Pediatric obesity has been called “an epidemic within an epidemic” by the American Academy of Pediatrics. This condition causes hypertension, type 2 diabetes, and more, but has the potential to cause severe illnesses in adulthood such as cancer and cardiovascular disease. The number of cases diagnosed every year has been increasing, and within the different severity levels of the condition, severe obesity diagnoses have been increasing at the highest rate. This particular diagnosis raises a grave public health concern because it has been linked to extreme health conditions such as premature mortality.
In the past, federal government legislation that addressed childhood obesity centered on the prevention of the condition, as opposed to treatment. As recently as 2021, the Reducing Obesity in Youth Act was introduced to the U.S. Senate. It was meant to prevent and manage this disease after the COVID-19 pandemic exacerbated the number of cases and their potential repercussions. This act focused on the need for food security, and fitness and nutrition education in schools. It did not address possible medical interventions.
However, in the last five years, there has been a shift towards the adoption of pharmaceutical and surgical interventions as treatment for this condition. In 2019, the FDA approved Victoza, a GLP-1 receptor agonist, which is also used in Ozempic, for patients aged ten and older. Then in 2020, the agency approved Saxenda, another GLP-1 receptor agonist drug, for patients over the age of 12. Now, a recent study released in September 2024 in the New England Journal of Medicine asserted that Saxenda is safe for patients as young as six.
The stance on surgical intervention for young obesity patients has also changed. In 2019, the American Academy of Pediatrics published a policy statement addressing current treatments for childhood obesity and discussed the use of surgical intervention to treat the disease.
Pediatric obesity disproportionately affects Black and Hispanic children, and also becomes more prevalent as a child’s household income decreases. This could restrict access to treatment for those who most need it, but the Affordable Care Act of 2010 mandates Medicaid coverage for obesity treatment and intervention for any insured patient over the age of 6.
While the government has an interest in ensuring the health of younger generations as an investment in the future, the long-term effects of these pharmaceutical and surgical interventions are unknown. These treatments have only been made available to children and teenagers in the last few years. Given the absence of longitudinal studies, the government finds itself in a difficult position where it must act to combat the current childhood obesity epidemic, but it does not know what the eventual repercussions of these early interventions will be.
There must be consideration of the long-term efficacy of these methods, the issue of informed consent in pediatric surgery, the growing contention around surgical weight loss interventions, and the personal, medical, and financial costs of a possibly lifelong reliance on GLP-1 drugs. There are also concerns about the legality of these government projects, including accusations of government overstepping and the creation of a so-called “nanny state.” On a more personal level, there are concerns about the social and psychological effects of addressing obesity in such a clinical manner.
Pediatric obesity is a critical issue that is affecting some of the nation’s most vulnerable children. The shift in health policy from prevention and education to direct medical intervention has occurred rapidly, but we must proceed cautiously. After all, these children are the future, and we must be wary of hurting them in our haste to save them.