For the first time, the World Health Organisation (WHO) on Wednesday released guidelines on management of obesity in children and adolescents, strongly recommending against use of any weight loss drugs or surgery in children below the age of nine and only in very select cases in adolescents between the ages of 10 and 19.The guidelines allow the use of drugs and surgery for adolescents who are morbidly obese with lifestyle conditions such as type-2 diabetes, insulin resistance, or uncontrolled hypertension, and for those among whom lifestyle modifications such as diet and exercise have failed to achieve any results after six months.“Children and adolescents living with obesity are likely to develop lifestyle diseases much earlier in life and have to live longer with complications arising from them. We now know that losing weight can help prolong their lives. This is the reason we need to intervene aggressively in the early years,” says Dr Jothydev Kesavadev, chairperson, Jothydev’s Diabetes and Research Centre.What do the guidelines recommend? What are they against?The guidelines have looked at existing evidence on diet, exercise, use of digital technologies, drugs, surgeries, as well as the use of a combined behaviour change programme for effective obesity management in children and made the following recommendations.Based on evidence, the guidelines have strongly recommended the use of structured diets, physical activity and behaviour change, or all of these together for managing obesity in both children and adolescents. They recommend against the use of surgeries such as gastric bypass and drugs such as GLP-1 in children up to the age of nine years.Must Read | India overtakes US in childhood obesity, second only to China: By 2040, 20 mn children will be living with it in the country, says global reportWhile the guideline on the use of drugs is not specifically meant for GLP-1 alone — with these drugs being an area of interest when it comes to obesity — Dr Luz María De Regil, Director of the Department of Nutrition and Food Safety at WHO, said that there was no long-term data on the efficacy and effects of these drugs in children yet. She said that while the research was ongoing, WHO will continue to monitor the emerging evidence and change the guidelines in the future if necessary.The guidelines conditionally recommend the use of surgeries and drugs in adolescents between the ages of 10 and 19 years. These interventions, as mentioned above, are recommended only in those with severe obesity, living with conditions linked to obesity, or in whom other interventions have failed after six months.Story continues below this adDr Luz says that there is a lack of consensus because of a lot of pending questions on how long the medicines should be taken, when they should be stopped and when the maintenance dose should be reduced. The guidelines conditionally recommend the use of digital interventions such as active video games, exergames, exercise activity applications, pedometers or accelerometers among others that may increase physical activity and promote behavioural changes. While the evidence is not too strong, the guidelines say that such activities may be desirable while sedentary use of screens may be limited.Why are the guidelines necessary?Effective ways of addressing obesity in children and adolescents have become essential given the data. There were 170 million children and adolescents aged 5–19 years living with obesity in 2024, which include 70 million children aged 5–9 years and 100 million adolescents aged 10–19 years, according to WHO.More so for countries such as India. Dr Luz says, “While obesity is on the rise globally, the trends show that it is still growing at a rapid pace in low and middle income countries and arresting in high income countries. It has not started going down in any of the WHO regions.”In India, there was a three percentage point increase in obesity in girls and 3.7 in boys over a three decade period up to 2022, according to a Lancet study. While 0.2 million boys and 0.2 million girls were obese in 1990, 7.3 million boys and 5.2 million girls were obese in 2022. By 2020, India is expected to be home to over 27 million children and adolescents between the ages of 5 and 19 years living with obesity, accounting for 11% of the global burden, according to the Comprehensive National Nutrition Survey (CNNS) 2016-18.What do Indian physicians say?Story continues below this adDr Anurag Bajpai, president of the Indian Society for Paediatric and Adolescent Endocrinology, says that he has seen a three-fold increase in the number of children coming to his clinic with obesity. “Most of them come in with other co-morbidities such as fatty liver, prediabetes, and high cholesterol levels. So far, there were very limited treatment options but now the use of semaglutide has been approved in children over the age of 12 years by CDSCO (Central Drugs Standard Control Organisation). This should not be used by everybody and limited to children living with morbid obesity and complications,” he says. In fact, his society is currently in the process of drafting guidelines for the use of GLP-1 drugs in children and adolescents to ensure that it is not over-used and yet is offered to those who require it.“Diet, exercise, and other lifestyle changes — even the most rigorous ones — can reduce only 3% to 5% of the body weight in children. This can be effective in those who are borderline but will not be sufficient in many of the patients that we see today — teenagers weighing 140 to 150 kg with other co-morbidities,” he explains.According to Dr Bajpai, surgeries are generally not recommended in children and adolescents because they can result in improper nutrition and hamper their growth.