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Obesity: Surgery and Drugs – The Fight Against Childhood Obesity

John Simon had a good appetite even as a baby. He was chubby as a toddler, but he stayed that way long after others lost their baby fat. In the next few years, the weight continued to increase, significantly more than a healthy development could have been expected. By the time John was 14, he weighed nearly 450 pounds and was in critical condition.

What remained was an operation. John had part of his stomach removed. Now, nine months later, he has lost 70 kilos. “It was like a whole new beginning,” says the teenager from California.

Edward Kent of Minnesota, who was diagnosed with fatty liver disease, weighed 300 pounds and was 6 feet tall. He started taking a drug called Wegovy in January, which health authorities had only recently approved for use in children as young as 12. Since then he has lost almost 20 kilograms. “It’s an important thing,” says Edward’s mother, a doctor. “It’s about his health.”

Like John and Edward, more US youth are turning to new metabolism-boosting drugs and surgery to fight their obesity. It’s a small minority, but it’s growing. But the measures are controversial: some experts warn of caution in intervening so extensively in adolescence.

Those affected and their parents often see the only chance in the offensive and usually expensive surgeries and therapies – after many years of unsuccessful attempts to get the weight under control with diets or sport. “John tried with all his might,” says his mother. “It was getting harder and harder.”

80 percent of overweight adolescents continue to carry the burden into adulthood. This can have serious consequences for their physical and mental health. Extreme overweight or obesity indicates a pathological increase in body fat, and increasing obesity increases the risk of high blood pressure, cardiovascular diseases and diabetes, among other things.

A decade ago, the American Medical Association (AMA) first recognized obesity as a complex chronic disease, says Aaron Kelly of the Center for Pediatric Obesity Medicine at the University of Minnesota. However, constructive treatment methods lagged far behind. He thinks it makes sense to intervene in time. “We have to start early,” he says. “We can’t wait until later because it will be too late.”

In January, the American Academy of Child and Adolescent Medicine (AAP) approved new guidelines on this. These recommend considering obesity medications for children as young as 12 and surgical procedures as young as 13.

The guidelines met with an extremely divided response. While many of those affected heard them with relief and hope, sharp criticism also came from society. The organization Mental Health America, which is dedicated to the mental health of the population, calls the recommendations dangerous and discouraging. The criticism is that this would reinforce the stigma surrounding obesity and only reinforce eating disorders.

Possible causes of obesity, such as junk food and video games instead of exercise, were pointed out on social media, and doctors and parents were accused of making things too easy for themselves. Despite all the justified enthusiasm about new drugs, non-drug approaches should not be lost sight of, warns David Ludwig, endocrinologist at the Children’s Hospital in Boston. “Especially in children, diet and exercise must remain the top priority in the prevention and treatment of obesity,” he writes in the medical journal JAMA.

However, the experts emphasize that this is often not enough. Research shows that severe obesity cannot be cured with diet and exercise alone. More than 240 diseases and health problems are linked to obesity, and the signs often show up early, says Stanford University surgeon Janey Pratt. “When they come to me, important organs are already affected,” says the doctor, who also operated on John Simon, about the patients.

Body mass index of 75

Joint pain and shortness of breath made John noticeable as early as elementary school. By the time he was 12, he was suffering from sleep apnea, which is the repeated stopping of breathing during sleep, that he needed coffee to stay awake during the day. At school he was teased, attacked and bullied. John developed anxiety and was hospitalized for two months as a sixth grader for therapy.

“They shouted at me, hit me, pushed me,” says John. “I’ve been through a lot.” He tried diet and exercise and lost almost 40 pounds. But he couldn’t hold out, the weight came back – and even more, until John finally reached a body mass index (BMI) of 75. A BMI of 18.5 to 24.9 is considered ideal for adults, obesity is defined from a BMI of 30. The BMI is not considered suitable for children, but showed a clear trend with John.

He turned to Los Angeles pediatrician Callum Rowe with a cry for help. He referred the youth to Stanford University, where John met the surgeon Pratt. The doctor says that registrations for the surgery program there have doubled since the publication of the AAP guidelines.

According to studies, children who undergo this type of surgery lose on average a quarter to a third of their body weight. But about a quarter of the children would then gain weight again and would need further treatment, says Pratt. When taking the drug Wegovy, a clinical study showed an average weight loss of 16 percent over almost 16 months. However, if such treatment is stopped, the research shows that the kilos will come back. On the other hand, serious side effects can occur when taking it, such as inflammation of the pancreas.

The obesity drug worked well for Edward Kent. It switched off its cravings “like with a light switch”, says the mother. The last examination showed normal liver values ​​for the boy.

And John Simon’s liver function and blood sugar levels improved, according to Doctor Pratt. The arthritis has improved, the youngster can move around more easily, and sleep has also become more restful.

However, John is still suffering from the psychological consequences. The attacks at his school were so severe that teachers had to accompany the boy when he changed classrooms. In the coming school year, John is going to a new school where he hopes for a fresh start without any problems. “I just want to lead a happy, healthy life,” says the now 15-year-old. “Without the pain. And without the weight.”

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