Updated guidelines urge pediatricians to take a more proactive approach to treat childhood obesity

Vital Signs Summer 2023 - Pediatric Obesity
Health care, fitness and weight loss. Child on analytical balance.

Updated guidelines are calling upon pediatricians to take a more proactive approach when they note weight problems in children and teens, including recommending obesity medications and bariatric surgery as acceptable and effective treatments.

The evidence-based guidelines, issued by the American Academy of Pediatrics, explore the range of treatment options, including diet and exercise, available to children and teens. However, the recommendations differ from previous advice by urging doctors and parents not to delay treatment to address significant weight issues and to transition to more aggressive treatment if lifestyle modification is ineffective.

About one-in-five U.S. kids, ages 2 through 19, are obese, according to the U.S. Centers for Disease Control and Prevention. The guidelines suggest considering obesity medications as early as age 12. While some parents may be taken aback by the recommendations, the advice is based on recent scientific evidence that has helped to reveal the underlying physiological pathways that lead to weight problems and the advent of targeted medications addressing those biological underpinnings. "We've learned obesity is a chronic disease and not just a lack of willpower or due to a poor lifestyle," says Dr. Manal Habib, a UCLA Health pediatric endocrinologist and weight-management specialist.

Obesity medications and bariatric surgery, she says, "target the chronic disease aspect of it." These approaches are justified in light of the serious consequences of obesity that are increasingly seen in children, including type 2 diabetes, high blood pressure, high cholesterol, sleep apnea, nonalcoholic fatty liver disease and joint problems.

Clinical trials have shown weight-loss medications that have been approved by the FDA are safe and tolerable in children as young as age 12; trials are ongoing for younger age groups. Evidence also supports the effectiveness of bariatric surgery for some teens, Dr. Habib says. "Historically, bariatric surgery has been viewed as a last resort. The guidelines outline that we're targeting the pathway physiology of the disease. We should be referring these patients earlier rather than waiting for things to get more severe," she says.

The guidelines, however, are not without controversy, even within the medical community. "The clinical practice guideline focuses on weight loss as the primary marker of success and the primary tool to address health problems that develop in some children with obesity," says Dr. Cambria L. Garell, a UCLA Health pediatrician and associate medical director of the Fit for Healthy Weight program. "But it is not the weight per se that is the problem. What we worry about is the risk of diabetes, high blood pressure, high cholesterol, fatty liver disease and other comorbidities that can arise as a consequence of obesity."

A child who is overweight or obese but otherwise healthy and has no related health issues does not require aggressive weight loss, Dr. Garell adds. "I'm disappointed the guidelines didn't take a more nuanced approach. My major concern is that they miss an opportunity to highlight that there are tools that can address the associated health issues other than weight loss."

The guidelines also address approaches to prevent weight problems in children. For example, promoting healthier school environments is a measure that could help lower rates of childhood obesity. "A lot of studies have shown preventing obesity is much more effective than treating obesity," Dr. Habib says. "We need to advocate for these changes because, ultimately, prevention is much better than a cure."