US doctors criticised for urging drugs and surgery for obese children

Child on scales - Gareth Fuller/PA
Child on scales - Gareth Fuller/PA

Children as young as 13 should be given weight-loss drugs and offered surgery to combat obesity, according to new US medical guidance criticised for overlooking healthy lifestyles.

The American Academy of Pediatrics (AAP) issued its first comprehensive guide to treating childhood obesity in more than 15 years. It suggests doctors offer interventions sooner, including intensive therapy to children as young as six and weight-loss drugs and surgery for those in their early teens.

Obesity rates among schoolchildren in the US have nearly quadrupled since the 1960s and estimates suggest more than 14 million children in America are overweight.

The AAP, made up of tens of thousands of doctors that inform government healthcare policy, stresses in its report that obesity is not just a consequence of poor eating habits and a lack of exercise, but is often genetically predisposed.

It points to previous studies suggesting that lifestyle changes are often not enough to prevent an obese adolescent becoming an overweight adult, when conditions such as type two diabetes and high blood pressure can take hold.

Drugs that suppress appetite

In a significant departure from past advice, the academy is now recommending that children 12 and older with obesity should be offered treatment with drugs such as Wegovy that suppress appetite.

Those 13 and older with severe obesity should be offered bariatric surgery, which reshapes the stomach and rearranges the digestive system's anatomy, the academy said.

“Medical treatment and prevention need to go hand in hand,” writes Dr Nazrat Mirza, one of the authors. “Just like asthma, just like hypertension,” she said. “In hypertension you would tell somebody to cut salt, but then the blood pressure is still high, so you're still going to give them medication.”

Questions have been raised, however, about whether the recommendations come at the expense of a healthy and active lifestyle.

‘Biggest moral challenge’

“Turning to surgery and pills is quintessentially American,” said Arthur Caplan, a bioethicist at the NYU Grossman School of Medicine. Dr Caplan called obesity “one of the biggest moral challenges” our society faces but described medication and surgery as just “Band-Aids in a society that can’t figure out what to really do to protect the interests of its kids”.

Conservative commentators have suggested that the guidelines offer an easy way out for poor lifestyle choices.

Dr Katy Miller, who works with teenagers struggling with eating disorders at Children's Minnesota, said she feared the guidelines could be "setting kids up for a challenging relationship with their bodies".

"We are proposing treatment strategies that are expensive and even in the best circumstances are often unsuccessful," she told the BBC.

She thinks the focus should be more on the societal factors that impact childhood obesity. "How can we ask someone to diet when we're not addressing things like poverty, food scarcity and housing instability?" she asked.