Childhood obesity requires early, aggressive treatment, new guidelines say

Children with obesity should be offered more intensive treatment options earlier, including therapy and medication, says the leading U.S. pediatricians group.

The American Academy of Pediatrics' new guidance on childhood obesity — the first in 15 years — moves away from "watchful waiting," or delaying treatment to see if children outgrow obesity.

The group is now advising pediatricians to "offer treatment options early and at the highest available intensity" for one of the most common chronic diseases among children. Untreated, obesity is associated with a range of long-term health problems including heart disease and diabetes.

"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," Dr. Sandra Hassink, an author of the new guidance and vice chair of the AAP's Clinical Practice Guideline Subcommittee on Obesity, said in a news release.

The most effective interventions require upwards of 26 hours over three to 12 months of intense, in-person behavior and lifestyle treatment from health care providers. Such treatment includes coaching on nutrition, physical activity and changes in behavior, such as role modeling by parents.

This approach should be used for kids 6 and older – and may be recommended for those as young as 2 – and their families, the AAP says. But it acknowledges that this kind of time-consuming treatment is not universally available and is often difficult to deliver.

After this intensive therapy, weight loss drugs should be considered for adolescents as young as 12, the AAP says, while teens 13 and older with severe obesity should be evaluated for weight loss surgery.

This push to treat obesity earlier comes on the heels of the approval for children 12 and up of a new weight loss medicine called Wegovy, a weekly injection of a drug that is also used to treat diabetes. While it helped adolescents reduce their BMI – or body mass index – by about 16%, it's been difficult to access due to recent shortages and insurance companies declining to cover it.

The more than 14.4 million children who live with obesity face pervasive, harsh and unfair stigma, often even from doctors who are supposed to treat them. The AAP guidelines call for a "whole child" approach, acknowledging that obesity has complex causes including genetics and socioeconomic status rather than personal choices and emphasizing communication that is nonstigmatizing and supportive. [Copyright 2023 NPR]