On Monday, the American Academy of Pediatrics listed new guidelines for treating obesity in those aged two years or older for the first time in 15 years–and the recommendations include weight-loss medication and even bariatric surgery for children.
The guidelines acknowledge that obesity is a chronic disease linked to factors such as lack of access to nutritious foods, physical activity and healthcare.
The new recommendations focus on treatment of obesity rather than obesity prevention, which “will be addressed in another forthcoming” policy statement, according to the academy.
It’s recommended that children six years or older should be annually tested for obesity through methods like body mass index (BMI) checks and motivational interviews.
Children under the age of two were not included in the recommendations because it’s hard to “practically define and measure excess adiposity in this age group,” according to the new guidelines.
Overweight in children and teens is defined as having a BMI at or above the 85 percentile and below the 95 percentile—obesity in children and adolescents is defined as having a BMI at the 95 percentile or higher, according to the Centers for Disease Control and Prevention.
For example, a 10-year-old boy with a BMI of 21 would put him in the 85 percentile and be considered overweight, where a 10-year-old boy with a BMI of 23 (95 percentile) would be considered obese.
Over 14.4 million children in the U.S. have childhood obesity and are at a higher risk for type two diabetes, sleep apnea, gallbladder disease, heart disease, asthma and joint and bone issues, accordingto the CDC.
The objective of the new guidelines is to assist patients in making sustainable “changes in lifestyle, behaviors or environment,” Dr. Sandra Hassink, an author of the new guidelines and vice chair of the AAP’s Clinical Practice Guideline Subcommittee on Obesity, said in a news release.
The academy recommends the use of weight-loss drugs in children aged 12 years or older, as well as behavioral therapy and lifestyle treatment. There was not enough evidence to recommend the use of weight-loss drugs in children under the age of 12 for the sole purpose of treating obesity. For children aged 13 or older with severe obesity, weight-loss surgery should be looked into, according to the new guidelines. A study found that adolescents who received bariatric surgery—a class of surgical procedures performed on the intestines or stomach to help with weight loss—saw a BMI reduction of 29%.
WEIGHT-LOSS MEDICATION APPROVED FOR CHILDREN
There are several Food and Drug Administration approved weight-loss drugs for children. The research group said glucagon-like peptide-1 receptor agonists (a class of type two diabetes drugs that are linked to weight-loss) like semaglutide, exenatide, liraglutide and dulaglutide reduce hunger by “slowing gastric emptying and by acting on targets in the central nervous system.”
- Novo Nordisk’s Wegovy—an injectable diabetes drug under the generic name semaglutide—is approved for children 12 and up with obesity. Due to popular demand, Wegovy is now listed by the FDA as being in a supply shortage.
- Daily injectable liraglutide (brand name Saxenda) is FDA approved for obesity management in children 12 years or older.
- In June 2022, the FDA approved a supplemental indication for phentermine and topiramate extended-release capsules (brand name Qsymia) for chronic weight management in patients aged 12 or older diagnosed with obesity.
- Daily capsule orlistat (brand names Alli and Xenical) are FDA approved for use in children 12 years or up to treat obesity.
OFF-LABEL WEIGHT-LOSS DRUGS
- Exenatide (another weekly injectable under brand names Byetta and Byduren) was approved for use in children 10 to 17 years of age with type two diabetes. Although it hasn’t been approved for weight-loss purposes, studies have found that obese children aged 9 to 16 experienced significant weight-loss while taking exenatide.
- Daily pill Metformin—brand names Fortamet and Glumetza—is a type two diabetes drug. Studies have found that the use of metformin in obese children aged 10 or up resulted in “significant reductions in weight.” A 2021 AAP report found that metformin was the most commonly prescribed weight-loss drug among children and adolescents.
- Topiramate is an FDA approved seizure medication approved for use in adults and children, according to the U.S. National Library of Medicine. A study found that children 12 and up with severe obesity who took topiramate for a 16 week period saw reductions in BMI and weight.
A study published in the New England Journal of Medicine found that adolescents aged between 12 and 17 who took Wegovy along with counseling lost an average of 14.7% of their body weight. Participants who received the placebo gained 2.7% of their initial weight. Over 40% of patients reduced their starting BMI by 20%, Aaron Kelly, co-director of the Center for Pediatric Obesity Medicine at the University of Minnesota told NBC. A 17-year-old participant told NBC that she lost 70 pounds during the trial.