The World Health Organization (WHO) issued its first global guidelines on managing obesity in children and adolescents on October 7, setting out what health systems should offer the estimated 170 million young people aged 5 to 19 who were living with obesity in 2024. The two documents, one for children from 29 days to under 10 years and one for adolescents aged 10 to 19, put structured diet, physical activity and behavior-change programs at the center of care and rule out medicines and surgery for the youngest patients.
According to the WHO news release, the 170 million figure includes 70 million children aged 5 to 9 and 100 million adolescents aged 10 to 19. Prevalence in the 5-to-19 age group has quadrupled since 1990, from 2% to 8%, the agency said.
The guidelines strongly recommend structured dietary, physical activity and behavior-changing interventions, delivered individually or as part of a multimodal program, for children and adolescents with obesity. Digital health interventions are conditionally recommended, with parent or caregiver supervision.
On drugs and surgery, the recommendations split by age. WHO does not recommend pharmacological treatment, bariatric surgery or weight-loss devices for children aged 0 to 9. For adolescents aged 10 to 19, approved medicines may be considered only when a supervised multimodal lifestyle program has not achieved the desired results, and bariatric surgery may be considered under strict conditions for those with severe obesity.
Dr Luz María De Regil, director of WHO’s Department of Nutrition and Food Safety, said in the release that the foundation of obesity care for children and adolescents “is not medicine or surgery”. She also said the priority must be to ensure that every child and adolescent can access quality care.
The guidelines also tell health workers to address obesity and mental health conditions early and together, using inclusive, developmentally appropriate and family-engaged strategies. WHO said treatment alone cannot reverse the rise in obesity and called for policies that make healthy diets and physical activity more accessible and affordable. The guidelines form part of the WHO acceleration plan to stop obesity.
How the guidelines were built
The children’s guideline runs to 120 pages and the adolescent guideline to 133. WHO describes them as “adoptable and adaptable, practice- and science-informed global clinical and public health recommendations” built on a primary health care approach. The recommendations are based on systematic evidence reviews and weigh benefits, harms, equity, feasibility, acceptability, costs and the values of children and caregivers, according to the publication pages. The intended audience is policymakers, program managers and health workers.
Speaking at a media briefing the same day, WHO Director-General Dr Tedros Adhanom Ghebreyesus said the guidelines strongly recommend structured changes to diet, behavior and physical activity, and that treatment should improve health, functioning and well-being, not just weight. WHO later corrected the briefing transcript to say the rise in prevalence from 2% to 8% took place over 35 years, not 25.
Why it matters
Until now WHO had no global clinical guidelines specific to child and adolescent obesity. The new documents give ministries and clinicians a common reference point, with a structured lifestyle program as the default first step and drug or surgical options reserved for adolescents who have not responded to supervised care.
The age cutoffs are the most consequential detail for clinicians. With no pharmacological treatment recommended below age 10, and medicines for 10-to-19-year-olds conditional on a supervised lifestyle program that has not delivered results, the guidance makes supervised lifestyle care the gatekeeper for any prescription. It also ties obesity care to mental health, asking services to recognize and treat both at the same time.
What to watch
WHO said the two guidelines sit alongside its existing recommendations for adults as part of a life-course approach to obesity. The next test is uptake: whether national programs adopt the recommendations and fund the structured lifestyle programs they rely on. The agency framed treatment as only one part of the response, pairing the clinical guidance with its call for population-wide policies on diet and physical activity.
The caveats
The news release summarizes the recommendations but does not reproduce the evidence tables or the strength of every recommendation; those sit in the full guideline documents. The prevalence figures are WHO estimates for 2024. This article draws on the WHO release, the briefing transcript and the publication pages, not on an independent review of the underlying studies.
This article is for general information and does not replace advice from a qualified clinician. Corrections: email the editor using the address on the Contact page.
