Mon. Jul 22nd, 2024

Health panel urges interventions for children and teens with high BMI

With obesity continuing to loom as a major public health threat, a leading panel of independent U.S. health experts released recommendations Tuesday urging doctors to refer children and teens with obesity to programs that can provide guidance on healthy eating, safe exercising and understanding food labels.

The guidelines from the U.S. Preventive Services Task Force apply to children and teenagers 6 and older with a body mass index — known as a BMI — in the 95th percentile. BMI is a calculation that estimates body fat based on weight and height. The recommendations are consistent with guidance from 2017, but the task force said it is going further, moving from screening alone to implementing interventions.

Some physicians and obesity experts laud the efforts to address the rising crisis, but others say the task force should also consider medication interventions, including the use of a semaglutide drug, the increasingly popular class of weight-loss medications. The Food and Drug Administration approved use of the drug Wegovy in children 12 and older in 2022.

“Having the option of medication in the appropriate clinical scenario is very important,” said Susma Vaidya, an associate medical director at the IDEAL Clinic, the weight-loss program at Children’s National Hospital in D.C. “I am a big believer in medication, and I think that we have been advocating for lifestyle change for a long time and haven’t made a whole lot of progress.”

Somourne K. Williams, 50, whose son, BJ, started a weight-loss drug in March 2023, said the tipping point for her was when her son was bullied in school.

“He wrote a suicide note, and when I asked him why, he said he ‘felt helpless because he couldn’t help his weight,’” Williams, who lives in South Carolina said.

Weighing 340 pounds at age 16 and having diabetes, BJ set a goal weight of 220 pounds, which he achieved in January. Williams said she was confident in the weight-loss drug, emphasizing that she believed the benefits outweighed potential risks.

“He’s more outgoing, and he’s at a healthier weight,” Williams said. “Now, seeing him smile means the world to me.”

In a 2023 randomized controlled trial of semaglutide involving adolescents ages 13 to 17 with a BMI at or above the 95th percentile, 44 percent of the teens taking the drug recorded a drop in BMI so significant they were reclassified as being normal weight or overweight, rather than obese.

But as demand for anti-obesity medications has skyrocketed, reports of side effects, including nausea, vomiting and diarrhea, have caused some parents to fear that anti-obesity drugs will have long-term health consequences. Physicians respond that the physical and mental effects of obesity can be lifelong and crippling.

Children who are obese are at increased risk of developing chronic conditions such as Type 2 diabetes, high blood pressure and heart disease. Obesity in childhood can have significant mental and social implications, including depression and anxiety.

“We don’t have long-term data on weight-loss drugs, and I get that it is a concern, but we do have long-term data on the outcomes associated with obesity, and we know that individuals with obesity are at risk for certain comorbidities,” Vaidya said.

The Centers for Disease Control and Prevention categorize 20 percent of children and teenagers ages 2 to 19 to be obese. As part of its guidelines, the Preventive Services Task Force said that providing 26 hours or more of counseling and supervised physical activity for up to one year resulted in weight loss for both children and adolescents.

Pediatricians say adding an anti-obesity medication to a weight-loss program can improve a patient’s BMI significantly, and it’s a step taken if the benefits outweigh the harm.

“It’s a case-by-case decision based on the child, but we’re not talking about the teen who wants to lose a few pounds for the summer,” said Mona Sharifi, a pediatrician and researcher at Yale School of Medicine and a fellow of the American Academy of Pediatrics. “We’re talking about the child who is severely affected, and they need to be presented with all their options.”

The task force said it did not include weight-loss drugs in its recommendations because the drugs have not been studied sufficiently in adolescents. It emphasizes the importance of conducting additional research before recommending that medications be incorporated into treatment plans, according to John M. Ruiz, a U.S. Preventive Services Task Force member. Recommendations or changes are typically implemented every five years, but as evidence on the drugs emerges, the guidance could be amended, he said.

“If there’s a fundamental shift in our understanding of health challenges, the task force can sometimes review the recommendations,” Ruiz said.

Unlike the task force, the American Academy of Pediatrics recommended in 2023 that weight-loss medications for eligible patients be reviewed with families. The biggest hurdle is getting insurers, including government programs, to cover the cost of medications. The Medicare Modernization Act of 2003 restricts coverage of weight-loss medications such as Wegovy, which can cost more than $1,000 a month without insurance.

The CDC estimates that childhood obesity costs the United States more than $1 billion in health spending annually. Sharifi said early interventions might decrease that cost but added that if there is no funding for these programs, a larger pool of people will need expensive medications and surgeries later.

“What’s heartbreaking is despite years of recommendations demonstrating strong evidence, we still do not have access to intensive behavioral treatment programs nationally,” Sharifi said. “There are pediatricians trying to fit these interventions into their 20-minute appointment with families and that doesn’t work.”

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