Are Pediatricians Actually Recommending Surgery and Weight-Loss Drugs For Some Young People?

In a shocking decision, the American Academy of Pediatrics updated its guidelines for childhood obesity for the first time in 15 years; now, they include not only behavioural and lifestyle changes, but also weight-loss drugs and surgery in their treatment recommendations.

“We now have evidence that obesity therapy is effective. There is treatment, and now is the time to recognize that obesity is a chronic disease and should be addressed as we address other chronic diseases,” Sandra Hassink, MD, medical director of the AAP Institute for Healthy Childhood Weight and co-author of the new guidelines told NBC News.

This news comes as the prevalence of childhood obesity has increased over the past decade, per the Centers for Disease Control and Prevention. Between 2017 and 2020, 19.7 percent of children and adolescents in the US were considered obese, affecting approximately 14.7 million children between ages 2 and 19. Whereas, in 2007-2008, the prevalence among the same age group was 16.9 percent, according to the CDC. The COVID-19 pandemic has also played a role in adolescent weight gain due to disrupted routines, increased stress, and less physical activity.

The decision to change the AAP guideline has stirred up controversy on social media about whether or not weight-loss medications and surgery are the best solutions.

“I struggled with childhood obesity and the scars from it negatively impacted my life for decades. In spite of this I’m grateful that I never had a surgical intervention as a teenager. There was nothing wrong with my body, my problems were mental & emotional,” wrote Matt Izzo, a fitness coach and ironman athlete, on Twitter.

“The new guidelines from the American Academy of Pediatrics are devastating, harmful, and WILL lead to more eating disorders. And trust me, my colleagues and I have no need for more clients. ,” tweeted Shira Rose, LCSW, an eating disorder therapist.

“As a parent and educator, someone who grow up fat and took weight loss meds and then had bariatric surgery:

I’m disturbed that the AAP would recklessly promote changing a developing human’s body. This is so harmful,” tweeted Chanea Bond, a teacher and literacy educator.

Others seem to think that the new guidelines could be a step in the right direction. “Finally! AAP publishes guidelines for treating pediatric obesity. “…watchful waiting or unnecessary delay in treatment is no longer acceptable,” tweeted Sarah Ro, MD, an obesity medicine physician.

What do the new guidelines actually say and how will they impact your child’s next doctor’s visit? Here’s what you need to know.

What Do the New AAP Guidelines Actually Say?

First, it helps to know what the AAP means by “obesity.” According to the AAP, “Overweight is defined as a body mass index (BMI) at or above the 85th percentile and below the 95th percentile for children and teens of the same age and sex. Obesity is defined as a BMI at or above the 95th percentile for children and teens of the same age and sex.”

New AAP guidance recommends that pediatricians and other clinical providers focus on earlier intervention, which means starting evaluation and treatment for childhood obesity as early as age 2, instead of waiting until age 6.

For children considered obese, the AAP recommends “comprehensive obesity treatment,” which can include nutrition support, physical activity treatment, behavioral therapy, pharmacotherapy, and metabolic and bariatric surgery.

The AAP emphasized that intensive behavioral and lifestyle treatments are their first-line approach and are the “most effective known behavioral treatment for child obesity.” It’s recommended that these interventions happen in-person, engage the whole family, and include at least 26 hours of nutrition, physical activity, and behavior change lessons over three to 12 months, the AAP says.

But the new guidelines also suggest that pediatricians consider weight-loss drugs (including Orlistat, Saxenda, Qsymia, and Wegovy) for children ages 12 and up and who struggle with obesity, as well as metabolic and bariatric surgery for teens age 13 and older with severe obesity alongside these behavioral and lifestyle interventions.

For kids 16 and older, the drug phentermine has been approved. And for those age 6 and older who have a genetic disposition to obesity, setmelanotide has been approved.

What Can Parents Expect at Checkups Now?

Checkups, in many ways, will remain the same. “Pediatricians have always checked weight and height to make sure children are growing in a healthy way, and that will not change,” said Jennifer Woo Baidal, MD, assistant professor of pediatrics at Columbia University in an interview for New York Presbyterian’s “Health Matters.” But the new guidelines may change how soon your child’s provider brings up certain intensive lifestyle interventions (like reducing sedentary activity and changes in diet). If your child is gaining weight more quickly than expected, their pediatrician may bring up interventions sooner rather than later. Also, “recommendations to start medications may occur more quickly than in the past. And for adolescents with severe obesity, pediatricians may refer them to bariatric surgery earlier on,” Dr. Baidal said.

As far as side effects go, the new AAP guidelines don’t go without acknowledging the parental concern regarding disordered eating and poor mental health. “The prevalence of eating disorders is not well-characterized in patients participating in obesity treatment, but disordered eating patterns may be more common among youth with obesity compared with youth at a healthy weight,” the AAP says. Because of that pediatricians and other primary care doctors are encouraged to evaluate patients before, during, and after intensive behavioral intervention for the presence of disordered eating, as well as for greater-than-expected weight change. In terms of mental health concerns, “there is no evidence that obesity treatments harm patients’ quality of life,” per the AAP, but they also acknowledged that more research is necessary to better understand how these treatments can impact a child’s mental health.

Ultimately, the decision to move forward with these new recommendations will be one for you and your child to discuss with the provider. “Seeking a consultation to understand more about what surgery means does not mean a commitment to it,” Dr. Baidal emphasized. And the same goes for new drug interventions.