The World Health Organization (WHO) released its first-ever guidelines to address how clinicians should manage obesity in children and adolescents, which include conditional recommendations for obesity medications and even surgery for children over the age of 10.

Since 1990, the number of children ages 5-9 years and adolescents 10-19 years living with obesity has quadrupled, skyrocketing from 2% to 8%. Upwards of 170 million children and adolescents now live with the chronic condition, which increases the risk of a host of medical complications including type 2 diabetes and cardiovascular disease.

For children especially, obesity can come with stigmatisation, discrimination, and bullying, the WHO notes.

Obesity in children is projected to increase most rapidly in lower- and middle-income countries, where access to healthy foods and exercise now mirrors that in upper-income countries.

The growing global burden of overweight and obese children has led the WHO to issue guidelines for what it terms “person-centered” care, which is a combination of nutrition, physical activity, behavioral management, and in some cases, medication or even surgery.

The WHO recommendations are a product of evaluating 35 scholarly review articles, but research is still evolving, especially for pharmaceutical-based interventions in children.

Conditional recommendations for medication

For children under 10, the WHO does not recommend obesity drugs or bariatric surgery. Instead, the focus should be on structured interventions such as healthy eating, physical activity, and behavioral change, Dr Luz Maria De Regil, director of the WHO’s Department of Nutrition and Food Safety, told a press conference in Geneva this week.

If this three-pronged approach fails for adolescents, WHO recommends that, in some instances, obesity drugs could be used if the child is mentally and physically prepared. 

Several blockbuster drugs now dominate the weight loss market. In the US, nearly one in five adults reported taking a GLP-1 drug such as Ozempic or Weygovy at some point for diabetes or weight loss. 

The WHO notably added GLP-1s to its recommended guidelines for obesity treatment for adults in 2025, a step in what the global health agency said is a “conditional” sign of approval for the cutting-edge medications that have become so popular.

The picture for children is a bit more complicated, WHO scientists said. While pharmaceutical giants Novo Nordisk and Eli Lilly are both running clinical trials in children as young as six, the WHO had little research to draw on to assess whether the drugs meet the bar of safety or efficacy for children under 10. 

But that hasn’t stopped prescriptions, as a study published in the journal, Pediatrics, reported that the number of children aged eight to 11 on GLP-1s “increased sharply” between 2019 and 2026. Their study estimates that out of a cohort of over 3.5 million children with obesity – and without diabetes – roughly 20,000 children were prescribed GLP-1s. 

A recent analysis from Lurie Children’s Hospital in Chicago found that GLP-1s may be linked to nutritional deficiencies in children, most notably a lack of vitamin D. The researchers found that only 5% of pediatric patients on GLP-1s received nutritional counseling. 

“As appropriate pediatric use of GLP-1s becomes more widespread, we need to understand the risks during periods of rapid growth and pubertal development,” said Dr Justin Ryder, the study’s senior author and vice chair of research for the Department of Surgery at Lurie Children’s Hospital. 

Ryder, who is also an associate professor of surgery and pediatrics at Northwestern University, commented in a press release that the study highlights the need for proactive nutrition counseling as children are growing as any deficiencies early in life could have lasting effects.

There are also concerns about adherence to the drug regimen and long-term effects when children start so young, said Dr Laurence Grummer-Strawn, the unit head of Nutrition and Food Safety Action at WHO. 

He cautioned that because obesity is a long-term chronic condition, it is especially important to understand these drugs in children before recommending them. That is why the guidelines don’t focus on or recommend a specific weight loss drug.

“WHO recognizes this is a rapidly evolving field,” said De Regil. Her team is monitoring data as it becomes available on long-term anti-obesity medications in children.

Surgery in severe teen cases

Bariatric surgery also falls under a conditional recommendation for adolescents 10-19 years old. With only a handful of studies to analyze, the team acknowledged that the balance of benefits and harms “are not entirely clear.”

Again, WHO stresses that the decision to undergo an invasive surgery requires “physical and mental maturity” for those with the most severe forms of obesity. 

“That’s why it’s conditional,” said Dr Maria Nieves Garcia Casal, a WHO scientist in the Department of Nutrition and Food Safety. 

The WHO only recommends surgery for those with a Body Mass Index (BMI) for age greater than four standard deviations above the WHO growth reference median, which is a high threshold for a surgical intervention.

Nutrition, exercise, mental health

The guidelines stress that obesity management goes beyond simple weight loss, involving a combination of structured dietary, exercise, and behavior-changing interventions that work best when tailored to the individual.

Digital technologies, including active video games or phone apps that encourage movement,  could also help children manage their obesity, although the WHO’s recommendation is conditional as excessive screen time should be limited. 

The recommendations also emphasise the importance of addressing mental health alongside obesity: “Anxiety, depression, low self-esteem and emotional dysregulation can contribute to unhealthy eating behaviours, physical inactivity and social withdrawal, and children and adolescents living with obesity may experience stigma and bullying that harm their emotional well-being,” the WHO notes in a media release issued alongside the guidelines. 

Worrying trends in low- and middle- income countries

Obesity is on the rise globally and across all regions; however, the rate of increase has mostly plateaued in developed nations, while it is increasing in low and middle-income countries.

In much of Latin America, sub-Saharan Africa, Caribbean and Pacific Island nations, and South and Southeast Asia, the rate of childhood obesity is rapidly accelerating. In some countries with already high burdens of childhood obesity, like in the US and the Middle East, that rate is mostly stagnant.  

A Nature study published earlier this year noted that the increase in obesity rates in children is happening across regions and afflicting most low- and middle-income countries: Tanzania, Rwanda, Ethiopia, Nepal, Bangladesh, Saudi Arabia, Malaysia, and Chile all saw steady or rapid increases in the past three decades.

“These highly varied dynamics suggest that the social, economic and technological trends that influence the availability, affordability and use of different foods may have helped control the rise in obesity in high-income countries,” the study authors write, “but require policy interventions in low-income and middle-income countries.”

Prevention and treatment go ‘hand in hand’

While the guidelines focus on treating obesity in children, the WHO acknowledged the role of addressing a child’s environment, including unhealthy food options in schools, persistent marketing of unhealthy food to children and the lack of safe places to play. 

Dr Laurence Grummer-Strawn, unit head of Nutrition and Food Safety Action, argued that much of what remains outside of a child’s individual control has deep consequences for their obesity risk. These include whether a child was breastfed, their junk food marketing environment, and their school environment. 

“Countries need to create environments that make healthy diets and physical activity accessible and affordable, while ensuring that children and adolescents already living with obesity can access high-quality care free from stigma and discrimination,” said De Regil. 

“We need to prevent obesity wherever we can, and ensure that those already living with obesity receive the care and support they need.”

Image Credits: Commons , WHO, UNICEF, Nature/ NCD-RisC.