What you need to know about the new childhood obesity guidelines

The prevailing wisdom for treating obesity in kids used to be “wait and see.” New guidelines released last week turn that advice on its head, recommending early and aggressive treatment to prevent complications such as diabetes and liver disease, which have become far more common in children.

Back in 2007, when the American Academy of Pediatrics first addressed the condition, the medical community did not recognize obesity as a disease, and the treatment options for children were mostly limited to counseling about diet, nutrition and exercise. Today, doctors recognize the issue as urgent because of the potential of damaging, lifelong health consequences. We also have highly effective and safe (albeit sometimes costly) pharmaceutical and surgical interventions that were not available before.

“The greater harm is in delaying,” said Matt Haemer, an obesity specialist at Children’s Hospital Colorado.

Here are the three most important takeaways from the new guidelines, according to doctors who specialize in childhood obesity.

1. Obesity is a chronic medical condition, not primarily a consequence of lifestyle choices.

The guidelines from the American Academy of Pediatrics recognize that the disease is driven by all sorts of social and environmental factors, as well as family genetics. Think of it like heart disease or cancer, says Ann O’Connor at CHRISTUS Children’s Hospital in San Antonio. “It’s far more complicated than just eating less.”

2. Medications are a tool that can be used in children 12 and older in a safe manner. Bariatric surgery can also be considered for severe obesity in children 13 and older.

There are now two main groups of drugs available for weight loss. The newest ones, such as Wegovy by Novo Nordisk, are weekly injections designed to treat diabetes that have been shown to be remarkably effective for weight loss. But doctors say it can be challenging to get insurance coverage and the shots can cost upward of $1,000 a month out of pocket. The older group of drugs, which include appetite-suppressants phentermine/topiramate, can cost $25 to $30 a month for generic versions of the pills. They can still make a difference in many patients, but weight loss has been shown to be less significant than with the newer drugs, and some patients experience high blood pressure on those medications.

Mary Savoye, associate director for pediatric obesity at Yale New Haven Children’s Hospital, said she expects behavioral therapy will remain at the core of treatment plans at most centers, and be used along with medication and surgery. The “Bright Bodies Program” she and her colleagues pioneered - which involves exercise classes, nutrition education and parent counseling - was cited in the new AAP guidelines as being the basis of the recommendation for 26 hours of intensive behavioral therapy a year.

Many children see results in six months to a year from the new medications, Savoye said, but that does not mean they are cured. She said while there’s no consensus on how long patients should remain on the drugs, “we are thinking it’s for their lifetime.” She said treatment should continue to include nutrition and behavioral modification as well.

“We are very honest with our patients. We say that we want you to know you may have to take it for a very long time and maybe forever,” she said.

3. More must be done to ensure access to treatments for all children who need them.

The number of pediatric obesity specialty centers in the United States is growing but they are still mostly limited to large metropolitan areas. These practices typically bring a wide range of specialists - which can include pediatricians, endocrinologists, hepatologists, surgeons, social workers, psychologists, fitness experts and nutritionists - under one roof to create a multipronged plan for a child suffering from obesity.

Some of these centers see thousands of patients each year so it can take a while to get an appointment.

Insurance can be tricky to navigate. Doctors say bariatric surgery for those who are severely obese is usually covered. But only a few states mandate reimbursement for medication and behavioral treatments under Medicaid and private plans vary in their coverage. A bill that would coverage through Medicaid for intensive behavioral therapy and prescription drugs was introduced in Congress in 2013 but has not gained momentum.

Related: Children struggling with obesity should be treated early and aggressively, new guidance says