Pharmacotherapy in childhood obesity: Key points from the 2023 AAP clinical practice guideline

Despite increased awareness and interventions, childhood obesity continues to rise and remains a major public health and global challenge. In the United States, approximately one fifth of youth are affected, leading to significant cardiometabolic, psychosocial, and economic consequences. The 2023 American Academy of Pediatrics (AAP) Clinical Practice Guideline for the Evaluation and Treatment of Children and Adolescents with Obesity introduced evidence-based recommendations focused on early identification, comprehensive evaluation, and multimodal management of pediatric obesity. This article summarizes the guideline's major screening and treatment recommendations and focuses on current pharmacotherapy. Body Mass Index (BMI) remains the primary screening tool, supported by assessment of comorbidities and contributing factors such as genetics, endocrinopathies, medications, and environmental influences. Intensive health behavior and lifestyle treatment (IHBLT) is the cornerstone of therapy with pharmacotherapy recommended for adolescents aged 12 years and older as adjunct therapy when appropriate, with bariatric surgery reserved for adolescents aged 13 years and older with higher levels of obesity, which is safe and effective for achieving durable weight loss and improving obesity-related comorbidities. Despite advances, significant gaps persist in long-term safety data, efficacy in younger children, equitable access to care, and sustained weight maintenance after pharmacological treatment ends.