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Pediatricians Recommend Weight-Loss Drugs for Obese Children

American Academy of Pediatrics urges early, intensive treatment


Children 12 and older who are obese should be offered weight-loss medications alongside lifestyle and behavioral counseling, according to new American Academy of Pediatrics guidelines.


By Sarah ToyFollow

Jan. 9, 2023 12:01 am ET


The American Academy of Pediatrics for the first time recommended physicians offer weight-loss drugs for children with obesity, aiming to take early action against an increasingly common condition linked to a host of health problems.


Children 12 or older who are obese should be offered medications for weight loss alongside lifestyle and behavioral counseling, according to guidelines published on Monday by the largest professional association of pediatricians in the U.S. The association also recommended that doctors offer to refer severely obese children 13 or older to surgeons to assess whether they would be good candidates for bariatric surgery. It said pediatricians should screen obese children for high cholesterol, diabetes and hypertension.


The guidance is more aggressive than previous recommendations the AAP published in 2007. It focuses on intensively treating obesity immediately rather than in stages, said Sarah Hampl, a lead author of the guidelines and a pediatrician at Children’s Mercy Kansas City in Kansas City, Mo.


“What we now know is that obesity is a chronic disease in children and adolescents,” she said. “Treatment should be started early and at the highest available intensity.”


Obesity is on the rise in the U.S. About a fifth of children in the U.S. are considered obese, according to the most recent data from the Centers for Disease Control and Prevention.


The rate of increase in body mass index, a screening tool doctors use to detect excess body fat, more than doubled among young children and adolescents during the pandemic.


Public-health experts cited school closures, disrupted routines and increased stress as possible reasons for the surge. Rates of other health problems including stress, heart attack and stroke also increased during the pandemic.


The AAP mentioned some drugs that could be prescribed for such treatment, including orlistat, which blocks fat absorption; semaglutide, which decreases hunger; and metformin, a diabetes drug.


Orlistat and semaglutide are approved by the Food and Drug Administration for treatment of obesity in children 12 years and older. Metformin hasn’t been approved as a weight-loss drug, though it has been used off-label for that purpose in children. Studies of its effect on weight loss have shown mixed results, the AAP said. Pediatricians can consider prescribing it to children with obesity under specific conditions, the AAP said: alongside intensive health behavior and lifestyle counseling and when there is another medical reason to do so, such as Type 2 diabetes.


People who are overweight or obese are more likely to develop Type 2 diabetes, heart disease, stroke, arthritis and breathing problems. By the time children who are obese reach adulthood, they may already have some of those health problems, said Stanley Spinner, a pediatrician and chief medical officer of Texas Children’s Pediatrics.


“We have to prevent this and catch it early,” Dr. Spinner said. But he said he wouldn’t be comfortable prescribing weight-loss drugs to children until long-term side effects are better understood.


Research has shown some benefit in prescribing certain drugs for weight loss and the AAP will continue to evaluate benefits and risks, Dr. Hampl said.


Sustained weight loss is difficult to achieve because so many factors affect it. Genetics, limited access to healthy food in some places and the promotion of unhealthy foods are among factors that can contribute to obesity, Dr. Hampl said.


Some people don’t have access to doctors who specialize in treating obesity, she added, so it is helpful for pediatricians to understand available options such as prescription medications.


“We have more tools in our toolbox now than ever before,” Dr. Hampl said.


Write to Sarah Toy at sarah.toy@wsj.com

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