Obesity Care Expands Toolkit for Pediatric Specialists
Addressing Childhood Obesity: A Multifaceted Approach from Lifestyle to Advanced Therapies
childhood obesity is a complex chronic disease requiring a thorough and individualized treatment strategy, ranging from lifestyle modifications to advanced interventions like pharmacotherapy and bariatric surgery. This approach, as highlighted by Dr. Anya Vidmar at the Society for Pediatric Dermatology 2025, emphasizes the critical role of pediatric clinicians in recognizing obesity as a disease and actively participating in a team-based care model.
For children requiring modest weight reduction, lifestyle interventions remain the cornerstone of treatment. However, for those with severe obesity and associated complications, more advanced therapies are increasingly necessary and effective. Recent years have seen significant advancements in pharmacologic therapies, with GLP-1 receptor agonists like liraglutide and semaglutide emerging as highly effective options. These medications have demonstrated an average 16% body weight reduction over a year and show promise in improving comorbidities such as type 2 diabetes and hypertension. While their cost and access can be limiting factors, their efficacy is undeniable.
Newer agents, such as tirzepatide, a GLP-1/GIP dual agonist, are offering even greater weight loss potential, approaching that of bariatric surgery, with a favorable gastrointestinal side effect profile. even though currently FDA-approved only for individuals 18 and older, many pediatric clinicians are successfully utilizing these medications off-label. Dr. Vidmar noted that in her practice of nearly 900 pediatric patients on anti-obesity medications, serious adverse effects have been rare.
More accessible oral agents,including phentermine and topiramate,either individually or in combination (as in the FDA-approved phentermine and topiramate extended-release,Qsymia),are also valuable tools. These medications are particularly beneficial for children with hyperphagic phenotypes and are often easier to prescribe due to their lower cost and broader availability. Metformin, while not a primary weight-loss medication, serves as a useful adjunct for patients with prediabetes, polycystic ovarian syndrome, or insulin resistance-related skin changes.
The underutilization of bariatric surgery in adolescents is a significant concern, despite robust data supporting its safety and efficacy. The 2023 American Academy of Pediatrics (AAP) guidelines now recommend considering bariatric surgery as a first-line therapy for children with class II or III obesity. dr.Vidmar urged a reframing of the narrative around surgery, emphasizing that laparoscopic sleeve gastrectomy is well-tolerated, minimally invasive, and does not impede growth or puberty.
crucially, Dr. Vidmar stressed that access, rather than cultural factors, is often the primary barrier to care. The success of an accessible bariatric surgery program at CHLA,a safety-net hospital serving a predominantly Hispanic,publicly insured population,resulted in over 300 referrals within three months. This experience underscores the imperative for healthcare systems to develop culturally sensitive, flexible, and decentralized care models that meet families where they are.
Dr.Vidmar implored all pediatric clinicians, including dermatologists, to recognize obesity as a chronic disease and embrace their role within a team-based treatment framework. Through early detection, appropriate referrals, and shared decision-making, pediatric subspecialists can play a vital role in dismantling barriers and improving the long-term health outcomes for children living with obesity.
References
- Vidmar A. Managing obesity with an eye toward dermatology. Oral presentation at: society for Pediatric dermatology 2025; July 23-26, 2025. Seattle, Washington.
- Hampl SE,Hassink SG,Skinner AC,et al. Clinical practice guideline for the evaluation and treatment of children and adolescents with obesity. Pediatrics. 2023;151(2):e2022060640. doi:10.1542/peds.2022-060640