By Dr. Asnat Raziel, bariatric surgeon specializing in obesity treatment, metabolic health and healthy longevity; Director of the Multidisciplinary Center for Obesity Treatment, Assia Medical, Assuta Ramat HaChayal, Tel Aviv
Childhood obesity treatment: why starting early matters
Childhood obesity treatment begins long before any diet or medication. When a child gains weight, parents often hear, “He’ll grow into it” or “It will pass with age.” However, the medical guidelines tell a different story. The American Academy of Pediatrics (AAP) is the professional organization of pediatricians in the United States. According to its clinical guidelines, childhood obesity is a complex chronic disease.
Still, starting early does not mean a strict diet. Instead, it means checking the child’s health, understanding the environment they grow up in and giving the family the right support. In this article, I review the American and Israeli guidelines, the data from Israel and what actually happens in clinics.
How many children in Israel live with excess weight?
First, the numbers. According to measurements by Israel’s school health services in the 2021–2022 school year, 19.5% of first graders had overweight or obesity. In seventh grade, the rate was 31.4%. That is almost one in three seventh graders.
In addition, the COVID-19 period made things worse. Data from Israel’s National Program for Quality Indicators in Community Healthcare showed a rise in obesity rates. Among 7-year-olds, the rate rose from 6.8% in 2019 to 7.7% in 2021. Among 14- to 15-year-olds, it rose from 10.2% in 2017 to 11.8% in 2021. Moreover, the social gap stands out. In 2019, among 14- to 15-year-olds, the obesity rate in the lowest socioeconomic cluster was 1.63 times higher than in the highest one.
How is obesity diagnosed in children?
In adults, doctors use fixed BMI cutoffs. In children, by contrast, the body changes with age and puberty. That is why doctors interpret BMI by age and sex, using growth charts. According to the American guidelines, overweight starts at the 85th percentile and runs up to just below the 95th. Obesity starts at the 95th percentile. Among other criteria, the guidelines define severe obesity as a BMI of at least 120% of the 95th percentile for age and sex.
The guidelines recommend measuring height and weight at least once a year, starting at age two. Keep in mind that this number is only a starting point for an evaluation. It does not describe the child or their worth.
What do doctors check beyond weight?
Before any childhood obesity treatment, it is important to get to know the child and the family. The doctor asks about eating habits, activity, sleep and emotional well-being. They also review medications, medical and family history and living conditions. A physical exam and a blood pressure check matter too.
Why does this matter? Childhood obesity is linked to abnormal blood fats and changes in blood sugar control. Other related conditions include fatty liver disease and sleep-related breathing problems. Some children also struggle emotionally or socially.
Doctors tailor blood tests to age and risk. For example, the American guidelines recommend checking blood lipids, blood sugar and liver function in children aged 10 and older with obesity. In younger children, or in overweight without obesity, the doctor decides how far to go based on risk factors. So there is no single “test package” for every child.
Childhood obesity treatment starts with the family
The foundation of treatment is a program that combines nutrition, physical activity and habit change. Importantly, the family takes an active part in it. It helps to build a home routine you can actually keep: regular meals, nutritious food on hand and enough sleep. Conversations with the child should focus on health, strength and feeling good, with no blame and no shaming comments about their body.
The American guidelines stress that the amount of support changes the outcome. The most effective programs include at least 26 hours of multidisciplinary family sessions over three to 12 months. They recommend offering this kind of treatment from age six, and it can also be considered for children aged two to five. When no such program is available, it is worth building broad support with the pediatrician, a dietitian and other professionals.
Movement, sleep and screens: small steps at home
Physical activity does not have to start at a gym. Playing outside, walking, biking, swimming or dancing are all excellent first steps. The World Health Organization recommends an average of 60 minutes a day of moderate- to vigorous-intensity activity for ages five to 17. That said, even a gradual start helps a child who is not active today.
Likewise, regular sleep is part of a healthy routine. The Israeli guideline adds practical advice: no more than two hours a day of screen time, five servings of fruits and vegetables a day and a regular breakfast. It also recommends family meals at least five times a week, and water instead of sweetened drinks.
Childhood obesity treatment with medication
Are medications right for children? The answer depends on age, the severity of obesity, the child’s medical condition and each drug’s approved indication. The American guidelines recommend offering adolescents aged 12 and older with obesity medication as an option. This is in addition to behavioral and family-based treatment, not instead of it.
For children aged eight to 11, the guidelines allow doctors to consider medication only according to the drug’s approved indication. Even so, this is not a recommendation to give medication to every child in this age group. For children under eight, the guidelines do not present medication as a routine step.
Obesity medications for adolescents in Israel
In 2023, the Israel Society for Pediatric Endocrinology published guidance on liraglutide treatment for ages 12 to 18. According to the document, the treatment targets adolescents with obesity and related conditions who weigh more than 60 kg. A pediatric endocrinologist, or a doctor who treats childhood obesity, recommends the treatment. It continues only if the adolescent has lost 4% of their weight after four months.
Furthermore, in 2024 Israel approved weekly semaglutide for use in adolescents. For the first time, the 2026 national health basket (the list of treatments Israel’s health funds must cover) included Wegovy for ages 12 to 18, together with a professional support program.
What about surgery for adolescents?
In the United States, the guidelines recommend offering adolescents aged 13 and older with severe obesity a referral for evaluation at a multidisciplinary metabolic and bariatric surgery center. Such a referral is not a decision to operate. Rather, it gives the family a professional picture of their options.
In Israel, on the other hand, the rules are far more conservative. Under Ministry of Health guidelines, surgeons generally perform bariatric surgery on adolescents from age 16. Below 16, surgery is possible only in exceptional cases, with approval from a Ministry of Health exceptions committee. Before surgery, a pediatric endocrinologist and a child psychiatrist evaluate the adolescent, and so does a pre-surgery committee. In addition, the adolescent takes part in a structured weight loss program for at least six months at a bariatric center.
In practice, the number of operations is small. According to Israel’s National Bariatric Surgery Registry, 460 adolescents had bariatric surgery in Israel between 2018 and 2024. Their average age was 16.9, and their average BMI was 46.4. In most cases (87.6%), surgeons chose a sleeve gastrectomy. However, long-term follow-up is worrying: only 14.5% were still in nutritional follow-up four years after surgery.
What do Israeli guidelines say about childhood obesity treatment?
In 2015, the Israel Medical Association, the Israel Pediatric Association and the Israel Association of Family Physicians published a joint clinical guideline on preventing and treating obesity in children and adolescents. Its definitions are very similar to the American ones. For example, severe obesity is a BMI of 120% of the 95th percentile, or a BMI above 35.
The guideline makes pediatricians and family doctors responsible for early detection, the initial evaluation and referral to multidisciplinary care. As a reasonable first goal, it cites an 8% to 10% drop in BMI. However, it predates the era of the new medications. For that reason, it leaves decisions about medication and surgery to experienced centers.
The gap between guidelines and reality
Family doctors and pediatricians are the first to see the child, so childhood obesity treatment usually starts with them. In practice, though, there is a gap. A study of 370,629 children aged 2 to 18 at Clalit Health Services, Israel’s largest health fund (HMO), looked at children whose BMI matched overweight or obesity. The researchers found that 49% of 5- to 18-year-olds with overweight had no diagnosis in their medical record. Among 5- to 18-year-olds with obesity, the rate was 18.4%.
Recording the diagnosis matters. Children with a recorded diagnosis received significantly more referrals for tests, to a dietitian and for endocrine consultation. Doctors also measured them again later and prescribed medication at a significantly higher rate.
Medication is also still rare. A study from Schneider Children’s Medical Center analyzed Clalit data from 2017 to 2024. Only 2,236 of 307,208 adolescents aged 10 to 18 with overweight or obesity (0.7%) received medication. Most of them (73.8%) received metformin. The study did not include weekly semaglutide, which Israel approved for adolescents only in 2024. In addition, experts note that resources at the health funds are limited compared with the level of support the guidelines recommend.
The picture is similar worldwide. A 2026 review found that in one study, 74% of children with obesity had no screening at all for related conditions. In the United States, before the guidelines came out, only 0.4% of 8- to 17-year-olds with obesity received medication around the time of a visit. After publication, the likelihood of receiving medication rose by 65%. By contrast, the rate of referral for nutrition counseling, 9.7% before the guidelines, did not change significantly.
Which programs operate in Israel?
In 2011, the Ministries of Health, Education and Sport launched the national “Efshari Bari” (Healthy Is Possible) program. In addition, school health services measure height and weight in first and seventh grades. There are also regulations on food quality in schools, and the health funds measure BMI as an annual quality indicator.
One notable step was the tax on sweetened drinks. The tax took effect in January 2022, and Israel repealed it in January 2023. A Ministry of Health study showed that while the tax was in place, sales of the drinks studied fell by 24.14% to 30.65%, depending on the tax rate. What’s more, sales did not return to their previous level even after the repeal.
On the treatment side, multidisciplinary clinics operate in medical centers. For example, the lifestyle change clinic at Schneider Children’s Medical Center includes endocrinologists, genetics experts, dietitians and a psychosocial team. Finally, adding Wegovy to the national health basket is the latest major step, and structured medical support is due to take shape alongside it.
Bottom line: childhood obesity treatment is a shared journey
Biology, environment, habits and life circumstances all shape childhood obesity. That is why childhood obesity treatment should be personal. You can start early without rushing into a treatment that does not suit the child’s age. First, listen to the child and check their health. Then treat any related conditions and work with the family on practical changes. In the end, the goal is not just a number on the scale. The goal is a healthy childhood and a good relationship with food, movement and the body.
The information in this article is general and does not replace personal medical advice.
References
Guidance on liraglutide treatment in children aged 12 to 18 (in Hebrew)
Pediatric overweight and obesity increased in Israel during the COVID-19 period
Recorded diagnosis of overweight/obesity in primary care is linked to obesity care performance rates
Prevalence and Predictors of Guideline Concordant Pediatric Obesity Care: A Narrative Review
Shifts in US Pediatric Obesity Treatment After the AAP Guidelines
Pre-bariatric surgery committee: eligibility criteria (Maccabi Healthcare Services, in Hebrew)
Sweetened drinks tax achieved its goal, then Israel repealed it (in Hebrew)
