WHO's first child obesity guidelines put lifestyle changes ahead of GLP-1 drugs and surgery

The World Health Organization issued its first-ever global guidelines on childhood and adolescent obesity, drawing a clear line against the use of weight-loss drugs and surgery for younger children at a moment when GLP-1 medications like Ozempic and Mounjaro are rapidly entering paediatric medicine.

The guidelines, covering children from 29 days old through age 19, strongly recommend structured dietary changes, physical activity and behaviour-changing programmes as the foundation of care. For children aged 0–9, WHO explicitly does not recommend pharmacological treatment, bariatric surgery or weight-loss devices. For adolescents aged 10–19, approved medicines may be considered only after a supervised multimodal lifestyle programme has failed to produce results — and bariatric surgery only under strict conditions for severe cases.

The foundation of obesity care for children and adolescents is not medicine or surgery, but access to comprehensive support that enables healthy eating, physical activity and sustainable behaviour change.— Dr. Luz María De Regil, Director, Department of Nutrition and Food Safety, WHO

The scale of the problem the guidelines are responding to is considerable. In 2024, 170 million children and adolescents aged 5–19 were living with obesity — 70 million of them aged just 5–9, and 100 million aged 10–19. Obesity prevalence in that age group has quadrupled since 1990, rising from 2% to 8%, according to WHO.

The new recommendations sit in deliberate contrast to WHO's guidelines for adults, issued in December 2025, which endorsed GLP-1 agonists as a tool for tackling obesity in grown-ups. The paediatric guidelines make clear that the evidence base for those drugs in children — particularly younger ones — does not yet justify the same approach.

That caution arrives as real-world use of GLP-1 drugs in children is accelerating sharply. According to a 2026 study published in Pediatrics and cited by Nutrition Insight, GLP-1 use among US children under 12 increased 310-fold between 2019 and 2026. A separate study found that one in six US children on these medications developed nutritional deficiencies within a year, and that fewer than 25% received nutritional counselling within six months of starting treatment.

WHO scientist Maria Nieves Garcia Casal told reporters that bariatric surgery could be considered during adolescence for severe obesity accompanied by complications such as type 2 diabetes or hypertension — but only if diet and lifestyle changes had already failed, according to CTV News.

The guidelines recommend that any multimodal intervention account for a child's age, gender, health status, food preferences, cultural context and interests, as well as the resources and support available to parents and caregivers. Digital health interventions are conditionally recommended, but only with parent or caregiver supervision. Interventions should be delivered and supervised by health workers with knowledge of nutrition, physical activity and behaviour change.

Mental health is woven through the recommendations as well. WHO notes that anxiety, depression, low self-esteem and emotional dysregulation can contribute to unhealthy eating and physical inactivity, while children living with obesity frequently experience stigma and bullying that compound the harm. Health workers are directed to address both obesity and mental health conditions early and together.

Our priority must be to ensure that every child and adolescent can access quality care and supportive environments from an early age, helping them achieve and maintain a healthy weight and laying the foundation for lifelong health and well-being.— Dr. Luz María De Regil, Director, Department of Nutrition and Food Safety, WHO

WHO is also explicit that clinical guidelines alone cannot reverse the obesity trend. The agency continues to call for regulatory and fiscal policies that make healthy diets and physical activity more accessible and affordable, including action across education, urban planning, transport and social protection.

The paediatric guidelines were developed by WHO's Guideline Development Group, which assessed evidence for potential interventions through systematic reviews, weighing benefits and harms, equity, feasibility, acceptability, costs, and the values and preferences of children and their caregivers. Together with the adult guidelines released in December 2025, they form part of what WHO describes as a life-course approach to obesity care.

Why it matters — With GLP-1 drugs already being prescribed to millions of children despite limited long-term safety data, WHO's first paediatric obesity guidelines set a global clinical standard that puts the brakes on pharmaceutical shortcuts and places the burden of care on health systems to deliver accessible, sustained lifestyle support.

Reported by who.int, reuters.com, ctvnews.ca, forbes.com, nutritioninsight.com, iris.who.int