The American Academy of Pediatrics (AAP) felt that something had to be done quickly. This month, the Professional Association of Pediatricians in the US presented a new guideline for the 14 million American children who suffer from obesity. The plans: intensive behavioral interventions from the age of 2 and – if that does not help – medication from the age of 12 and the possibility of a stomach reduction from the age of 13.
Anita Vreugdenhil, professor and pediatrician of gastrointestinal and intestinal diseases at Maastricht UMC+, understands that the Americans are sounding the alarm. “Twenty percent of children in the United States are obese. Those figures are gigantic, as are the consequences. We see that more than fifty percent of children with obesity have the early stage of one or more chronic diseases. You can think of kidney disease, diabetes and sleep apnea.”
Vreugdenhil is the founder of the Center for Overweight Adolescent and Children’s Healthcare (COACH) in Maastricht. Here children and young people with overweight and obesity are treated and scientific research is done. This is important, because although the figures from the United States cannot be compared with the Netherlands, the number of children and young people with obesity is also rising here. In 2019, 2.7 percent of children (4 to 12 years old) were seriously overweight, in 2021 this will rise to 3.6 percent. Among young people (12 to 18 years old), this was 1.9 percent in 2019 and 2.9 percent in 2021.
Enough reason to conduct serious research into the effects of medication or stomach reduction in obese children. Vreugdenhil: “We have developed lifestyle programs that are successful. An intensive program of this kind has an effect on 70 percent of the children, but this has not helped 30 percent sufficiently. You want something extra for those children.”
When are you obese?
If you are an adult and your Body Mass Index (BMI) is over 30, you are obese. The BMI is a method to measure the relationship between your height and weight. You can do that here. For children, doctors use a similar measurement method.
Obesity drug
The American AAP advises obesity medication for children aged 12 and older who are not (sufficiently) helped by healthy eating and more exercise and lifestyle coaching. These are medicines that ensure that the feeling of hunger decreases and that the feeling of being full lasts longer. According to pediatrician-endocrinologist Erika van den Akker of Erasmus MC, these medicines will also be used in the Netherlands in the future. “The drug has already been approved by the European Medicines Agency, but is hardly prescribed because it is not yet reimbursed by the health insurer,” she explains.
Van den Akker does not dare to say when obesity medication for children will be reimbursed, but expects that insurers will tack. “It has been established that this medication contributes to health,” she explains.
First operation
In the Netherlands, stomach reduction in young people is only permitted in a research context. A study is currently underway to investigate whether an intervention fits into the overall care process for obese children aged 13 and older. Several centers participate in this.
The first research results are not expected until five years from now. But, Vreugdenhil emphasizes, it will not be America here. “There, doctors just started operating. Their guidelines do not clearly describe how these children are selected and what is needed to prepare children for the subsequent process.”
Strenge criteria
The criteria that have been drawn up nationally in the Netherlands state, among other things, that only young people with a BMI of 40 or a BMI of 35 with health problems could be eligible for a stomach reduction. In addition, the young person must have followed a lifestyle intervention for at least a year with insufficient results.
Also, psychological or social factors should not have stood in the way of losing weight. Finally, the treating team must be convinced that the child is aware of the consequences of an operation. Because once you have a stomach reduction, you can’t go back and will have to eat adapted for the rest of your life.
More money for lifestyle guidance
This is the reason why Vreugdenhil and Van den Akker repeatedly emphasize that medicines and surgery are aids, but are certainly not the solution to the obesity problem. “It starts and ends with lifestyle. More money really needs to be made for that, because if you do it right you may not get around to operating,” says Vreugdenhil. “All children in the Netherlands are entitled to guidance. We are now working hard to get this in the basic health insurance package in 2024. That seems to work.”
Pediatrician Saskia Bouma can’t wait for the time to come. In her practice in Bijlmer in Amsterdam, she helps children with (severe) overweight and their parents. “These children need to be supervised very intensively, but we have very little time for that in the Netherlands,” she says. “The health insurer only reimburses my treatment for a few hours a year, that’s it. The dietician, physio and youth doctor also have a few hours. There really needs to be much more time for coaching.”
Suffer under weight
Because the reasons why children develop obesity vary widely, according to Bouma. “Sometimes parents are not sure what is healthy and what is not, but there may also be psychological or genetic reasons,” she explains. In her practice, the pediatrician sees many children suffering from their obesity. “They are bullied much more often, which has a huge impact on their development. As a society, we must realize that obesity is not a matter of eating less. It is a chronic disease.”
