New guidelines from the American Academy of Pediatrics (AAP) state that obese children should be evaluated and treated “early and aggressively” with medications or weight loss surgeries.1 This is the first guidance from the AAP in 15 years on childhood obesity, which affects more than 14.4 million children in the U.S. and has tripled in the past three decades.
According to new AAP guidelines released last month, doctors should offer children 12 years of age and older appropriate weight loss drugs and offer surgical weight loss options for those 13 years and older.1
Guidelines Discuss Obesity as a Biological Problem, Not a Lifestyle Problem
The new guidance points to obesity being a biological problem and a complex, chronic disease. Sandra Hassink, MD, medical director for the AAP Institute for Healthy Childhood Weight, said that the guidelines aim to reset the inaccurate view of obesity as a personal behavior problem.
“This is not different than you have asthma and now we have an inhaler for you,” Dr. Hassink said.1
Aaron Kelly, PhD, co-director of the Center for Pediatric Obesity Medicine at the University of Minnesota said that obesity is not a lifestyle problem but that it predominately emerges from “biological factors.” 1
Obesity Rates Tripled Over the Past Three Decades
In years past, childhood obesity has been called “one of the most serious public health challenges of the 21st century.” Over the past three decades, childhood obesity rates have tripled in the U.S. and, today, one in six children is considered overweight or obese.2
“What we see is a continuation of weight gain and likelihood that they’ll have obesity in adulthood,” said Ihuoma Eneli, MD, who was a co-author of the AAP guidance. This is the first time the AAP’s guidance sets specific ages for children and teens to be offered drugs and surgery to lose weight. Dr. Eneli says that these should be offered in addition to diet, exercise, and other lifestyle interventions.1
CDC Expands Childhood Obesity Charts from BMI of 37 to BMI of 60
Shortly before the change in the AAP guidelines, the U.S. Centers for Disease Control and Prevention (CDC) expanded their Childhood Body Mass Index (BMI) Charts to reflect the country’s surging and “highly alarming” obesity rates to include those in the “severely” obese category. In December 2022, the chart was expanded from a BMI of 37 to a BMI of 60. According to pediatric endocrinologist Marisa Censani, MD, the updated charts will allow for better screening and tracking of obesity, which will allow for introduction of earlier interventions.3
Governor Ron DeSantis of Florida has commented on the AAP’s guideline changes, saying that pediatricians are “trying to monetize this issue” through use of drugs and surgeries.4
“Fact of the matter is, kids years ago were more active than they are now, they had better diets than they have now,” Gov. DeSantis said. “So why don’t we focus on those things rather than try to pump them with pharmaceuticals.”4
The AAP guidance argues that there is more evidence than ever that obesity treatment for children is safe and effective.4
New AAP Guidelines Follow Announcement of Recently Approved Obesity Drugs
The guidelines also come as new drug treatments for obesity in children have emerged. In December, a weekly injection of Wegovy was approved for children ages 12 and older.1 The drug is being marketed by pharmaceutical company Novo Nordisk A/S. Companies Eli Lilly & Co. and Pfizer are tailgating Novo with obesity drugs that mimic the same weight-related hormone known as GLP-1, which suppresses feelings of hunger. The drugs have also been used to reduce blood glucose levels which can help with diabetes.5
Wall Street has high expectations for this class of drugs with the obesity market in the country expected to reach $30 billion by 2030, according to analysts.5
In words that sounded more like marketing for the latest iPhone rather than a worldwide health crisis, Pfizer CEO Albert Bourla said in a Jan. 9, 2023 conference:
GLP-1, clearly everybody’s excited about that. This is a market that will grow to $90 billion altogether, and we are very confident about that given the current size of the market and the current growth rates.5
Bourla also said that Pfizer could earn an additional $10 billion in sales as a result of doctors prescribing the GLP-1 drug off label.5
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