New guidelines: use medication, early surgery for obesity in children

Children struggling with obesity should be evaluated and treated early and aggressively, including medication for children as young as 12 and surgery for those as young as 13, according to new guidelines released on Monday.

The long-standing practice of ‘watchful waiting’ or delaying treatment to see if children and adolescents grow or overcome obesity on their own is only compounding the problem which affects more than 14.4 million young people in the United States. 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 childhood obesity guide in 15 years from the American Academy of Pediatrics. “What we’re seeing is continued weight gain and the likelihood of them having (obesity) as adults.”

For the first time, the group’s advice 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 interventions on behavior and lifestyle, said Eneli, director of the Center for Healthy Weight. and nutrition at Nationwide Children’s Hospital.

In general, physicians should offer obese adolescents 12 and older access to appropriate medications and severely obese adolescents 13 and older with referrals for weight-loss surgery, although circumstances may vary.

The guidelines aim to reset the inaccurate view of obesity as “a personal issue, perhaps a failure of individual 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 that you have asthma and now we have an inhaler for you,” Hassink said.

Young people who have a body mass index that reaches 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 severely obese. BMI is a measure of body size based on height and weight calculation.

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

The group’s advice takes into account that obesity is a biological problem and that it 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 issue. It is not a lifestyle disease,” he said. “It emerges mainly from biological factors.”

The guidelines come as new drug treatments for obesity in children have emerged, including the approval late last month of Wegovy, a weekly injection, for use in children aged 12 and over. 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, made by Novo Nordisk, helped adolescents reduce their BMI by about 16% on average, better than results in adults.

A few days after the December 23 clearance, pediatrician Dr Claudia Fox prescribed the drug to one of her patients, a 12-year-old girl.

“What it offers patients is even the ability to have a near-normal body mass index,” said Fox, also a weight management specialist at the University of Minnesota. “It’s like a whole other level of improvement.”

The drug affects how 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 might be,” he said.

Still, specific doses of semaglutide and other anti-obesity drugs have been hard to come by due to recent shortages caused by manufacturing issues and high demand, spurred in part by celebrities on TikTok and other social media platforms. social media bragging about increased weight loss.

Also, many insurers won’t pay for medications, which cost around $1,300 a month. “I sent the prescription in yesterday,” Fox said. “I’m not holding my breath that insurance will cover it.”

A pediatric obesity expert has warned that while obese children need to be treated early and intensively, he fears 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’m against the willy-nilly use of these drugs without addressing the cause of the problem.”

Lustig said children need to be assessed individually to understand all of the factors that contribute to obesity. He has long blamed excess sugar for the rise in obesity. He urges a 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 into the drug’s effectiveness in a more diverse group of children and the potential long-term effects before starting to use it. prescribe it regularly.

“I would like it to be used a little more consistently,” she said. “And I should be bringing in this patient frequently enough to be monitored.”

At the same time, she welcomed the group’s new focus on the rapid and intensive treatment of obesity in children.

“I really think it’s a realization that diet and exercise aren’t going to be enough for a number of teens who struggle with it — maybe the majority,” she said.

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The Associated Press Health and Science Department is supported by the Howard Hughes Medical Institute Science and Education Media Group. The AP is solely responsible for all content.

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