A New Chapter in Obesity Care
The World Health Organization has issued its first-ever comprehensive guidelines for managing obesity in children and adolescents, a response to the quadrupling of obesity rates in young people since 1990. This new framework provides a structured approach
for healthcare professionals, but its most debated component is the conditional approval of pharmacological intervention for teenagers. This move acknowledges that for some, lifestyle changes alone are not enough. The guidelines draw a clear line: for children under 10, drugs and surgery are not recommended. The focus for this younger group remains squarely on holistic support involving healthy eating, physical activity, and behavioural changes. However, for adolescents aged 10 to 19, the WHO now says approved medicines can be a considered option.
Which Medicines Are on the Table?
The guidelines do not endorse a free-for-all on weight-loss drugs but make way for specific, tested medications. The primary class of drugs discussed are GLP-1 receptor agonists, such as liraglutide (sold as Saxenda) and semaglutide (sold as Wegovy). These injectable medications, originally developed for type 2 diabetes, have been shown to be effective for weight management by mimicking a hormone that signals fullness to the brain and slows stomach emptying. In India, semaglutide has been approved by the Central Drugs Standard Control Organisation (CDSCO) for use in children over 12. These are not over-the-counter solutions but potent prescription drugs that require careful medical oversight. Clinical trials have shown that these medications can help adolescents lose a significant percentage of body weight when used correctly.
The 'Strict Conditions' Explained
The WHO's approval comes with critical caveats. Medication is not a first-line treatment. It is only to be considered for adolescents (aged 10-19) after a comprehensive, supervised multimodal lifestyle program—involving diet, exercise, and behavioural therapy—has failed to produce the desired results. The decision to prescribe must be made on an individual basis, ensuring the teenager is physically and mentally prepared for treatment. Furthermore, these drugs must be used as an adjunct to, not a replacement for, continued lifestyle interventions. Experts in India echo this caution, stating that these medications should be reserved for those with morbid obesity and related health complications, like fatty liver or prediabetes, and not for everyone seeking to lose weight.
Why the Shift in Stance Now?
The change in policy is driven by alarming data. Globally, around 170 million children and adolescents were living with obesity in 2024. India is facing its own crisis, projected to have over 27 million obese children and adolescents by 2030, accounting for 11% of the global burden. This surge is linked to increased consumption of ultra-processed foods, sedentary lifestyles, and aggressive food marketing. Health experts have recognised that obesity is a complex chronic disease, not simply a failure of willpower. For some adolescents with severe obesity, even rigorous diet and exercise may only lead to a 3% to 5% weight reduction, which is insufficient to reverse serious health risks. This medical reality has prompted the WHO to include pharmacotherapy as a potential tool in a broader, more robust treatment strategy.
Balancing Hope With Caution
While the new guidelines offer hope for teenagers struggling with severe obesity and its related health issues, experts urge a balanced perspective. The long-term effects of these drugs on growing bodies are still being studied, and there are concerns about potential nutritional deficiencies if not managed properly. The goal of treatment should always be to improve overall health and quality of life, not to conform to societal pressures about weight. The WHO itself stresses that the foundation of care is not medicine or surgery, but creating a supportive environment that enables healthy habits for life. The availability and cost of these medications also present significant hurdles for many families. Therefore, the focus remains on a 'person-centered' approach, where medication is just one possible component of a comprehensive and compassionate care plan.
