Childhood obesity: WHO draws a new treatment line - what it means for India

Children with obesity under the age of 9 should not be given weight-loss medicines, bariatric surgery or weight-loss devices, while adolescents aged 10-19 could be considered for approved anti-obesity medicines if a supervised programme combining diet, physical activity and behavioural interventions fails to deliver the desired results.

That age-based treatment divide is among the sharpest takeaways from the World Health Organisation's (WHO's) new guideline on the integrated management of obesity in children and adolescents - a significant shift from its earlier guidance, which focused more on identifying, preventing and managing excess weight in young children.

The advisory covers kid and adolescents aged 29 days to 19 years.

The new guideline treats obesity as a chronic, relapsing disease that can require long-term, structured care rather than simply telling a child to eat less and exercise more.

The scale of the problem explains the shift. In 2024, an estimated 170 million children and adolescents aged 5-19 were living with obesity, including 70 million children aged 5-9 and 100 million adolescents aged 10-19.

Obesity prevalence in this age group has quadrupled since 1990, rising from 2% to 8%.

For India, the issue is particularly complex. The country is dealing with a double burden of malnutrition - undernutrition and micronutrient deficiencies on one side and increasing overweight and obesity on the other.

Rapid changes in diets, greater consumption of energy-dense packaged foods, sedentary lifestyles and longer screen time have made childhood obesity an increasingly important public-health concern.

WHAT COUNTS AS OBESITY?

The WHO does not use the adult definition of obesity - a BMI of 30 or above for children because their bodies are constantly growing and their body composition changes with age and sex.

For children aged 5-19 years, obesity is defined as BMI-for-age more than two standard deviations above the WHO growth-reference median. For children under five, WHO defines obesity as weight-for-height more than three standard deviations above the WHO Child Growth Standards median.

That distinction matters because childhood obesity is not simply about body weight. Excess adiposity during the growing years can increase the risk of type 2 diabetes, cardiovascular disease and other non-communicable diseases later in life. Children can also face bullying, stigma and discrimination because of their weight.

The new WHO guidance therefore moves away from viewing obesity purely as an individual behavioural problem and recognises the influence of biology, genetics, food environments, physical activity, behaviour and wider social factors.

FROM PREVENTION TO TREATMENT

The biggest change is that the new guidelines provide a much more comprehensive treatment pathway for children and adolescents who already have obesity.

WHO strongly recommends structured interventions combining diet, physical activity and behaviour change, delivered individually or through a multimodal programme. The idea is not to put children on a crash diet or impose a single restrictive eating pattern, but to provide sustained support appropriate to their age and development.

The guideline considers several dietary approaches, including diets that alter calorie intake, macronutrient composition or particular components such as sugar, salt and fibre, as well as dietary patterns such as Mediterranean-style or whole-food approaches.

This is important because there is no single "obesity diet" that WHO is telling parents to follow.

The emphasis is instead on a structured and sustainable approach that supports healthy growth while addressing excess weight.

WHO also conditionally recommends digital health interventions, but with parent or caregiver supervision.

This marks a substantial expansion from the earlier WHO guidance. The previous 2017 recommendations were principally concerned with preventing and managing overweight and obesity among children under five in primary healthcare. The 2026 guideline goes further into treatment of established obesity across childhood and adolescence.

NO DRUGS UNDER 9

The most headline-making recommendation is the age divide on medical treatment.

For children aged 0-9, WHO does not recommend pharmacological treatment for obesity. It also does not recommend bariatric surgery or weight-loss devices for this age group.

For adolescents aged 10-19, however, approved obesity medicines may be considered when a supervised multimodal lifestyle programme has not achieved the desired result.

This is particularly significant at a time when medicines such as GLP-1 drugs have transformed obesity treatment. But there is an important distinction: WHO's new adolescent guideline should not be interpreted as recommending a particular GLP-1 drug for all teenagers with obesity.

The US and some other countries have approved medicines including semaglutide and liraglutide for certain adolescents, but regulatory approval in a country is not the same as a WHO recommendation.

WHO's own separate guideline on GLP-1 medicines for obesity is focused on adults and covers medicines including liraglutide, semaglutide and tirzepatide.

So for parents, the message of the new childhood guidelines is not "obesity injections for children." It is that medicines can become one option for carefully selected adolescents, and only after a supervised lifestyle-based programme has failed to achieve the desired outcome.

The same caution applies to bariatric surgery.

WHO has not recommended weight-loss surgery for children aged 0-9. For adolescents, it may be considered under strict conditions for those with severe obesity.