Battling against child obesity: Pediatricians suggests weight loss drugs in addition to healthy diets

11 Jan 2023 --- The American Academy of Pediatrics (AAP) has published a report on new guidelines to tackle the epidemic of child and adolescent obesity in the US. In addition to nutritional diets, weight loss drugs or surgery are being proposed as an extra measure. 

According to the report, 14.4 million children and adolescents suffer from obesity, making it the country’s most common pediatric chronic disease.

“These guidelines are for treating children with obesity and recommend a comprehensive approach. This includes intensive health behavior and lifestyle treatment, which includes nutrition and physical activity intervention,” Sarah Hampl, lead author of the report and professor of pediatrics at the University of Missouri-Kansas City School of Medicine, tells NutritionInsight.

“Rates of obesity and severe obesity in children are rising. There are many personal, family and societal costs associated with obesity, so early intervention is essential to help prevent later illness and death. I am unsure if there is a specific time when obesity levels will drop.”

While the academy is pushing for safe medications, addiction risks have not yet been confirmed. Hampl says that, to her knowledge, there is no evidence that weight loss medications are addictive. The AAP says in an announcement that “there is more evidence than ever that obesity treatment in children is safe and effective.”

“There are several decades of evidence to support this treatment’s effectiveness, yet it alone may not be sufficient for all adolescents with obesity. Some adolescents may require weight loss medication in addition to intensive health behavior and lifestyle treatment,” she says.

Cure rather than prevent?
The guidelines are based on systematic reviews and expert panels. It serves as a prevention guide for annual BMI (Body Mass Index), dietary patterns and nutrition and physical activity counseling for children starting at age two.

The report says that because obesity is a chronic disease with escalating effects over time, a life course approach to identification and treatment should begin as early as possible.“Our guidelines state that adolescents with severe obesity should be referred for evaluation for metabolic and bariatric surgery to a comprehensive pediatric metabolic and bariatric surgery center which is able to help them thoroughly prepare for surgery and follow them long-term after surgery,” says Hampl.

She adds that weight loss medication or metabolic and bariatric surgery may be lifesaving for adolescents with severe obesity-related complications.

When medication is the approach
The report says that because obesity is a chronic disease with escalating effects over time, a life course approach to identification and treatment should begin as early as possible and continue longitudinally through childhood, adolescence and young adulthood with the transition into adult care.

The authors recommend pediatricians and other primary health care providers that they “may offer children ages eight through 11 years of age with obesity weight loss pharmacotherapy, according to medication indications, risks and benefits as an adjunct to health behavior and lifestyle treatment,” states the report.

It continues to say that for children below 12 years old, there is insufficient evidence to use pharmacotherapy solely for obesity.

“Medications should be prescribed by healthcare providers who have had training on their use. When these medications are used, adolescents should be monitored for side effects like with any other medication. These medications may be needed for a lifetime.” 

The guidelines state that more advanced treatments should be considered in addition to intensive health behavior and lifestyle treatment.

“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,” Hampl details.

Underlying reasons
One reason for child and adolescent obesity given in the report is the marketing of foods with low nutritional value. Another is food insecurity, where the report points out that children living in households with food insecurity tend to have a higher BMI score and waist circumference measurement and a greater likelihood of being obese or overweight.Hampl says that a closer look at families is needed, as to where they live, their access to nutritious food, health care and opportunities for physical activity.

Although food insecurity is mainly connected to adolescents that have experienced food insecurity during childhood, the report also details that female children in a food-insecure environment have a higher risk for obesity, which originates from a lower socioeconomic status.

“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 associated with health, quality-of-life outcomes and risks. Our kids need the medical support, understanding and resources we can provide within a treatment plan that involves the whole family,” says Hampl.

In the World Health Organization’s report on obesity published last year, it says that there is no current evidence supporting weight loss medication used as a monotherapy. It argues that “clinicians prescribing these medications to adolescents should provide or refer to intensive behavioral support for patients and families as an adjunct to pharmacotherapy.”

Hampl says that there is a lack of evidence that weight loss medication is addictive. However, the American Addiction Center said in an announcement in November that “addiction to weight loss pills is a genuine possibility for those who use these medications – even for people who don’t think they are ‘abusing’ the drugs.”

By Beatrice Wihlander