A 'Lifestyle First' Approach
The cornerstone of the new WHO guidance is a strong recommendation for a 'lifestyle first' strategy. For all children and adolescents living with obesity, the primary approach should be a structured and supportive program that includes changes to diet,
increased physical activity, and behavioural interventions. This multimodal plan should be tailored to the individual and involve the family. Dr. Luz María De Regil, a director at the WHO, emphasized that the foundation of care is not medicine or surgery, but comprehensive support for sustainable healthy habits. The guidelines also conditionally recommend digital health interventions, such as apps, but only with parental or caregiver supervision.
When Are Medical Treatments an Option?
The WHO's clarification draws a clear line for when more intensive treatments can be considered for teenagers aged 10 to 19. Pharmacological treatment with approved medicines is only suggested after a supervised, multimodal lifestyle program has been tried and has not produced the desired results. Specifically for teens with obesity-related health complications, this trial period should last at least six months before medication is considered. The prescription must also come after a specialist, multidisciplinary assessment and requires ongoing follow-up. This means that medicines are not a first-line treatment and are reserved for specific circumstances under expert care.
The Role of Bariatric Surgery
The guidelines state that bariatric surgery may be considered for adolescents with severe obesity, but only under very strict conditions. Similar to medication, surgery is positioned as a later option, to be considered only after a comprehensive, supervised lifestyle and behavioural program has proven unsuccessful. The decision must be made following a specialist assessment that carefully weighs the individual's circumstances, including the potential benefits and risks of such a significant intervention. For children under the age of 10, the WHO does not recommend pharmacological treatments, weight-loss devices, or bariatric surgery at all.
Why This Guidance Now?
These guidelines are a direct response to a dramatic increase in childhood and adolescent obesity worldwide. In 2024, an estimated 170 million children and adolescents between the ages of 5 and 19 were living with obesity. This includes 100 million adolescents aged 10-19. The prevalence in this age group has quadrupled since 1990, climbing from 2% to 8%. The WHO defines obesity as a chronic, relapsing disease with serious health consequences that can start early in life, such as an increased risk for type 2 diabetes and cardiovascular disease. Beyond physical health, the guidelines also stress the importance of addressing mental well-being, as children and adolescents with obesity often face stigma, bullying, and discrimination.
A Focus on Overall Well-Being
A key message throughout the WHO's new framework is that obesity management should aim to improve a young person's overall health, functioning, and well-being, rather than focusing solely on weight loss. Care should be person-centred, age-appropriate, and responsive to the needs of each child and their family, with an emphasis on long-term follow-up. Health workers are encouraged to assess factors beyond diet and exercise, including sleep patterns, mental health, and access to healthy food and safe environments for physical activity. The WHO maintains that while treatment is crucial, it alone cannot reverse the obesity epidemic and continues to call for public policies that make healthy lifestyles more accessible and affordable for everyone.
