Pediatrics Group Recommends Weight-Loss Drugs, Surgeries for Children With Obesity

For the first time in 15 years, the American Academy of Pediatrics (AAP) recommended that doctors prescribe weight-loss drugs for children with obesity, saying that early and proactive intervention is needed for the increasingly common problem.

In a set of new guidelines released on Jan. 9, the organization noted that pediatricians now have more evidence than ever before that obesity treatment for children is safe, effective, and provides long-term health benefits for children and their families.

Because obesity is a chronic disease with escalating effects over time, said the guidelines, it’s better to identify and treat obesity sooner than later. For children with obesity as young as 6, the family may need to start working with pediatricians and health care providers on changes to behavior and lifestyle.

The previous guidelines, released in 2007, recommended a “watchful waiting” approach to childhood obesity, which is no longer deemed appropriate.

“There is no evidence that ‘watchful waiting’ or delayed treatment is appropriate for children with obesity,” said Dr. Sandra Hassink, vice chairwoman of the clinical practice guideline subcommittee on obesity for the AAP. “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.”

In another major change, the AAP said physicians should offer young patients anti-obesity drugs and weight-loss surgeries alongside health behavior and lifestyle treatment. This comes after several drugs received federal approval for obesity treatment in adolescents.

For children aged 12 and up, the new guidance recommends four drugs—Orlistat, Saxenda, Qsymia, and Wegovy. It also recommends phentermine, a medicine used to lessen appetite, for teens aged 16 and older.

The guidelines also emphasized the role of parents in supporting their child’s obesity treatment, saying that doctors should have a better understanding of the “unique contextual elements” that affect the patient and family and that influence treatment.

“Research tells us that we need to take a close look at families—where they live, their access to nutritious food, health care, and opportunities for physical activity—as well as other factors that are associated with health, quality-of-life outcomes, and risks,” said Dr. Sarah Hampl, chairwoman of the guideline subcommittee. “Our kids need the medical support, understanding, and resources we can provide within a treatment plan that involves the whole family.”

One in five children and adolescents in the United States is living with obesity, according to the U.S. Centers for Disease Control and Prevention (CDC).

In December 2022, the CDC updated the Body Mass Index (BMI) chart that doctors have been using to estimate whether a child’s body mass composition is considered healthy compared to the broader population. For instance, a 16-year-old boy who is five feet, eight inches tall and weighs 240 pounds would have a BMI of 36.5 and be described as severely obese.

The previous BMI chart for children, published in 2000, stopped at a BMI of 37. The new chart has been extended to BMI measurements of up to 60 to reflect the increasing number of children with severe obesity.