The World Health Organization (WHO) has urged health authorities to first seek lifestyle interventions to treat obesity in children and adolescents rather than opting for pharmacological treatment.
In its first global guidelines for child and adolescent obesity, the agency sets out how health systems and health workers can deliver the best care in these non-adult age groups. The notice comes as obesity prevalence in those aged between five and 19 years has quadrupled since 1990, affecting 170 million individuals in 2024.
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To help address this sharp rise, the WHO recommends structured dietary, physical activity and behaviour-changing interventions delivered together as one framework or via individual programmes. Digital health interventions are also of use under certain supervisions.
The most salient aspect of the guidelines was that the agency does not recommend pharmacological treatment, weight loss devices, or bariatric surgery for those aged nine and under.
“The foundation of obesity care for children and adolescents is not medicine or surgery, but access to comprehensive support that enables healthy eating, physical activity and sustainable behaviour change,” said Dr Luz María De Regil, WHO’s director of the department of nutrition and food safety.
The guidelines are published as weight loss drugs have become the most famous and best-selling drugs in the world. Glucagon-like peptide-1 receptor agonists (GLP-1RAs) have become a first port of call for adults seeking weight loss in the private sector, raising questions about the jabs’ use in paediatric and young teenage patients.
“Our priority must be to ensure that every child and adolescent can access quality care and supportive environments from an early age, helping them achieve and maintain a healthy weight and laying the foundation for lifelong health and well-being,” De Regil added.
The WHO has not completely negated the utility of pharmacological intervention, however. For adolescents aged 10 to 19 years, treatment with approved medicines may be considered only when a supervised multimodal lifestyle programme has not achieved the desired results, it says. Bariatric surgery meanwhile remains an option but only for those with severe obesity, the agency states.
Use of GLP-1RAs has been spearheaded in recent years by Eli Lilly’s tirzepatide and Novo’s semaglutide. Lilly’s tirzepatide sales, which combines Zepbound and Mounjaro, reached just shy of $15bn in sales in Q2. In reaching this figure, the product overtook MSD’s cancer blockbuster Keytruda to become the top-selling drug in the world. The obesity space is currently undergoing a paradigm shift with the advent of oral options. Both Novo and Lilly have approved daily pills to treat obesity, though unlike injectable GLP-1RAs, these are not approved for use in children.
