New guidelines: Use drugs, early surgery for obesity in children

New guidelines: Use drugs, 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 Monday.

The long-standing practice of “watchful waiting,” or delaying treatment to see if children and teens will outgrow or beat obesity on their own, only exacerbates the problem that affects more than 14.4 million young people in the US. 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 guidelines on childhood obesity in 15 years from the American Academy of Pediatrics. “What we see is continued weight gain and the likelihood of having (obesity) in adulthood.”

For the first time, the group’s guidelines specify the age at which medical treatments such as drugs and surgery — along with intensive diet, exercise and other behavioral and lifestyle interventions — should be offered to children and teenagers, said Eneli, director of the Center for Healthy Weights. . and nutrition at Nationwide Children’s Hospital.

In general, doctors should offer obese adolescents 12 years and older access to appropriate medications, and severely obese teens 13 years and older should offer recommendations for weight loss surgery, although situations may vary.

The guidelines aim to reverse the inaccurate view of obesity as “a personal problem, perhaps a failure of a person’s diligence,” said Dr. Sandra Hassink, medical director of the AAP Institute for Healthy Childhood Weights and co-author of the guidelines. .

“This is no different than if you have asthma and now we have an inhaler for you,” Hassink said.

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

Obesity affects nearly 20% of children and teens 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 lifestyle problem. It is not a lifestyle disease,” he said. “It mostly stems from biological factors.”

The guidance comes as new drugs to treat obesity in children emerged, including the approval late last month of Wegovy, a weekly injection, for use in children 12 and older. 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, manufactured by Novo Nordisk, helped teenagers reduce their BMI by about 16% on average, better than results in adults.

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

“What it offers patients is the ability to have even a near-normal body mass index,” said Fox, also a weight management expert at the University of Minnesota. “It’s like a whole different 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 would be,” he said.

Still, specific doses of semaglutide and other obesity drugs have been hard to come by due to recent shortages caused by production problems and high demand, fueled in part by celebrities on TikTok and other social media platforms touting improved weight loss.

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

One pediatric obesity expert warned that while obese children must 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 medication,” said Dr. Robert Lustig, a longtime specialist in pediatric endocrinology at the University of California, San Francisco. “I am against the involuntary use of these drugs without addressing the root cause of the problem.”

Lustig said children need to be evaluated individually to understand all the factors that contribute to obesity. For a long time, he blamed too much sugar for the rise in obesity. It calls for a sharp focus on nutrition, especially on 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 on the drug’s effectiveness in a more diverse group of children and possible long-term effects before she starts prescribing it regularly.

“I would like to see it used on a little more consistent basis,” she said. “And I would have to visit that patient often to monitor him.”

At the same time, she welcomed the group’s new emphasis on rapid, intensive treatment of childhood obesity.

“I definitely think this is a realization that diet and exercise is not going to work for a certain number of teenagers who are struggling with this — maybe the majority,” she said.

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

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