The American Academy of Pediatrics (AAP) has released new guidelines on treating childhood obesity for the first time in 15 years, including drugs and surgery as options for the first time.
The group noted that early and aggressive treatment is needed as obesity rates among children have risen over the last 15 years – going from 17 per cent to 20 per cent, figures from the Centers for Disease Control and Prevention (CDC) show.
The number of obese children has tripled since the 1980s and quadrupled among adolescents.
The head of the Division of Pediatric Endocrinology and Diabetes at Mount Sinai Kravis Children’s Hospital, Dr Joan Han, said that the pandemic made the problem worse, according to NBC News.
A report from the CDC revealed that the rate of weight increase almost doubled in 2020, compared to the years before the pandemic.
Almost 15 million children and teenagers in the US are affected by obesity, according to CDC figures. Extra weight leads to physical health problems, such as Type 2 diabetes and increased blood pressure, but also impacts mental health.
The fresh guidelines note that obesity is a complicated and chronic condition without an easy solution.
The first approach should be to make changes in lifestyle and behaviour, the AAP says, adding that the new recommendations also advise for the first time that anti-obesity drugs and surgery be used.
The new approach comes after new research and approvals of new drugs.
The medical director of the AAP Institute for Healthy Childhood Weight, Dr Sandra Hassink, a co-author of the new guidelines, told NBC News that “we now have evidence that obesity therapy is effective. 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”.
The new guidelines are urging doctors to step in earlier rather than later, noting that there’s no evidence that a wait-and-see approach works.
The guidelines state that among children aged six years and up, and at times among those between two and five years old, the first measure should be regarding lifestyle and behaviour.
For those aged 12 and up, the new recommendations urge that drugs and surgery be used in addition to changes in lifestyle.
Research has found that an individual’s weight is affected by diet and exercise, but also by genetics and hormones, which has prompted the development of new medications.
“The breakthrough that happened in the last few years was people started realizing that there are hormones made in the gut that have multiple roles related to obesity. By targeting these, medications can help people feel full faster and help stabilize insulin levels,” Dr Han told NBC News.
“The problem with these medications is they are very expensive and insurance often doesn’t cover them,” Dr Han added, noting that one of the drugs used, Wegovy, can cost $1,500 a month.
In addition to drugs, the guidelines state that teenagers suffering from severe obesity should have the ability to undergo weight-loss surgery.
“The sooner the better for many things,” Dr Han told NBC. “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.”
Dr Hassink noted that surgery and drugs are not initial treatment options and should only be employed in specific scenarios when lifestyle changes don’t yield the results needed.
She added that the lifestyle changes needed can be very difficult for many families to follow.
“There is work going on, but we can safely say that all of us in this country are living in an environment that tends to promote obesity across the board,” Dr Hassink told NBC.
“There are a huge number of drivers of obesity that come from the environment itself. The more adverse the environment around you, the harder it is to live a healthy lifestyle,” she added.
A pediatric endocrinologist at Cleveland Clinic Children’s, Dr Roy Kim, told the outlet that “we can recommend more servings of vegetables and more fun physical activity. However, if a person’s neighborhood has no grocery stores to shop at or sidewalks or parks to walk in, these recommendations are not realistic”.
“We need to make walking places safe, easy and comfortable. We need to figure out ways to leverage existing opportunities for people to exercise and access healthy food that is cheap and convenient,” Dr Han said.
“The best, most effective, safest, and most economical approach will always be prevention,” Dr Kim added.
