A growing number of children are entering their teenage years with a health problem once associated mainly with adults. Childhood obesity has become a global concern, prompting the World Health Organization (WHO) to issue its first guidelines on how children and adolescents living with obesity should be treated.
The new recommendations put a clear emphasis on prevention, healthy eating, physical activity and long-term behavioural change. Medicines and weight-loss surgery have a role in some older adolescents, but WHO says they should not replace the basics of obesity care.
The scale of the problem is significant. Around 400 million children and adolescents aged five to 19 were overweight in 2024, including about 170 million who were living with obesity. The prevalence of obesity in this age group has quadrupled since 1990, rising from 2% to 8%.
WHO says obesity is a chronic, relapsing disease that can affect a child’s physical and mental health from an early age. It can increase the risk of conditions such as type 2 diabetes and cardiovascular disease later in life. Children living with obesity may also face bullying, stigma, discrimination, low self-esteem and other emotional difficulties.
The new guidance is designed to change the way childhood obesity is approached. Instead of focusing only on reducing weight, healthcare providers are encouraged to look at a child’s overall health, functioning and wellbeing.
WHO strongly recommends structured dietary programmes, regular physical activity and interventions designed to support sustainable behavioural change. These can be delivered individually or as part of broader programmes involving families and caregivers.
The emphasis on family support is important because children’s eating habits and activity levels are closely connected to their home and social environments. WHO says caregivers should be involved in obesity management and that healthy choices need to be practical and sustainable rather than temporary restrictions.
Digital health support can also be used in some cases, although WHO recommends that such interventions for children be supervised by parents or caregivers.
The recommendations differ according to age. WHO does not recommend weight-loss medicines, bariatric surgery or weight-management devices for children aged below 10. Instead, treatment should focus on diet, exercise, behavioural interventions and supportive environments.
The approach changes for adolescents aged 10 to 19. Approved obesity medicines may be considered when a supervised, comprehensive lifestyle programme has failed to achieve the desired results. Even then, medication is not positioned as the starting point.
Bariatric surgery may also be considered for adolescents with severe obesity, but only under strict conditions and after unsuccessful treatment. WHO stresses that such decisions need to take into account the young person’s physical and psychological maturity and should be part of specialist care.
The guidance comes at a time when newer weight-loss medicines, including GLP-1 drugs, have generated considerable interest among adults and increasingly among younger patients. WHO, however, says there is currently insufficient evidence about the long-term safety and effectiveness of these medicines in children and adolescents.
That does not mean the medicines have been ruled out completely. Instead, WHO has placed them within a carefully controlled treatment pathway for adolescents when other interventions have not worked.
The organisation is also taking a broader view of the problem. It says medical treatment alone cannot reverse the global rise in childhood obesity. Children need environments where nutritious food is accessible and affordable and where physical activity is easier to incorporate into everyday life.
That means tackling obesity requires action beyond hospitals and clinics. WHO is calling for measures involving education, urban planning, transport and social protection, alongside policies that improve access to healthy diets and opportunities for exercise.
Mental health is another important part of the new approach. Anxiety, depression, low self-esteem and emotional difficulties can contribute to unhealthy eating and inactivity. At the same time, children with obesity may experience bullying and social exclusion.
WHO therefore recommends that mental health concerns and obesity be addressed together, using age-appropriate and family-centred care.
The guidelines also reflect a shift away from viewing obesity simply as a matter of appearance or individual choice. WHO describes it as a chronic health condition requiring long-term, people-centred care.
The message is particularly relevant as childhood obesity becomes more widespread across countries and income groups. The organisation wants health systems to identify children who need help early and ensure that care continues over time rather than relying on short-term weight-loss programmes.
WHO’s first global guidelines for children and adolescents are therefore aimed at creating a common framework for doctors, policymakers and health systems.
