Medicine and surgery are not the answer for overweight children, the World Health Organisation has said, releasing its first guidelines addressing the escalating obesity among children and adolescents, and in which it recommends structured diets, physical activity and behaviour changes, reports IOL.
The guidelines advise against pharmacological treatment, bariatric surgery or weight-loss devices for children under nine, and for those between 10 and 19, “treatment with approved medicines may be considered only when a supervised multimodal lifestyle programme has not achieved the desired results”.
Bariatric surgery should be considered only under strict conditions for adolescents with severe obesity, the agency cautions.
Since 1990, the number of obese children aged five to nine, and adolescents between 10 and 19, has quadrupled, skyrocketing from 2% to 8%.
More than 170m children and adolescents now have the chronic condition, which increases the risk of medical complications that include type 2 diabetes and cardiovascular disease, reports Health Policy Watch.
The growing global burden is what prompted the issuing of guidelines, for what the WHO terms “person-centred” care – a combination of nutrition, physical activity, behavioural management, and in some cases, medication or, in severe cases, surgery.
The recommendations are a product of evaluating 35 scholarly review articles, but research is still evolving, especially for pharmaceutical-based interventions in children.
“The rise of obesity is observed everywhere, in all regions,” said Luz Maria De Regil, director of the WHO’s nutrition and food safety department.
“The foundation of obesity care for children and adolescents is not medicine or surgery, but access to comprehensive support that enables healthy eating, physical activity and sustainable behaviour change.”
While pharmaceutical giants Novo and Eli Lilly are both running clinical trials on their GLP-1 drugs in children as young as six, the WHO had little research to draw on to assess whether these meet the bar of safety or efficacy for children under 10.
But that hasn’t stopped prescriptions, with a study published in the journal Paediatrics reporting that the number of children aged eight to 11 on GLP-1s “increased sharply” between 2019 and 2026.
The study estimates that out of a cohort of more than 3.5m children with obesity – and without diabetes – roughly 20 000 of them were prescribed GLP-1s.
A recent analysis from Lurie Children’s Hospital in Chicago found that GLP-1s may be linked to nutritional deficiencies in children, most notably a lack of vitamin D. The researchers found that only 5% of paediatric patients on GLP-1s received nutritional counselling.
“As appropriate paediatric use of GLP-1s becomes more widespread, we need to understand the risks during periods of rapid growth and pubertal development,” said Dr Justin Ryder, the study’s senior author and vice chair of research for the Department of Surgery at the hospital.
There are also concerns about adherence to the drug regimen and long-term effects when children start so young, said Dr Laurence Grummer-Strawn, unit head of Nutrition and Food Safety Action at WHO.
He cautioned that because obesity is a long-term chronic condition, it is especially important to understand these drugs in children before recommending them. That is why the guidelines don’t focus on or recommend a specific weight loss drug.
Surgery in severe teen cases
Bariatric surgery also falls under a conditional recommendation for adolescents 10-19 years old. With only a handful of studies to analyse, the team acknowledged that the balance of benefits and harms was not entirely clear.
It said the decision for invasive surgery requires “physical and mental maturity” for those with the most severe forms of obesity.
“That’s why it’s conditional,” said Dr Maria Nieves Garcia Casal, a WHO scientist in the Department of Nutrition and Food Safety.
The WHO only recommends surgery for those with a Body Mass Index (BMI) for age greater than four standard deviations above the WHO growth reference median, which is a high threshold for a surgical intervention.
Developed regions
Obesity is on the rise globally and across all regions; however, the rate of increase has mostly plateaued in developed nations, while it is increasing in low and middle-income countries.
In much of Latin America, sub-Saharan Africa, Caribbean and Pacific Island nations, and South and Southeast Asia, the rate of childhood obesity is rapidly accelerating. In some countries with already high burdens of childhood obesity, like in the US and the Middle East, that rate is mostly stagnant.
A Nature study published earlier this year noted that the increase in obesity rates in children is afflicting most low- and middle-income countries
“These highly varied dynamics suggest that the social, economic and technological trends that influence the availability, affordability and use of different foods may have helped control the rise in obesity in high-income countries,” the study authors write, “but require policy interventions in low-income and middle-income countries.”
IOL article – WHO says no obesity drugs, surgery for under-10s (Open access)
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