Pediatricians now recommend drugs and surgery for obese children

Woman on a weight scale in kg

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

The new guidelines mark the first time the AAP has recommended weight-loss drugs for childhood obesity. Overall, the medical group urges immediate and intensive action to get ahead of obesity and overweight in children 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,” said Sandra Hassink, guideline author and vice chair of the Clinical Practice Guidelines Subcommittee on AAP Obesity, in a statement. “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.”

Obesity and overweight have long been stigmatized as simply conditions driven by personal choices. 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 teens are especially aware of the harsh and unfair stigma that comes with it,” said Sarah Hampl, MD, lead author of the guideline, in a communicated. . “Research tells us that we need to look closely at families – where they live, their access to nutritious food, health care and opportunities for physical activity – as well as other factors associated with health, quality of life consequences and risks.

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

In addition to recommendations for weight-loss medication for obesity and surgery for severe obesity, the counseling includes recommendations for motivational interviewing and intensive health behavior and lifestyle treatment. 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 health issues. The guidance addresses 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 extended growth charts for children and adolescents (ages 2-19) to track the growth and treatment of children with severe obesity. .

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

Before the pandemic, obesity affected approximately 14.7 million children and adolescents. The pandemic has made matters worse. According to a CDC study published in 2021, the rate of increase in BMI among children and adolescents doubled during the pandemic compared to pre-pandemic years. Those most affected by the increase were overweight or obese children and adolescents, as well as young school-aged children.

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