New guidelines say childhood obesity should be treated early and aggressively. Is this safe?

The American Academy of Pediatrics has released new guidelines for treating obesity in children and adolescents.

The 73-page guidelines outline a proactive approach in which children and their families are counseled early about weight-loss treatments. Treatments include time-intensive programs focused on nutrition and physical activity, as well as weight-loss medications for children as young as 12 and metabolic and bariatric surgery for adolescents 13 and older.

The guidelines are intended to curb the negative health consequences associated with untreated childhood obesity. Obese children and teens are at increased risk for heart disease, high blood pressure, insulin resistance, prediabetes and type 2 diabetes in both the short and long term. The report notes that studies have shown that a child's weight is a good predictor of their weight in adolescence and adulthood, and the link between obesity and increased health risks in adulthood is well established. Therefore, by having doctors treat obesity early, the authors write, the AAP aims to prevent a lifetime of health problems.

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The new guidelines have received mixed reactions, with some experts hailing it as a "long overdue and critical" shift in how U.S. doctors treat childhood obesity. Others say it perpetuates anti-obesity bias and could push doctors to use aggressive interventions as a first-line treatment rather than a last resort.

Live Science asked experts for their thoughts on the guidelines, and they generally agreed that the AAP provides an evidence-based review of childhood obesity and the best available treatments. However, as it stands, most children may not get the gold-standard care the guidelines recommend. As a result, there's a risk that busy pediatricians will recommend weight loss but lack the time to guide them through the process safely, potentially leaving children vulnerable to eating disorders. In addition, scientists are still studying the long-term consequences of diet pills.

The guidelines are intended to curb the negative health consequences associated with untreated childhood obesity. Obese children and teens are at increased risk for heart disease, high blood pressure, insulin resistance, prediabetes and type 2 diabetes in both the short and long term. The report notes that studies have shown that a child's weight is a good predictor of their weight in adolescence and adulthood, and the link between obesity and increased health risks in adulthood is well established. Therefore, by having doctors treat obesity early, the authors write, the AAP aims to prevent a lifetime of health problems.

The new guidelines have received mixed reactions, with some experts hailing it as a "long overdue and critical" shift in how U.S. doctors treat childhood obesity. Others say it perpetuates anti-obesity bias and could push doctors to use aggressive interventions as a first-line treatment rather than a last resort.

Live Science asked experts for their thoughts on the guidelines, and they generally agreed that the AAP provides an evidence-based review of childhood obesity and the best available treatments. However, as it stands, most children may not get the gold-standard care the guidelines recommend. As a result, there's a risk that busy pediatricians will recommend weight loss but lack the time to guide them through the process safely, potentially leaving children vulnerable to eating disorders. In addition, scientists are still studying the long-term consequences of diet pills.

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Many patients do not have the access, resources, or time to participate in structured and specialized pediatric obesity treatment, suggesting that children’s weight loss treatment may not be adequately monitored.

Older teens and young adults who are overweight or obese are more likely to engage in disordered eating behaviors, such as fasting, than their thinner peers, but are less likely to be diagnosed with an eating disorder than their underweight peers. This is dangerous because teens with disorders such as anorexia can have dangerous illnesses even if they are not underweight.

Doctors should discourage patients from using risky weight control strategies, explain the risks, and monitor the pace and extent of weight loss. Many doctors have limited training in eating disorders and limited time to interact with patients, so ensuring children receive that care can be difficult. The AAP also provides examples of using neutral language when talking about children's weight. Broadly, the guidelines define obesity as a complex, chronic disease influenced by a variety of factors, from genetics to socioeconomics, rather than a "reversible consequence of personal choices," as has been believed in the past, the guideline authors wrote.

The guidelines emphasize "treating the whole child" rather than focusing on a number on the scale. In practice, that means taking into account the child and their family's medical history, vital signs and labs, nutrition and physical activity habits, mental health, and social environment, rather than just checking their body mass index (BMI) — an estimate of body fat calculated from weight and height. That said, BMI remains a factor in children's assessments, even though the measure has been widely criticized as an imprecise measure of fat and a poor indicator of overall health. More precise methods of measuring body fat are more cost-intensive and time-consuming, and therefore are not often used in clinical or research settings.

"Overweight" is defined as a BMI at or above the 85th percentile and below the 95th percentile for children of the same age and sex, and "obese" is defined as a BMI at or above the 95th percentile. The higher the percentile, the more likely a child is to carry excess fat. However, this is still just one of several measures we have of a child's health and whether their weight is negatively affecting them.

What are my options for weight loss treatment?

One is motivational interviewing, a type of counseling in which doctors help children and their families adjust their nutrition and physical activity. A similar but more extensive intervention, called Intensive Healthy Behavior and Lifestyle Treatment (IHBLT), focuses on introducing similar lifestyle changes and making them sustainable in the long term.

The guidelines state, "IHBLT is most effective when it is delivered face-to-face, engages the entire family, and provides at least 26 hours of nutrition, physical activity, and behavior change sessions over a 3- to 12-month period." Despite the research support, these types of programs are not readily available for many children because few agencies host them and they are rarely covered by insurance.

As an adjunct to IHBLT, doctors can prescribe obesity-related weight loss medications for children ages 12 and older. These treatments include Wegovy (generic name semaglutide), a once-weekly injection that affects communication between the brain and the gut, reducing the user's appetite.

Weight-loss drugs approved for use in children have been in trials for about a year, but we don't yet have data on their use after five or 10 years. There are also no set recommendations for how long children should use these drugs. Adolescents 13 and older who are severely obese -- meaning their BMI is at or above 120% of the 95th percentile for age and sex -- can also be referred to a specialist for metabolic and bariatric surgery evaluation.

Evidence shows that these surgeries can reduce weight in teens and combat obesity-related health problems, such as diabetes and high blood pressure. However, eating disorder experts worry that surgeries can harm patients' relationships with food by changing how and what foods they eat, according to NPR; other experts worry that doctors are turning to surgery too quickly without exhausting other options, according to STAT.

Others believe that surgery is just another option for patients and should be considered if necessary.

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Source: Live Science "Childhood obesity should be treated early and aggressively, new guidelines say. Is that safe?"

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