Weight-loss options for US youth are hard to come by

[June 17, 2024]  By Robin Respaut and Chad Terhune

(Reuters) - For many U.S. parents seeking help for a child with obesity, the most widely-endorsed treatment is out of reach - and it's not the popular weight-loss drug Wegovy. Leading medical groups recommend intensive behavioral counseling - 26 hours within one year - to teach children and their families practical ways to eat healthier and move more. But these programs are not widely available, and wait lists can run for several months. They are often not covered by health insurance and require a time commitment that is difficult for many families to make, according to interviews with more than a dozen doctors and parents. As a result, fewer than 1% of the nearly 15 million U.S. children with obesity get this type of structured care, the U.S. Centers for Disease Control and Prevention told Reuters. Efforts by the CDC and others to expand insurance coverage have stalled, doctors involved in the process told Reuters. "The coverage for these programs was never good, and we're not seeing any movement toward improvement," said Dr. Joseph Skelton, a professor of pediatrics and an obesity medicine specialist at Wake Forest University School of Medicine.

The prevalence of obesity among U.S. children has steadily increased, from 5% in 1980 to nearly 20% now, according to the CDC. Novo Nordisk's Wegovy was approved for adults in 2021 and for adolescents in late 2022, offering a highly effective way to lose weight for the first time. Novo still cannot meet demand for the drug among adults, with at least 25,000 first-time prescriptions dispensed each week. A much smaller, but growing, number of families are seeking the drug for their adolescents, Reuters found in February. Many doctors and parents are wary of using the medication without data on whether Wegovy can affect a child’s development, or pose other long-term risks. CHANGING HABITS Ruth Medina of Holyoke, Massachusetts, wanted to see if a change in family habits, rather than medication, could help her 15-year-old daughter, Jelainie, when she reached 200 pounds this year. The family has a history of type 2 diabetes, she said, a condition exacerbated by excess weight. "I don't want to go down that path. That's when I got scared," Medina said. Jelainie's pediatrician recommended the healthy weight program at Holyoke Health Center where children and their parents come for visits with a dietician and community health worker to set individual goals, plus group sessions about cooking, deciphering nutritional labels and other lifestyle changes. Dr. Vinny Biggs, who oversees the program, said families face a four-month wait to enroll. Medina and her daughter’s participation is covered, in part, by the state Medicaid health insurance program, Biggs said. At the family's first session this month, Jelainie cut up cauliflower, carrots and other vegetables to prepare a paella dish alongside her instructors. Mother and daughter said they liked the meal and took home leftovers and the recipe. Jelainie has lost some weight. She started walking more, playing tennis and snacking on fruits and vegetables. Her mother still worries about the appeal of the many fast-food restaurants close to their home. "We walk by so many temptations," Medina said. "I want to do whatever I can to get her to a healthy weight." RED LIGHT, GREEN LIGHT The U.S. Preventive Services Task Force, an influential federal panel of experts, says it's better to stick to lifestyle changes for adolescents with obesity until more data on the long-term safety and effectiveness of the drugs are available, according to a draft recommendation published in December. The American Academy of Pediatrics says that youth aged 12 and older should be offered medications for obesity, but only as an "adjunct to health behavior and lifestyle treatment."

A 15 year-old patient, Jelainie Camacho, cuts up a cauliflower with help from chef and community health worker (CHW), Ana Jaramillo, as part of a healthy weight clinic teaching children and their families healthier eating habits, at the Holyoke Health Center in Holyoke, Massachusetts, U.S., June 11, 2024. REUTERS/Brian Snyder

The task force examined clinical trials involving intensive behavioral programs for children and found that, on average, children lost 5.7 pounds.But Wegovy and similar drugs helped people lose pounds more dramatically - 15% or more of their body weight in clinical trials. That track record, and a lack of insurance coverage for counseling, are likely to convince more families to try the medicines in the future. Some doctors say that wider Wegovy use by youth will make it even more essential for children to learn healthy-eating habits for the long run. They worry that reliance on the drugs alone could contribute to nutritional deficiencies or eating disorders. "Many of us believe it would make sense to offer behavioral counseling along with the drug," said Dr. Thomas Robinson, a professor of pediatrics and director of the Center for Healthy Weight at Stanford Medicine Children's Health in Palo Alto, California. "These drugs are very effective at reducing weight and health risks, but you don't all of a sudden adopt a healthy diet or become more physically active." At Stanford's lifestyle-counseling program, instructors give parents and their children long-established lessons about eating wisely: High-calorie foods, such as ice cream or even almonds, are "red-light" foods that should be eaten sparingly. Vegetables are a "green light" – and can be consumed in unlimited quantities. Most foods are yellow and fall somewhere in between, Robinson said. Health insurance doesn't cover Stanford's program, so families pay out-of-pocket or receive financial assistance from the hospital, Robinson said. The full cost is $3,500. Since 2022, the CDC, American Academy of Pediatrics and other key experts have pushed for better coverage of obesity counseling. In September, an American Medical Association (AMA) panel rejected one of those efforts: a request for a dedicated medical code for the 26-hour program that would help providers bill for their services. In a statement, the AMA told Reuters the application didn't meet the panel's criteria, without providing further details. In general, new codes may not be approved if they include non-clinical services, such as cooking classes, according to the AMA. Even if a code is granted, health insurers can still refuse to pay for medical services. In a statement to Reuters, the CDC said that ensuring equitable access to both obesity medications and lifestyle treatment "is pivotal so that families have access to multiple options to address child obesity and support optimal health."

(Reporting by Chad Terhune and Robin Respaut; Editing by Michele Gershberg and Rod Nickel)

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