A majority of nurse practitioners and physician associates (84%) said they did not agree with the inclusion of bariatric surgery and antiobesity medications in the childhood obesity guideline issued by the American Academy of Pediatrics (AAP), according to a recent Clinical Advisor poll.

Of the survey respondents, 16% said they agree with the AAP recommendations. One reader said that in addition to considering use of medications and bariatric surgery for children with obesity, greater investment in nutrition and exercise programs for children and making junk food a high-priced and taxed commodity is necessary.

Another reader believes that medications are safer than bariatric surgery and questioned whether the long-term complications of bariatric surgery in children have been studied. “Adults have enough deficiencies and eating disorders after surgery, why include children?,” the reader asked.

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Other readers were opposed to the AAP recommendations. “I see nothing but problems and regaining of weight among adults who are treated with medication and surgery. Imagine how many ups and downs these kids will have into adulthood,” one reader said. “They are not fully developed in any part of their body so how can we know they aren’t doing it for the wrong reasons or might regret it,” another reader said.

“I am a mother and a psychotherapist and am appalled at the direction that the AAP has taken here,” said one respondent. Yet another said that treating symptoms instead of the underlying problem, which is multifaceted, should be the focus of interventions to reduce obesity rates in children and adolescents. “Society and policymakers are the major problem,” they said. Another respondent suggested that family education should be the target of intervention strategies.

About the Guideline Recommendations

In the updated guideline, the AAP moved away from a watchful waiting approach to see if children outgrow obesity and now recommends that treatment options be offered early and at the highest intensity available. The AAP recommends the following treatment options:

  • Motivational interviewing
  • Intensive health behavior and lifestyle interventions
  • Antiobesity medications
  • Metabolic and bariatric surgery used alone or in combination with other treatment modalities

As this debate continues, Clinical Advisor will continue to update readers on the latest information.


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