The kids are all right, but obesity a threat

New US guidelines recommending bariatric surgery and pharmacotherapy for adolescents have caused a stir.

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International aid organisation UNICEF says Australian children are mostly healthy, even if obesity continues to be a creeping problem.

Unsurprisingly, around 95% of children under 18 do not get the daily recommended intake of vegetables.

A recently updated and re-released UNICEF report, The Wellbeing of Australia’s Children, rates their vegetable intake as “inadequate”, especially in the context of low levels of self-reported physical activity among children and adolescents.

Around one in three Australians between ages five and 24 is overweight or obese, with slightly higher rates among First Nations Australians.

The report notes that these rates have been slowly climbing over the past 15 years.

Paediatrician and University of Sydney childhood obesity researcher Professor Louise Baur said the biggest movements were not necessarily in the level of obesity among children and adolescents, but in the way it was distributed among the population.

“There is a widening social disparity – when there have been surveys, and this has been documented in NSW especially, it’s the kids from more socially disadvantaged areas who have a higher BMI and that’s going up,” she told The Medical Republic.

“And kids in more affluent areas will tend to have very stable and healthier levels of overall BMI.”

More anecdotally, Professor Baur said she had observed a rise in complications relating to childhood obesity.

“We are seeing a rise in type 2 diabetes in adolescents, for example – when I was a junior doctor in the 1980s, we basically didn’t see it, but it’s very different now,” she said.

“We have certainly seen a rise in obstructive sleep apnoea.

“It’s not all related to obesity, but the increase in prevalence certainly is.”

Earlier this year, the American Academy of Paediatrics released its first clinical practice guideline on managing children and adolescents with obesity.

Some of the recommendations have drawn criticism, specifically the moderate-strength recommendations to offer pharmacotherapy – drugs like metformin, semaglutide and liraglutide – to children 12 years and older with obesity, and to offer bariatric surgery to children 13 and older with severe obesity.

In the context of the guideline, obesity was defined as having a BMI in the 95th percentile and severe obesity was defined as having a BMI greater than or equal to 120% of the 95th percentile for age and sex.

Professor Baur supports the American guidelines and said that the criticism had, for the most part, come from groups that had not read the guidelines in detail.

Most of the criticism, she said, centred on fears that treating children for obesity could potentially trigger an eating disorder.

It’s an area that Professor Baur herself has extensively researched.

“The children and adolescents series of papers [I did with the University of Sydney] showed that professionally run weight management services for treatment-seeking children and young people in general lead to improvements in disordered eating, depression, anxiety and self-esteem,” she said.  

As to whether teenagers should be offered pharmacotherapy or surgery, Professor Baur said it was important to take a patient-centred approach.

“It depends on what’s right for the young person [as an individual],” she said. “If you have someone who’s got abnormal liver function, has type 2 diabetes, who’s 15 years of age with a very high BMI, the way you will treat that and support that person is very different from a 10-year-old whose BMI is not nearly as high and who doesn’t have those health complications.”

Drug regulators in America and Europe have both taken steps to green-light GLP-1 receptor agonists for use in adolescent weight management, making it likely that there will be an Australian approval in the near future.

When that eventually happens, Professor Baur warned against seeing the drugs as a panacea.

“All the people in those RCTs [which proved efficacy] have the medication given on the background … of receiving support for behavioural weight management, which of course is the foundation of treatment,” she said.

“And then [the prescription] is additional on top of that.”