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

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Children struggling with obesity should be evaluated and treated early and aggressively, including drugs for children as young as 12 and surgery for children as young as 13, according to new guidelines released on Monday.

The long-standing practice of “watchful waiting” or delaying treatment to see if children and teens outgrow or overcome obesity on their own only makes the problem that affects more than 14.4 million youth in the US worse. 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 guideline on childhood obesity in 15 years by the American Academy of Pediatrics. “What we see is a continuation of weight gain and the likelihood that they will have (obesity) in adulthood.”

For the first time, the group’s guidance establishes the ages at which children and teens should receive medical treatments, such as drugs and surgery — in addition to intensive dieting, exercise and other behavioral and lifestyle interventions, said Eneli, director of the Centro de Peso Health and Nutrition at Nationwide Children’s Hospital in Columbus, Ohio.

In general, clinicians should provide adolescents 12 years and older with obesity with access to appropriate medications and adolescents 13 years and older with severe obesity access to weight-loss surgery, although situations may vary.

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

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

Young people with a body mass index equal to or greater than the 95th percentile for children of the same age and gender are considered obese. Children who reach or exceed this level by 120% are considered severely obese.. BMI is a measure of body size based on a height and weight calculation.

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 guidance takes 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 issue. It’s not a lifestyle disease,” he said. “It emerges predominantly from biological factors.”

The guidelines come as new drug treatments for 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, made by Novo Nordisk, helped teens reduce their BMI by about 16% on average, better than results in adults.

A few days after the December 23 authorization, 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 a near-normal body mass index,” said Fox, who is 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 and helps you feel fuller than you would otherwise,” he said.

Still, specific doses of semaglutide and other anti-obesity drugs have been hard to come by due to recent shortages caused by manufacturing issues and high demand, spurred in part by celebrities on TikTok and other social media platforms bragging about greater weight loss. .

Also, many insurers won’t pay for the drug, which costs about $1,300 a month. “I sent in the recipe yesterday,” said Fox. “I’m not holding my breath that insurance covers this.”

A specialist in pediatric obesity cautioned that while children with obesity should be treated early and intensively, he feared that some doctors could quickly turn to drugs or surgery.

“It’s not that I’m against drugs,” said Dr. Robert Lustig, a longtime specialist in pediatric endocrinology at the University of California, San Francisco. “I am against the indiscriminate use of these drugs without addressing the cause of the problem.”

Lustig said children should be evaluated individually to understand all the factors that contribute to obesity. He has long blamed excess sugar for the rise in obesity. He calls for a sharp focus on diet, particularly 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 on potential long-term effects before she starts prescribing it regularly.

“I wish it was used a little more consistently,” she said. “And I would have to have that patient come in quite frequently to be monitored.”

At the same time, she welcomed the group’s new emphasis on immediate and intensive treatment of obesity in children.

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

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The Associated Press Department of Health and Science is supported by the Educational and Science Media Group at the Howard Hughes Medical Institute. AP is solely responsible for all content.

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