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Health panel recommends interventions for children and adolescents with high BMI

As obesity continues to pose a major threat to public health, a group of independent U.S. health experts released recommendations Tuesday urging doctors to refer children and adolescents for obesity. to programs that can provide advice on healthy eating, safe physical activity and understanding food labels.

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

Some doctors and obesity experts welcome efforts to address the growing crisis, but others say the task force should also consider drug interventions, including the use of a semaglutide-based drug, the increasingly popular class of weight loss drugs. The Food and Drug Administration approved the drug Wegovy for use in children 12 years and older in 2022.

“Having the option to take medications in the appropriate clinical scenario is very important,” said Susma Vaidya, associate medical director at the IDEAL Clinic, the weight loss program at Children's National Hospital in Washington. “I'm a big believer in medication and I think we've been advocating for lifestyle change for a long time and we haven't made much progress.

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

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

Weighing 340 pounds at age 16 and suffering from diabetes, BJ set a goal weight of 220 pounds, which he reached in January. Williams said she has confidence in the weight-loss drug, emphasizing that she believes the benefits outweigh the potential risks.

“He’s more outgoing and his weight is healthier,” Williams said. “Now seeing him smile means everything to me.”

Williams said she pays $68 every 90 days, with the rest covered by insurance. Without insurance, the drug would cost $500 out of pocket, even after applying coupons to reduce the cost, she said.

In a 2023 randomized controlled trial of semaglutide involving adolescents aged 13 to 17 with a BMI at or above the 95th percentile, 44% of adolescents taking the drug experienced a drop in BMI so large that they had reclassified as normal weight or overweight. than obesity.

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

Obese children are at increased risk of developing chronic diseases such as type 2 diabetes, high blood pressure and heart disease. Childhood obesity can have significant mental and social consequences, including depression and anxiety.

“We don't have long-term data on weight-loss drugs, and I understand that's a concern, but we do have long-term data on the consequences associated with obesity, and we know that obese people are at risk . for certain comorbidities,” Vaidya said.

The Centers for Disease Control and Prevention classifies 20 percent of children and adolescents ages 2 to 19 as obese. As part of its guidelines, the Preventive Services Task Force said providing 26 hours or more of counseling and supervised physical activity for up to a year led to weight loss in children and adolescents .

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

“It's a case-by-case decision based on the child, but we're not talking about the teenager who wants to lose a few pounds for the summer,” said Mona Sharifi, a pediatrician and researcher at the Yale School of Medicine. Medicine and researcher. member of the American Academy of Pediatrics. “We're talking about the child who is seriously affected, and we need to present them with all the options available to them.”

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

“If there is a fundamental change in our understanding of health challenges, the task force may sometimes revisit 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 for weight-loss drugs such as Wegovy, which can cost more than $1,000 a month without insurance.

The CDC estimates that childhood obesity costs more in the United States than $1 billion in health care spending per year. Sharifi said early interventions could reduce that cost, but added that if there was no funding for these programs, more people would need expensive medications and surgeries later.

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

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