For the first time ever, experts with the American Academy of Pediatrics are recommending proactive medical intervention against childhood obesity. The organization’s new guidelines will no longer ask doctors to simply observe or delay treatment in children with obesity, defined as a body mass index over 30. They instead now emphasize a range of options, such as dietary and lifestyle counseling for younger children as well as medications and/or surgery for children 12 and over.
Past standards for treating childhood obesity have called for “watchful waiting,” the hope being that a child’s BMI (a measure of both weight and height) would naturally lower over time as they grew. In 2007, the AAP’s previous recommendations promoted a step-based approach, where doctors might slowly escalate from observation to treatment. But these new recommendations—released Monday—are the first clinical practice guidelines to put obesity treatments front and center.
“There is no evidence that ‘watchful waiting’ or delayed treatment is appropriate for children with obesity,” said Sandra Hassink, one of the authors behind the guidelines and vice chair of the AAP Clinical Practice Guideline Subcommittee on Obesity, in a statement released by the organization. “The goal is to help patients make changes in lifestyle, behaviors or environment in a way that is sustainable and involves families in decision-making at every step of the way.”
The lengthy guidelines outline a multitude of available treatments, depending on a child’s age and other circumstances (children under 2 are not considered eligible for obesity treatment).
For younger children, these options can include intensive health behavior and lifestyle treatment, which can involve regular counseling sessions with the child and family over a 3- to 12-month period. For children 12 and over, doctors are now advised to consider medications as a front-line option. And teens 13 and over can also be evaluated for bariatric surgery as a potential treatment.
In crafting its recommendations, the AAP cites many studies suggesting that the benefits of these treatments outweigh any potential risks they can carry. Patients who have undergone bariatric surgery seem to have a lower risk of developing obesity-related complications such as type 2 diabetes and have a longer life expectancy when compared to non-surgical patients matched in age and baseline BMI, for instance. Long-term health benefits have been seen in teen bariatric patients specifically, too.
A new class of medication, called incretins, has also greatly changed the landscape of obesity treatment in recent years. These drugs, combined with diet and exercise, have led to far larger weight loss on average than most other treatments and are approaching the typical results seen with bariatric surgery.
Last month, the Food and Drug Administration extended the approval of Novo Nordisk’s Wegovy, the first drug of this new generation, to children over 12, following clinical trial data showing that teens saw a similar improvement in BMI as 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, the drug can still cost over $1,000 a month, however.
The AAP’s guidelines arrive at a time when the rise in U.S. obesity rates, including among children, has only accelerated, likely in part due to the covid-19 pandemic. The new recommendations notably do not cover how best to prevent obesity in children, though the organization has promised to release separate recommendations for that in the near future.
“The medical costs of obesity on children, families and our society as a whole are well-documented and require urgent action,” said lead author Sarah Hampl in a statement. “This is a complex issue, but there are multiple ways we can take steps to intervene now and help children and teens build the foundation for a long, healthy life.”