WHO launches new guidelines for the management of obesity in children and adolescents
The World Health Organization (WHO) has launched new guidelines for the integrated management of obesity in children and adolescents, providing evidence-based recommendations to strengthen care for young people living with obesity around the world.
The guidelines set out a people-centred approach to obesity management through primary healthcare, recognising the need to combine effective treatment and care with wider action on the environments and systems that shape health. An accompanying paper, "Bending the curve early in life: WHO guidelines for the integrated management of obesity in children and adolescents," has been published in Obesity Reviews, the scientific journal of the World Obesity Federation.
The publication forms part of a special issue of Obesity Reviews bringing together evidence that supported the development of the WHO guidelines, spanning areas including integrated and multimodal care, behaviour change, health worker competencies and surgical interventions.
A people-centred approach to obesity care
Childhood and adolescent obesity has risen substantially worldwide. Between 1990 and 2022, the global age-standardised prevalence of obesity among children and adolescents aged 5–19 increased from 1.7% to 6.9% among girls and from 2.1% to 9.3% among boys.
Against this backdrop, WHO has developed two complementary guidelines: one covering children under the age of 10 and another for adolescents aged 10–19. Both are designed around people-centred, integrated management delivered through primary healthcare by trained multiprofessional teams.
Importantly, the approach goes beyond weight alone. The guidelines consider physical and mental wellbeing, quality of life, health conditions associated with obesity, access to healthcare and the values and preferences of children, adolescents and their families.
To understand what matters most to the people the guidelines are designed to serve, WHO commissioned seven systematic reviews exploring the views of children and adolescents living with obesity and their parents and carers. Their message was clear: families value supportive interactions, and interventions that build confidence and self-esteem rather than focusing on weight loss alone.
They also recognise that obesity is strongly shaped by wider societal and environmental factors. Effective management therefore needs to sit alongside coordinated action addressing the social, economic, environmental and commercial determinants of health – moving away from approaches centred on individual responsibility.
What do the guidelines recommend?
WHO strongly recommends structured dietary, physical activity and behaviour-change interventions for children and adolescents living with obesity, either individually or as part of integrated, multimodal care. Digital health interventions can also be considered with appropriate parental supervision.
Rather than prescribing a single diet or physical activity programme, interventions should take account of each young person's age, health, cultural context, interests, values and preferences, with parents and caregivers playing an important supporting role.
The recommendations distinguish carefully between children and adolescents when considering more intensive treatment options. Pharmacotherapy and bariatric surgery are not recommended for children under 10. For adolescents, these options may be considered under specific circumstances, including appropriate developmental and psychological assessment, and should be delivered within specialised multidisciplinary settings with close monitoring.
Specifically, pharmacotherapy may be considered for adolescents where a structured and supervised multimodal lifestyle intervention has not improved obesity-related outcomes, while bariatric surgery may be considered for adolescents with severe obesity under the same conditions. In both cases, treatment should only follow an assessment of pubertal development, final adult height and psychological stability, with close monitoring for adverse events and long-term follow-up. No recommendation is made on weight-loss and weight-management devices, owing to a lack of evidence.
Across the recommendations, WHO emphasises equity, human rights and inclusion, recognising that access to appropriate obesity management can differ substantially between and within populations.
From evidence to implementation
The guidelines are intended to support countries in strengthening obesity care as part of their health systems, rather than treating obesity management as a standalone service.
How care is offered matters as much as what is offered. The guidelines encourage health workers to ask permission before discussing obesity with a child or adolescent, recognising that some young people may not yet feel ready – and to make clear that the door is always open when they are. It is a simple but important step towards building trust and avoiding the harm that stigma can cause.
Implementation will require trained healthcare professionals, multidisciplinary teams, clear referral pathways and the integration of obesity management into primary healthcare and essential health benefit packages. At the same time, action across education, food, social protection and community systems will be needed to create environments that support the health and wellbeing of children and adolescents.
This reflects an important principle for the global response to obesity: prevention and treatment are complementary, not competing, priorities. Young people already living with obesity need access to appropriate, evidence-based and stigma-free care, while governments and societies must continue to address the wider drivers contributing to rising obesity prevalence.
The guidelines have also been developed as a living body of work, allowing emerging evidence and changing considerations around feasibility, equity, human rights, new technologies and approaches to obesity management to inform future updates.
Supporting the evidence through Obesity Reviews
The accompanying WHO paper is published as part of a dedicated Obesity Reviews special issue, "Obesity management in children and adolescents: Prioritisation of guideline development, obesity diagnosis, multimodal and surgical interventions and competent obesity management."
The special issue brings together several of the reviews that contributed to the evidence base underpinning the guidelines, including research examining health worker competencies, behaviour-change interventions and bariatric surgery and weight-management devices. Articles in the special issue include:
- Garcia-Casal MN, Pardo-Hernandez H. Integrated Obesity Management for Children and Adolescents for Improved Health: A Special Issue – [LINK TO ADD]
- Garcia-Casal MN, et al. Bending the curve early in life: WHO guidelines for the integrated management of obesity in children and adolescents – [LINK TO ADD]
- Waldrop SW, et al. Ensuring Competent Care Provision for Children and Adolescents With Obesity in the Primary Care Setting – Read the article
- Carrano FM, et al. Surgery and Minimally Invasive Devices for the Treatment of Obesity in Children and Adolescents: A Systematic Review and Meta-Analysis – Read the article
- Xie X, et al. Cognitive Behavioral Interventions for Children and Adolescents With Overweight or Obesity: A Systematic Review and Component Network Meta-Analysis (open access) – Read the article
- Dâmaso AR, et al. Multidisciplinary Therapy to Target Obesity and Its Complications in Adult Population: A Narrative Review (open access) – Read the article
As the scientific journal of the World Obesity Federation, Obesity Reviews provides a platform for high-quality evidence and research that can help inform policy, practice and the global response to obesity. The publication of this special issue alongside the launch of the WHO guidelines helps make the evidence informing this important step in childhood and adolescent obesity care available to researchers, healthcare professionals and decision-makers worldwide.
