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January 09, 2023

New childhood obesity guidelines advise drugs, surgery as treatment options in some cases

The American Academy of Pediatrics is moving away from the 'watchful waiting' approach it previously recommended

New guidelines for childhood obesity emphasize that intense behavioral and lifestyle changes should be the first treatment approach, but they also now recommend anti-obesity medications and surgery in some cases.

The guidelines, published Monday by the American Academy of Pediatrics are intended to assist clinicians as they treat children with obesity. It marked the first time they have been updated since 2007.

"We now have evidence that obesity therapy is effective," Dr. Sandra Hassink, medical director of the AAP Institute for Healthy Childhood Weight and co-author of the new guidelines, told NBC News. "There is treatment, and now is the time to recognize that obesity is a chronic disease and should be addressed as we address other chronic diseases."

Childhood obesity is a serious problem in the United States, affecting nearly 20% of children and adolescents ages 2 to 19, according to the Centers for Disease Control and Prevention. Obesity rates risen over the years, with the COVID-19 pandemic exacerbating the issue

Obesity can lead to high blood pressure, high cholesterol, type 2 diabetes, joint problems, depression and breathing problems such as asthma and sleep apnea. 

The new guidelines stress that obesity is a complex condition with no quick fix. Surgery and medications are not first-line treatments; the AAP recommends they be considered only when lifestyle changes prove ineffective. The recommendation to consider their use was made in response to research and drug approvals made in recent years. 

Studies have shown that a person's weight is not solely determined by diet and exercise; genetics and hormones also may play a role. This understanding has been the basis for the development of new medicines — there are currently four drugs approved for obesity treatment in adolescents ages 12 and older. 

The last set of guidelines recommended a "watchful waiting" approach to childhood obesity. But information collected over the past decade revealed no evidence that delaying appropriate treatment is beneficial, the new guidelines say.

"There is no evidence that 'watchful waiting' or delayed treatment is appropriate for children with obesity," Dr. Sandra Hassink, an author of the guideline, said in a news release. "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 first treatment approach for children ages 6 and older – and, in some cases, ages 2 to 5 – is working with heath care providers to adopt lifestyle changes, according to the guidelines. Because obesity is considered a chronic disease, treatment is most effective when patients receive at least 26 hours of face-to-face counseling during the year, the guidelines say. Experts acknowledge that this may pose a challenge for some families. 

Children ages 12 and older should be offered anti-obesity drugs alongside lifestyle changes, the guidelines say. Those 13 and older with severe obesity should be evaluated for weight-loss surgery. 

"The sooner the better for many things," Dr. Joan Han, chief of the division of pediatric endocrinology and diabetes at Mount Sinai Kravis Children's Hospital, told NBC News. "There is research that shows that getting bariatric surgery sooner can reverse health issues like type 2 diabetes and high blood pressure, which is why surgery should be considered for pediatric patients."

Though guidelines on obesity prevention will be released in the future, the AAP emphasized the importance of funneling money into public health polices aimed at obesity prevention, evaluation and treatment. This includes creating safely walkable neighborhoods, giving schools the tools to support healthy lifestyles and assuring everyone has equal access to affordable, healthy food. 

Childhood obesity is a disease caused by complex genetic, physiologic, socioeconomic and environmental contributors. It is not something necessarily caused by one's individual choices — and the AAP notes that it should not be stigmatized by health care providers.

"Weight is a sensitive topic for most of us, and children and teens are especially aware of the harsh and unfair stigma that comes with being affected by it," Dr. Sarah Hampl, a lead author of the guidelines and pediatrician and weight management specialist at Children's Mercy of Kansas City, said in a news release. "Our kids need the medical support, understanding and resources we can provide within a treatment plan that involves the whole family."

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