For years, the standard approach to obesity in children was “watchful waiting”: monitoring a child’s weight in the hope they would outgrow it. In January 2023, the American Academy of Pediatrics (AAP) changed course. Its first comprehensive guideline on childhood obesity in 15 years calls for earlier, more active treatment, and for the first time includes medication and, for some teens, surgery.
Why the guidance changed
Childhood obesity has risen sharply over the past several decades in the U.S. and around the world. Obesity in childhood often continues into adulthood, and it’s linked to serious health problems such as type 2 diabetes, high blood pressure, high cholesterol, fatty liver disease, sleep apnea, joint problems and depression. Some of these conditions are now appearing in children.
“There is no evidence that ‘watchful waiting’ or delayed treatment is appropriate for children with obesity,” Dr. Sandra Hassink, vice chair of the AAP subcommittee that wrote the guideline, told CNN. She said the goal is to help families make sustainable changes to lifestyle, behaviors or environment, with families involved in decisions at every step.
What the new guidelines recommend
The guideline, published in the journal Pediatrics, treats obesity as a complex chronic disease rather than a matter of willpower. Key recommendations include:
- Treat early and intensively. Pediatricians should offer treatment as soon as obesity is diagnosed rather than waiting.
- Health behavior and lifestyle treatment comes first. The most effective programs are intensive and family-based, ideally involving 26 or more hours of face-to-face support over three to 12 months, focused on nutrition, physical activity and behavior.
- Medication for children 12 and older. Pediatricians should offer weight-loss medications to adolescents 12 and older with obesity, alongside lifestyle treatment, based on each child’s health and family preferences.
- Surgery for some teens 13 and older. Adolescents with severe obesity should be evaluated for referral to weight-loss (metabolic and bariatric) surgery at a specialized center.
- Look for related conditions. Children with obesity should be checked for problems like high blood pressure, abnormal cholesterol, prediabetes and fatty liver disease.
The AAP noted that the guideline focuses on evaluation and treatment, and said it would address prevention of childhood obesity in a separate statement.
Reactions and concerns
Many doctors welcomed the shift away from waiting. Others raised concerns about putting young people on long-term medication or recommending surgery, and about access, since intensive lifestyle programs, newer medications and specialized surgery centers aren’t available or affordable for every family. Some experts also worry about weight stigma and want care to focus on overall health rather than the number on the scale.
What this means for you
- Talk openly with your child’s pediatrician. Ask about your child’s growth, BMI and any related health risks.
- Make it a family effort. Changes work best when the whole household eats more whole foods, moves more, limits sugary drinks and gets enough sleep.
- Ask about programs. Your pediatrician may know of intensive, family-based programs in your area.
- Understand all the options. If medication or surgery is suggested, ask about benefits, side effects and long-term follow-up.
- Focus on health, not blame. Speak to children about feeling strong and healthy rather than about weight, and avoid shaming language.
The bottom line
The AAP now recommends treating childhood obesity early and actively, with lifestyle support for all and, for some adolescents, medication or surgery. Every child is different, so the best plan is one you build together with your pediatrician.
This article is for general information and isn’t medical advice. Talk with your healthcare provider about your individual needs.
