WHO Guidelines on Childhood Obesity: Treatment, Prevention and Key Recommendations

Subject: GS Paper 2: Health

Context: The World Health Organization (WHO) released its first-ever guidelines for managing obesity in children and adolescents.

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About Childhood and Adolescent Obesity

• WHO Definition of Childhood and Adolescent Obesity: According to the World Health Organization (WHO), childhood overweight and obesity are identified by comparing a child’s weight or Body Mass Index (BMI) with age- and sex-specific growth reference standards.
  • Children Under 5 Years:
    • Overweight: Weight-for-height is more than 2 standard deviations (SD) above the median of the WHO Child Growth Standards.
    • Obesity: Weight-for-height is more than 3 SD above the median.
  • Children and Adolescents Aged 5–19 Years:
    • Overweight: BMI-for-age is more than 1 SD above the WHO Growth Reference median.
    • Obesity: BMI-for-age is more than 2 SD above the median.
• Global Prevalence: In 2024, approximately 400 million children and adolescents aged 5–19 years were overweight, including 170 million living with obesity.
• Rising Trend: The prevalence of overweight (including obesity) among children and adolescents aged 5–19 years increased from 8% in 1990 to 20% in 2024.

Childhood Obesity in India

• Rising Prevalence: According to a Lancet study cited in the report, between 1990 and 2022, the number of children with obesity in India increased substantially.
• Boys: The number of boys living with obesity increased from 0.2 million in 1990 to 7.3 million in 2022.
• Girls: The number of girls living with obesity increased from 0.2 million in 1990 to 5.2 million in 2022.
• Increase in Obesity Prevalence: Between 1990 and 2022, obesity prevalence increased by approximately 3 percentage points among girls and 3.7 percentage points among boys.
• National Data: India’s Comprehensive National Nutrition Survey (CNNS), 2016–18, provides national estimates of nutritional status among children and adolescents.

Key Recommendations of WHO

• Lifestyle Interventions: Strongly recommends structured dietary interventions, physical activity, and behavior-change programs, individually or in combination, for children and adolescents with obesity.
• Children Below 10 Years: Strongly recommends against the use of weight-loss drugs or bariatric surgery in children aged 9 years and below.
• Adolescents (10–19 Years): Recommends the use of weight-loss drugs or bariatric surgery only in very select cases among adolescents aged 10–19 years.
• Digital Interventions: Conditionally recommends activity-tracking applications, pedometers, and active video games to promote physical activity and behavioral changes.
• Evidence Gaps: Highlights limited long-term evidence on the safety and effectiveness of weight-loss medicines in children.

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Why Are the Guidelines Necessary?

• Early-Onset Diseases: Childhood obesity increases the risk of Type 2 diabetes, insulin resistance, hypertension, fatty liver disease, and cardiovascular complications.
• Long-Term Health Impact: It can adversely affect physical, mental, and social well-being, persist into adulthood, and increase the risk of non-communicable diseases (NCDs).
• Widening Global Burden: Childhood obesity is rising rapidly in low- and middle-income countries, while the increase is slowing in high-income countries.
• Need for Early Intervention: Timely management can help prevent or delay obesity-related complications and reduce future health risks.

Role of Weight-Loss Drugs and Surgery

• GLP-1 Medicines: Mimic the action of the glucagon-like peptide-1 (GLP-1) hormone, helping regulate appetite, increase feelings of fullness, and reduce food intake.
• Semaglutide: A GLP-1 receptor agonist that helps reduce hunger, food intake, and body weight, while also improving blood glucose control.
• Bariatric Surgery: The Surgery alters the stomach and sometimes the digestive tract to limit food intake and, depending on the procedure, reduce nutrient absorption. 
  • It can also influence hunger and fullness signals, supporting substantial weight loss.

Key Concerns Regarding Weight-Loss Medicines and Surgery in Children and Adolescents

• Limited Long-Term Evidence: Lack of adequate long-term evidence on the safety and effectiveness of Glucagon-Like Peptide-1 (GLP-1) medicines in children, including uncertainties regarding treatment duration, discontinuation, and maintenance doses.
• Need for Cautious Use: Despite the Central Drugs Standard Control Organisation (CDSCO) approval of semaglutide for eligible adolescents aged 12 years and above, its use requires careful assessment of safety, suitability and applicable medical indications.
• Risks of Bariatric Surgery: Potential nutritional deficiencies and impaired growth raise concerns about the long-term safety of bariatric surgery in children and adolescents. 

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Way Forward

• Early Prevention: Promote healthy dietary habits, regular physical activity, and reduced sedentary time from childhood.
• Family-Based Interventions: Encourage supportive home and school environments that facilitate healthy lifestyle choices.
• Evidence-Based Treatment: Ensure medicines and surgery are considered only for appropriate patients under qualified medical supervision.
• Monitoring and Research: Strengthen long-term research on the safety and effectiveness of weight-loss medicines in children.
• Public Health Approach: Address the environmental, social, biological and lifestyle factors contributing to childhood obesity.

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