Tanya Altmann, MD, discusses childhood obesity, lifestyle changes, and medications

At the 2024 American Academy of Pediatrics (AAP) National Conference & Exhibition, Tanya Altmann, MD, a UCLA-trained pediatrician and AAP spokesperson, discussed the growing problem of pediatric obesity in the United States. With the increasing availability of weight management medications, including some groundbreaking treatments, Altmann—editor-in-chief of AAP's books, Caring for Your Newborn and Young Child: Birth to Age 5 and Your Baby’s First Year—hared her evolving perspective on how these new options can transform care for children struggling with obesity.

"As we know, obesity is a huge problem, growing problem in the United States, and we now have more tools, the weight management medications that we can begin using for kids and families who really need it," said Altmann. Initially hesitant about these medications, she explained that after hearing from pediatricians and endocrinologists who have successfully used them, she has come to recognize their potential. "I do really feel it can be a life-changing tool for these families," she emphasized.

Altmann highlighted the ongoing importance of lifestyle interventions, stating, "We need them outdoors, exercising. We need them eating healthy, nutrient-rich meals. We need them not spending time on screens." Despite these efforts, she noted that many families are doing everything right, yet some children continue to struggle. "There is this group of kids where they are just constantly thinking about food, and it's really overwhelming and detracts from their school, from their self-confidence," she explained.

The availability of weight management medications, such as semaglutide, has provided a critical new tool for these families. Altmann observed that the effects can be profound: "It really helps those kids no longer be completely focused on what their next meal and snack is, and they're not constantly hungry." As a result, children are able to focus on other aspects of their lives, including school and self-care. "They are able to focus more on eating a balanced meal with the rest of the family, exercising, they're more self-confident, they can focus more in school and do better," she shared.

According to a research letter published in JAMA in May of 2024, the amount of adolescents and young adults receiving GLP-1 receptor agonists including semaglutide (Ozempic) and tirzepatide increased approximately 6-fold from 2020 to 2023.¹

The US Preventive Services Task Force (USPSTF) ultimately recommended comprehensive, intensive behavioral interventions for children and adolescents aged 6 years and older with a high body mass index in June 2024. The USPSTF reviewed pharmacotherapy to address high BMI in youth, as 4 medications (orlistat, liraglutide, phentermine/topiramate, and semaglutide) are currently FDA approved to treat long-term obesity in adolescents aged 12 years and older.²

In a review of 8 clinical trials, All medications demonstrated increases in the likelihood of losing 5% and 10% of baseline weight or BMI, however, the USPSTF determined "the totality of the evidence was found to be inadequate," noting that only a single trial for each medication lasted longer than 2 months.²

Altmann concluded by stressing that while these medications are not a cure-all, they represent a valuable addition to the tools available for pediatricians and families. "There’s not just one thing that is going to really help these families, but it's another tool now, that missing piece that we didn't have before for those families that were listening to their pediatricians and doing everything else as they should be."

This combination of lifestyle changes and new medical therapies may offer a more comprehensive solution to the complex challenge of pediatric obesity.

References:

1. Kunzmann, K. Adolescent GLP-1 prescriptions increased 6-fold from 2020 to 2023. Contemporary Pediatrics. May 23, 2024. Accessed October 2, 2024. https://www.contemporarypediatrics.com/view/adolescent-glp-1-prescriptions-increased-6-fold-2020-2023

2. Fitch, J. USPSTF recommends intensive behavioral interventions for children with high BMI. Contemporary Pediatrics. June, 18, 2024. Accessed October, 2, 2024. https://www.contemporarypediatrics.com/view/uspstf-recommends-intensive-behavioral-interventions-for-children-with-high-bmi