For the first time in 15 years, the American Academy of Pediatrics on Monday released new guidelines for treating childhood obesity, 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% a twenty%, according to data from the Centers for Disease Control and Prevention. Since the 1980s, obesity rates have tripled in children and quadrupled in adolescents.
The pandemic made matters worse, said Dr. Joan Han, a 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. One CDC report found that the rate of weight gain nearly doubled in 2020, compared to the years before the pandemic.
Obesity affects almost 15 million children and adolescents in the US, CDC data show. Being overweight 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, chronic condition 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 novel recommendations are in response to a windfall in research and drug approvals in recent years.
“We now have evidence that anti-obesity therapy is effective. There is treatment, and now is the time to recognize that obesity is a chronic disease and must be addressed just like we treat other chronic diseases,” said Dr. Sandra Hassink, medical director of the AAP Institute for Healthy Childhood Weight and co-author of the new guidelines.
Part of that involves intervening sooner rather than later. There is no evidence, according to the guidelines, that so-called watching, waiting, or delaying appropriate treatment is beneficial.
For children with obesity ages 6 and older, and in some cases ages 2 to 5, the first focus should be to work with pediatricians and other health care providers on behavior and lifestyle changes, the new guidelines say. This is most effective when it includes at least 26 hours of one-on-one counseling over the course of about a year, something experts acknowledge can be challenging for families.
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 new understanding has been the basis for the development of new drugs.
“The breakthrough that happened in recent years was that people began to realize that there are hormones produced in the gut that have multiple functions related to obesity. By targeting these, the drugs can help people feel full faster and help stabilize insulin levels,» Han said.
The guidelines say pediatricians should offer weight-loss drugs to obese children 12 and older.
Four drugs are now 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 medication, called setmelanotide (brand name Imcivree), has been approved for children 6 years and older who have Barde-Biedl syndrome, a genetic disease that causes obesity.
Wegovy, which gained popularity last year as a weight-loss drug for adults, was approved by the Food and Drug Administration at the end of December for ages 12 and up. clinical trial Results published in the New England Journal of Medicine showed that a weekly injection of the drug, along with healthy exercise and eating habits, could help children ages 12 and older reduce their body mass index by about 16 percent, compared with just over 0.5% for a group that took a placebo.
However, new drugs are not available to everyone.
“The problem with these medications is that they are very expensive and insurance often doesn’t cover them,” Han said, adding that a month’s supply of Wegovy can cost up to $1,500, which is not affordable for most families. .
The guidelines also recommend that severely obese adolescents ages 13 and older consider discussing weight-loss surgery, which evidence It has been shown that it can be a safe and effective treatment with lasting results.
“The sooner the better for many things,” Han said. “There is research showing that having bariatric surgery sooner can reverse health problems like type 2 diabetes and high blood pressure, which is why surgery should be considered.” for pediatric patients.
A holistic approach
The AAP’s Hassink emphasized that medications and surgery are not first-line treatments and should be considered only in special circumstances when lifestyle changes prove ineffective for individual patients.
She also recognized that these lifestyle changes can be very difficult to adopt, especially for overworked, low-income parents.
“It’s being worked on, but we can safely say that all of us in this country live in an environment that tends to promote obesity across the board,” Hassink said.
The guidelines emphasize a holistic approach to the treatment of obesity. This includes looking at a child’s entire life, considering not just physical habits like diet and activity levels, but also mental health, the environment, and the social inequities she faces.
“There are a lot of drivers of obesity that come from the environment itself. The harsher the environment around you, the harder it is to live a healthy lifestyle,” Hassink said.
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 supermarkets 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.
The new guidelines do not directly address obesity prevention — that will come in a future guide — but they emphasize the importance of channeling funds toward public health policies aimed at obesity prevention. This includes creating safe and walkable neighborhoods, equipping schools with the tools they need to support healthy lifestyles throughout childhood, and making sure everyone has equal access to affordable healthy food, which is not yet a reality.
“We need to make places to walk safe, easy and comfortable. We need 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 highlights the importance of «one-stop» health care centers, with psychological, nutritional and other specialties all under one roof, to make it easier for families to get the help their children need.
Still, «it will take a whole society to make this possible,» he said.
Medications and surgery are expensive, and asking overburdened parents to implement lifestyle changes isn’t always realistic. Kim said that while recent advances in drugs to treat obesity are enormous, «the best, most effective, safest, and cheapest approach will always be prevention.»