Why the USPSTF Doesn't Yet Recommend Weight Loss Medications for Kids

Fact checked by Nick Blackmer

Key Takeaways

• The United States Preventive Services Task Force (USPSTF) has issued new draft recommendations for treating children with obesity.

• The guidelines recommend intensive behavioral interventions but do not suggest weight loss medications or surgery.

• Doctors have mixed reactions to the draft recommendations.

The United States Preventive Services Task Force (USPSTF) has issued new draft recommendations for children with high BMIs, and it’s a departure from guidelines from the American Academy of Pediatrics (AAP). The USPSTF recommends that doctors intervene to help children who have obesity, but stops short of suggesting surgery or medication.

The draft guidance, which was created by a group of experts and typically guides insurance coverage, focuses on an intensive behavioral model. But why do the draft recommendations differ from the AAP’s guidance and what do doctors think? Here’s what you need to know.

Behavioral Interventions Are a Major Component

The draft recommendations are designed for children aged 6 and up with a body mass index (BMI) above the 95th percentile for their age group.

To create the recommendations, experts analyzed evidence from 50 randomized controlled trials on weight loss in children. Based on the findings, the task force recommended “intensive behavioral interventions” that would involve both children and their parents, with at least 26 hours of help from a healthcare professional each year.

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Interventions can include supervised physical activity sessions, group sessions, and individual counseling. The goal of interventions is to teach children and their parents about healthy eating, exercise, reading food labels, setting goals for diet and exercise, and how to monitor their diet and physical activity.

The draft recommendations, which do not address children who are in the overweight BMI category, note that data show the more time children spent doing physical activity and the more interactions they had with experts, the more weight they lost.

The draft recommendations said that there is “moderate certainty” that these interventions can lead to “moderate net benefit” with no harm.

Because of the moderate side effects of obesity medication in the short term (like fecal incontinence, passing gas, and gallstones) and the lack of research regarding long-term use, the USPSTF does not yet recommend drugs for weight management in children with obesity.

How AAP Guidance Differs

The USPSTF’s draft recommendations are a departure from the AAP’s guidelines for treating obesity in children. Those recommendations also suggest intensive health behavior and lifestyle interventions, but say that doctors should offer children with obesity aged 12 and up weight loss medications along with health and lifestyle interventions. The guidance also states that children aged 13 and up with severe obesity should be evaluated for metabolic and bariatric surgery.

Pediatricians Stand Divided, But Aren't Opposed to Medication

Physicians are mixed on the new draft guidelines.

"Weight management in children is a complex issue,” Daniel Ganjian, MD, a board-certified pediatrician at Providence Saint John’s Health Center in Santa Monica, California, told Verywell. “There’s no one-size-fits-all approach, and decisions should always be made in consultation with a qualified healthcare professional who knows the child’s individual circumstances.”

Ganjian noted that the AAP and USPSTF are two different organizations and, with that, they may take a different approach to the same topic.

“The AAP has broader recommendations that may include medication and surgery in certain cases, while the USPSTF takes a more conservative approach based on the current strength of evidence,” he said.

The USPSTF guidance doesn’t do enough for childhood obesity, Fatima Cody Stanford, MD, MPH, an obesity medicine physician and associate professor of medicine and pediatrics at Massachusetts General Hospital and Harvard Medical School, told Verywell.

“This guidance needs to be revised,” she said. “This guidance presumes that lifestyle alone can address pediatric patients with excess weight when numerous studies have indicated that some patients may need additional tools to address excess weight.”

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Stanford said that the AAP was “diligent” in ensuring that pediatricians who care for children and teens evaluated the evidence around patients with obesity. “There is only one member of the USPSTF who is a pediatrician,” she said. “As such, they do not have the same knowledge base to evaluate this patient base. They would have been better served by having a group of pediatricians to inform their guidelines.”

David Stone, DO, a pediatric cardiologist at Corewell Health Helen DeVos Children’s Hospital in Lansing, told Verywell that he agrees with the USPSTF guidance, noting that he’s concerned about the potential for side effects with children using weight loss medications.

“Medication administration does not focus on the root cause of the issue,” he added. “The issue is uncurable without special attention to the underlying cause.”

But Stanford stressed that misses the point. Weight loss medications can help some children with obesity.

“We must personalize treatment for children and adolescents and use the right tools for the right patient,” she said. “Some patients need medications to address the dysregulation of food intake governed by their brain or gut.”

Stanford recommended that parents of children with obesity who are interested in weight loss medications get the proper healthcare team in place for their child, including finding a board-certified obesity medicine physician. Most anti-obesity medications are approved for ages 12 and up, she added.

“Pediatric patients must ensure they are assigned to reputable and skilled providers who know how to use medications safely,” she said.

The USPSTF draft recommendations are open to public commentary until January 16, 2024.

What This Means For You

The USPSTF’s draft recommendations for treating children with obesity stop short of suggesting weight loss medications or surgery. However, the AAP includes recommendations for both. If your child has obesity and you’re interested in more intensive treatment, talk to your doctor. They should be able to offer personalized guidance from there.

Read the original article on Verywell Health.