Shifts in US Pediatric Obesity Treatment After the AAP Guidelines

BACKGROUND/OBJECTIVES This study evaluated changes in child and adolescent obesity treatment initiation following 2023 American Academy of Pediatrics (AAP) guidelines recommending early intervention for obesity. METHODS Using electronic health record data from a collective of US health systems, we identified outpatient visits for children (aged 8–11 years) and adolescents (aged 12–17 years) with obesity (body mass index [BMI] at visit ≥95% percentile) and without type 2 diabetes between 2021 and 2024. A visit was randomly sampled for patients with multiple eligible visits. Patients without recent specific obesity treatment were followed for evidence of initiation, including nutrition referral (within 14 days) or counseling (within 90 days) and, separately, prescriptions for weight management pharmacotherapies (on- or off-label; within 14 days). Adjusted interrupted time series models estimated differences in the likelihood of incident nutrition counseling or referral and, separately, pharmacotherapy before vs after the guidelines. RESULTS Among 310 503 study patients (36.9% children, 63.1% adolescents), the mean (SD) BMI percentile was 97.4 (1.6) and 35.7% had severe obesity (class 2 or 3). Few patients without a recent history of specific obesity treatment had evidence of initiation during or shortly after their visit: 9.7% for nutrition referral or counseling and 0.4% for pharmacotherapy. Following the guidelines, the likelihood of pharmacotherapy initiation increased immediately (odds ratio [OR], 1.65; 95% CI, 1.23–2.21) and monthly since release (OR, 1.05; 95% CI, 1.03–1.07). No immediate change was observed in nutrition counseling/referral (OR, 1.05; 95% CI, 0.98–1.12), but a small increase in monthly trend since release occurred (OR, 1.01; 95% CI, 1.00–1.01). CONCLUSIONS Pharmacotherapy initiation increased after the AAP guidelines but remained low, whereas nutrition therapy was more common but changed minimally.