New guidelines to treat childhood obesity include drugs and surgery for the first time

By Kaitlin Sullivan NBCNews

For the first time in 15 years, the American Academy of Pediatrics (AAP) released new guidelines for treating childhood obesity on Monday, emphasizing the need for early and intensive treatment.

The guidance comes as childhood obesity rates have continued to rise over the past decade and a half, rising from 17% to 20%, according to data from the Centers for Disease Control and Prevention (CDC). Since the 1980s, obesity rates have tripled in children and quadrupled in adolescents.

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The pandemic made matters worse, according to Dr. Joan Han, professor and chief of the Division of Pediatric Endocrinology and Diabetes at Mount Sinai Kravis Children’s Hospital, who was not involved in the new report. A CDC report revealed that the rate of weight gain nearly doubled in 2020, compared to pre-pandemic years.

Obesity affects nearly 15 million children and adolescents in the United States, according to CDC data. Excess weight not only has consequences for physical health, including type 2 diabetes and high blood pressure, but also affects mental health.

The new guidelines emphasize that obesity is a complex and chronic pathology with no simple solution. Intensive behavior and lifestyle changes should be the first-line approach, but the AAP also includes recommendations for anti-obesity drugs and surgery for the first time. These new recommendations respond to a large amount of research and drug approvals in recent years.

“We now have evidence that anti-obesity therapy is effective. There is treatment, and it is time to recognize that obesity is a chronic disease and must be addressed as we address other chronic diseases,” explained Sandra Hassink, MD, medical director of the AAP Institute for Healthy Childhood Weight and co-author of the new guidelines.

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Part of that involves stepping in sooner rather than later. There is no evidence, according to the guidelines, that so-called observation waiting or delaying appropriate treatment is beneficial.

new treatments

For children 12 years and older, one of the major changes to the recommendations is the inclusion of anti-obesity drugs and weight-loss surgery along with lifestyle changes.

In recent years, research has increasingly shown that a person’s weight is determined by more than just diet and level of physical activity. Genetics and hormones can also play a role in how a person’s body uses and stores energy. This discovery has been the basis for the development of new drugs.

“The breakthrough in recent years has been that people have begun to realize that there are hormones made in the gut that have multiple roles in obesity. By targeting these, the drugs can help people feel full faster and help stabilize insulin levels,” Han explained.

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The guidelines indicate that pediatricians should offer weight-loss drugs to obese children 12 years and older.

There are currently four drugs approved for the treatment of obesity in adolescents 12 years and older -Orlistat, Saxenda, Qsymia and Wegovy- and one, phentermine, for adolescents 16 years and older. Another drug, setmelanotide (brand name Imcivree), has been approved for children ages 6 and older with Barde-Biedl syndrome, a genetic disease that causes obesity.

A girl chooses her lunch at John Liechty High School in Los Angeles, California, on December 7, 2022.
A girl chooses her lunch at John Liechty High School in Los Angeles, California, on December 7, 2022.Christina House/Los Angeles Times via Getty Images

The Food and Drug Administration (FDA) approved Wegovy in late December, a weight-loss medication intended for adults ages 12 and older that became very popular last year.

Results of a clinical trial published in the New England Journal of Medicine showed that a weekly injection of the drug, along with exercise and healthy eating habits, could help children ages 12 and older reduce their body mass index by 16 %, versus 0.5% for a group that took a placebo.

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However, new drugs are not available to everyone.

“The problem with these drugs is that they are very expensive and insurance often doesn’t cover them,” Han explains, noting that a month’s supply of Wegovy can cost as much as $1,500, an exorbitant price for most families.

The guidelines also recommend that severely obese adolescents aged 13 and over consider weight-loss surgery, which, based on available data, may be a safe and effective treatment with long-lasting results.

“The sooner the better for many things,” Han says. “There is research showing that having bariatric surgery earlier can reverse health problems such as type 2 diabetes and high blood pressure, which is why surgery should be considered in pediatric patients,” he added.

A holistic approach

The AAP’s Hassink stressed that drugs and surgery are not first-line treatments and should only be considered in special circumstances, when lifestyle changes prove ineffective for individual patients.

She also recognized that these lifestyle changes can be really hard to adopt, especially for overworked, low-income parents.

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“This is being worked on, but we can safely say that we all live in an environment in this country that tends to promote obesity across the board,” Hassink said.

The guidelines emphasize a holistic approach to the treatment of obesity. This includes considering the whole life of the child, not just physical habits such as diet and activity levels, but also mental health, the environment and the social inequities they face.

“There are a large number of factors driving obesity that come from the environment itself. The harsher the environment around you, the harder it is to lead a healthy lifestyle,” says Hassink.

Tangible change will require significant changes that are often beyond the control of the family.

“We can recommend more servings of vegetables and more fun physical activity. However, if a person’s neighborhood does not have grocery stores to shop or sidewalks or parks to walk, these recommendations are unrealistic,” said Dr. Roy Kim, a pediatric endocrinologist at Cleveland Clinic Children’s in Ohio.

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The new guidelines do not directly address obesity prevention, which will be the subject of future guidance, but emphasize the importance of devoting funds to public health policies aimed at preventing obesity.

This includes creating safe and walkable neighbourhoods, equipping schools with the tools to promote healthy lifestyles throughout childhood, and ensuring that everyone has equal access to healthy and affordable food – something that is not yet a reality. .

“We have to make places to walk safe, easy and comfortable. We have to find ways to take advantage of existing opportunities for people to exercise and access healthy food that is cheap and convenient,” Han said.

It also stresses the importance of health centers being “one-stop shops”, with psychological, nutritional and other specialty services under one roof, to make it easier for families to obtain the help their children need.

Even so, “it will take an entire society to make this possible,” he said.

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Medications and surgery are expensive, and it’s not always realistic to ask overwhelmed parents to make lifestyle changes. Kim says that while recent pharmacological advances in treating obesity are enormous, “the best, most effective, safest, and cheapest approach will always be prevention.”

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