Children’s Weight Loss Drugs and Surgery Force Parents to Make Hard Decisions : Shots

The availability of an effective weight-loss drug and its endorsement by major medical associations has provided parents with an easy way to treat childhood obesity. But for many parents, getting their children on what could be a lifelong prescription is not an easy decision.
The availability of an effective weight-loss drug and its endorsement by major medical associations has provided parents with an easy way to treat childhood obesity. But for many parents, getting their children on what could be a lifelong prescription is not an easy decision.

The mothers of Jenn McClellan, of Albuquerque, New Mexico, and Grace, of Bethesda, Maryland, have never met but share a common childhood trauma. Both came of age in the 1980s and ’90s, living in shame and stigma toward their mothers. body size. They tried every diet and pill known at the time, but one doctor after another told them to limit their calories and exercise more.

Since then, the scientific understanding of obesity has changed. Doctors now believe that the disease is caused by genetics, the brain and other organs, as well as environmental and psychosocial factors. The study also confirms what both women have wondered all along. Diet and exercise are only part of the puzzle, so diets don’t usually result in long-term weight loss.

Both women felt deceived and neglected by doctors who viewed obesity as a lack of willpower.

Each of these mothers now has a 12-year-old child, is facing weight-related social issues, and both are keen to help their children take a healthier path. .

“It’s traumatic because we’ve seen what happened to us,” said McClellan, a birthing educator who specializes in helping plus-sized mothers. “All I ever knew was the diet and the harm it did to my body.”

Grace, a software engineer who wants to use only her middle name to protect her daughter’s privacy, says the feeling that being overweight was her fault isolated her at an early age. “I didn’t have many friends all the way through middle school, even in high school,” she says.

Today there are treatments for severely obese children that Grace and McClellan didn’t get. Newer drugs like semaglutide, approved for weight loss under the brand Wegovy, help curb hunger and boost metabolism. Adolescent bariatric surgery has similar results.

Both treatments were added to the American Academy of Pediatrics’ recommended treatment guidelines for children ages 12 and 13 earlier this year, recognizing the growing threat of the disease in children. These guidelines help dictate the treatment recommended by pediatricians, which in turn may affect the likelihood that a patient will be diagnosed, treated, and covered by insurance. .

The new AAP guidelines, as well as the growing awareness of a new class of effective weight-loss drugs, have sparked controversy among many parents debating whether, when, and how to treat obesity in their children. it’s stirring up.

Like many parents, Grace and McClellan have different views on the issue.

To protect children from prejudice

Grace’s eldest daughter was active in sports, but around the age of 8 she began to inexplicably gain weight, much like Grace herself, although her eating habits remained unchanged. I was. As her body grew and her mobility decreased, her mood began to affect her, causing her distress.

So Grace struggled to get her junior high school kids to take a new anti-obesity drug. With no childhood obesity specialist available, she sought help from medical researchers and her daughter was diagnosed with PCSK1 deficiency, a rare genetic disorder that causes rapid weight gain. (After all, Grace was later diagnosed with the disease, too.)

Grace then battled insurance claims and other paperwork to get health insurance to pay for her daughter’s expensive treatment. This drug is only approved for people with weight gain associated with a few rare genetic disorders.

For the past year, her daughter has had refrigerated medication injected into her arm every morning before she leaves for school. Her mother says her medication has slowed her weight gain. In addition, she was uplifted just by knowing that her obesity was a treatable disease and that she was not to blame.

“I think it helps her grow into a healthier person, both psychologically and socially,” says Grace.

Grace wanted to intervene before her daughter developed obesity-related ailments such as diabetes, joint and liver problems. Noting that current barriers to care and treatment are insurmountable for most families, she hopes the new guidelines will make it easier for other children like her to access treatment and coverage. is.

“I really hope she can get around all the weight issues I’ve been having and struggling with.” [with] All my life,” says Grace.

make decisions about your child’s life

As an adult, Jen McClellan spends much of her time fighting back against the stigma and medical discrimination she’s experienced throughout her life. She is concerned that her son is exposed to weight bias in many ways, and she is teaching her son to accept and embrace all body types.

Still, she said, he still occasionally makes comments about wearing a sweatshirt wrapped around his belly to make it look smaller.

McClellan said doctors often push diets and medications to improve appearance rather than to fix an actual medical problem. She herself had not faced any health problems related to obesity. So to her, new advanced treatment options for children seem both familiar and dangerous.

She doesn’t believe that these new, agency-approved drugs—which primarily work to regulate appetite in the brain—will prove to be less harmful than many of the older drugs doctors have prescribed in the past. It contained metformin, which reduces sugar absorption, but she had constant diarrhea. “The minute I left them, I just took everything back, and more,” McClellan says.

She doesn’t believe doctors recommend unrestricted use of new drugs in young patients: “Are you saying our children need to take this drug?” for the rest of your life?

A more “terrifying” extreme, she found, is the possibility of bariatric surgery on children who have not yet reached puberty.

Rebellion against moral assumptions

Treating childhood obesity is a highly sensitive subject with stigma and sensitivity, and no easy, risk-free solution. Obesity medicine is still evolving rapidly, making the parent’s dilemma even more difficult. For example, there are no data on the long-term effects of newly approved drugs on adolescents. The new drugs, including Ozempic, were originally developed to treat diabetes and have only recently been approved for weight loss under the brand Wegovy.

Teenage bariatric surgery has a long and proven track record of being effective, but it carries risks such as complications, malnutrition and weight gain. Either way, neither drugs nor surgery are quick fixes, both are expensive and require serious lifestyle changes in nutrition and activity to work.

However, as previous pediatric guidelines recommended, discontinuing treatment (“careful waiting”) is not an option for children facing potentially fatal medical consequences. The most recent data available (2018) indicate that nearly 20% of her children are obese, of which 6.1% of her are severely obese.

“Some of these children have very serious life-threatening complications,” said Sarah Humple, a pediatrician at Children’s Mercy in Kansas City, Missouri, and co-author of this year’s new AAP guidelines. Some people are, and that’s what’s happening to them right now.” . The document, Hanpur said, is over 70 pages and strongly emphasizes the importance of changing family lifestyles to ensure nutrition, exercise, sleep and stress management, but at the same time “acting more urgently.” It is said that he is aware of today’s reality that it is necessary to raise

He argues that treatment does more than just improve physical ailments. It also helps address some of the associated mental health complications that often accompany obesity. Obesity is uniquely cruel in its prejudices. Large children are often bullied and feel excluded from sports and other activities because of their size.

For Faith Ann Heeren, it’s an argument in favor of therapy. Heeren, 25, had pre-diabetes and high blood pressure before undergoing bariatric surgery in high school.

“I think it has the potential to soften a lot of the internalized prejudices that have accumulated over the years,” says Hillen, now a Ph.D. Candidate for Obesity Research at the University of Florida.

Heeren said as a child she thought she was quiet and shy and that this was her nature, but she learned that the surgery changed that. “Since losing weight, I have become more vocal, assertive and speak louder. I think it’s because it doesn’t feel there anymore,” she says.

Are these other non-medical factors sufficient reasons to treat childhood obesity?

Fatima Cody Stanford, PhD, argues that it is possible.

“Obesity itself is a disease,” says Professor Stanford, an obesity expert at Harvard Medical School. “If we recognize obesity as a chronic disease, we have to treat it, not just as an effect on other diseases.”

Two Perspectives on How to Fight Stigma

But unlike cancer treatment, weight and size come with so many moral assumptions that many parents find the concept difficult to grasp, Stanford said. Parents and teens are reluctant to use medications or surgery because they believe that the causes of obesity are complex, often genetic, but admit their failures. It often happens.

“They’ve been taught to do this the right way. The right way is diet and exercise. That’s what I hear a lot,” says Stanford.

Similarly, considering a child’s mental health in their treatment, such as the issue of bullying, can be a contentious issue for parents, especially if medical problems are not yet apparent. .

Jenn McClellan, an Albuquerque mother, says size-reducing treatments exacerbate weight stigma. She believes that parents should set an example for their children to embrace different physiques rather than pushing them to follow small ideals. “They shouldn’t change their bodies because of bullying to conform to socially accepted patterns,” she says.

Many supporters of the growing fat tolerance movement share McClellan’s view. For example, the Society for Body Diversity and Health issued a statement condemning the AAP’s treatment guidelines, writing that they “exacerbate medical lipophobia and ultimately reduce the quality of care” in children. rice field.

But Grace said she couldn’t stand the thought of her daughter reliving her childhood struggles and living a life of alienation because of her body. She “just remembers all that sadness and loneliness. I wish I could go back and help her,” Grace says.

So when Grace’s daughter asked for help with weight management, Grace devoted herself to the task. These are difficult decisions that come down to so many different and very personal factors, but Grace says she’s grateful that there are new options to consider.

And since her daughter’s mental health has improved, she feels justified in her decision to continue treatment.

“She has more friends, better grades in school, and is more able to express herself, who she is, and who she is,” says Grace.

Instead, she says, the change has made her daughter less weight-stigmatized and more accepting. “I think it gave her a lot of empathy for people who were different from her,” says Grace.

Edited by Carmel Ross. Art produced by Meredith Rizzo.

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