenonly accelerated, likely in part due to the covid-19 pandemic. The new recommendations notably do not cover the best way to prevent obesity in children, although the organization has promised to publish separate recommendations to this effect in the near future.
“The medical costs of obesity to children, families and our society as a whole are well documented and require urgent action,” lead author Sarah Hampl said in a statement. “This is a complex problem, but there are many ways to intervene now and help children and adolescents lay the foundations for a long and healthy life.”