Lifestyle Advice Alone Usually Fails Children With Obesity

Aaron Kelly, a children's doctor in Minnesota who treats obesity, was asked about a new World Health Organization report that cautions against turning quickly to weight loss drugs and surgery for children with obesity. He said the report gets the basic description right, and then he offered a sharper conclusion about treatment.

“It’s not really that the patients themselves fail the treatments, it’s that the treatment fails them,” Kelly said.

Kelly argues that childhood obesity is a chronic, relapsing, and serious disease, a view he says is supported by the evidence. Children with obesity, he said, “are often stigmatized, bullied, and ostracized for their obesity,” and they face a higher risk of depression and anxiety. Many health care providers, in his view, underestimate how severe the disease is and overestimate how much control people have over body weight, much of which is controlled biologically.

The human stakes were clear in the account of Ibby, a girl who began struggling with weight and mental health at age eight during the COVID pandemic and, after bullying at school, came close to ending her life. Her mother, Andrea, said Ibby was later treated at a weight clinic with weight loss drugs and counseling. Of her daughter, Andrea said, “She’s lost seven and a half stone.” That British unit equals 105 pounds. She said the treatment reversed Ibby’s diabetes, headed off a coming liver transplant, and, along with support strategies from the clinic, transformed her mental health.

Kelly does not argue that every young child should receive medication. He noted that children up to nine should generally not start drugs except in extreme circumstances, and said very few drugs are approved for children under 12. The one he cited is liraglutide, a GLP-1 drug, meaning a drug that acts on gut and brain signals tied to appetite and blood sugar, approved in Europe for children ages six to 12.

His disagreement centers on teenagers. As he reads the report, 12 to 18 year olds should first try counseling on healthy behavior and lifestyle, and show unsatisfactory results, before they can be considered for drugs or bariatric surgery, an operation that changes the stomach or intestines to limit eating and absorb fewer calories. Kelly argues that requirement asks too much of lifestyle care alone, because, for the majority of young patients who try lifestyle treatment alone, he said “the reductions in body fat and body weight and body mass index are clinically insignificant.” That pattern, he believes, reflects strong biological forces combined with living in what he called an obesity promoting environment, and, in his words, “that’s where advanced therapies like medicines can be very, very helpful.”