New weight loss drugs and surgical procedures are becoming more popular among teenagers with severe obesity.

John Simon III was a hungry baby, a “chunky” toddler and a chubby little boy, his mother said. But by age 14, his weight had soared to 430 pounds and was a life-threatening medical condition.

Nine months after weight-loss surgery that removed a portion of his stomach, John has lost about 150 pounds, boosting his health — and his hopes for the future.

“It was like a whole new start,” said John, who will start high school in California this fall.

In Minnesota, Edward Kent was diagnosed with fatty liver disease. The 6-foot, 300-pound high school sophomore started using the obesity drug Wegovy in January — just a month after federal regulators approved it for children 12 and older — and has lost 40 pounds.

John’s mother, Dr. Barbara Van Eeckhout, an obstetrician-gynecologist, emphasized the significance of her son’s weight loss achievement, noting that it will have a lifelong impact on his health. Despite critics’ concerns about such early interventions, John and Edward are among a small but growing number of young adolescents who are resorting to approaches such as body-altering surgery and novel drugs that can rewire metabolism to shed off substantial amounts of weight.

For these teenagers and their parents, these aggressive, albeit often expensive, treatments are necessary alternatives after years of struggling with ineffective diet and exercise regimens. Reflecting on her son’s journey, Karen Tillman, John’s mother and an accountant, remarked that “John has tried with all of his might… it was getting harder and harder,” indicating that intervention was necessary in his case.

Adolescents who carry excess weight are at a high risk of retaining it into adulthood, with potentially severe consequences for their health and life expectancy, as approximately eighty percent do so.

Despite obesity being classified as a complex chronic disease a decade ago by the American Medical Association, effective treatments have remained elusive, according to Aaron Kelly, co-director of the Center for Pediatric Obesity Medicine at the University of Minnesota. Kelly suggests that since obesity is a biologically driven disease, early intervention is crucial and waiting until later in life is often too late.

In January, the American Academy of Pediatrics released guidelines proposing the consideration of obesity drugs for children as young as 12 and surgical intervention for those aged 13 and above. These recommendations, however, prompted immediate controversy.

The guidelines proposed by the American Academy of Pediatrics in January were met with backlash from various quarters, including advocacy groups such as Mental Health America, which described them as “dangerous” and “disheartening,” claiming that they would exacerbate eating disorders and reinforce harmful stereotypes about weight.

Others on social media criticized doctors and parents for seeking an easy way out, and some even accused parents of child abuse, blaming factors such as junk food and video games.

Dr. David Ludwig, an endocrinologist and researcher at Boston Children’s Hospital, cautioned that while the excitement about new weight-loss drugs is justifiable, non-drug options must not be overlooked.

“Especially for children, diet and exercise must remain at the forefront of obesity prevention and treatment,” he wrote in JAMA.

But medical experts who treat kids with severe obesity say research is clear: Diet and exercise alone aren’t enough. More than 240 diseases are associated with excess weight — including liver problems, diabetes and inflammation — and the signs show up early, said Dr. Janey Pratt, a Stanford University surgeon who performed surgery on John Simon.

“It’s already affecting major organs by the time they get to me,” Pratt said. “You’re dealing with a train that’s headed over a cliff.”

As early as elementary school, John struggled with several health problems, including joint pain, shortness of breath, and sleep apnea so severe that, by age 12, he required coffee to stay alert. John also developed anxiety after enduring frequent bullying from classmates, and as a sixth-grader, was hospitalized for two months with post-traumatic stress disorder.

John attempted numerous diets and exercise routines, successfully losing up to 40 pounds at times. However, he experienced intense food cravings, which caused him to regain the weight he had lost, and then some.

By the time Dr. Callum Rowe, a resident in pediatrics at a public health clinic situated at Children’s Hospital, Los Angeles, encountered John, he had a body mass index (BMI) of 75—an inexplicably high figure that surpasses standard BMI measurements, which are often used by medical practitioners to screen for obesity, despite their limitations in accurately predicting health outcomes.

John, who has a reserved demeanor and soft-spoken voice, reached out to Rowe for help with the goal of embarking on a “wellness journey.” Impressed by his insight and maturity, Rowe referred him to the weight-loss program at Stanford Medicine Children’s Health.

Although traveling to Palo Alto, located 350 miles north of their home in California, was a significant undertaking for John and his mother Karen Tillman, they were willing to do whatever it took to help John. His weight had been increasing rapidly, and they felt it was critical to take action.

Since the introduction of the AAP guidelines, sign-ups for Stanford’s surgical program have doubled, causing it to become one of the busiest clinics in the United States to carry out weight-loss surgeries for children, with over 50 of the approximately 2,000 procedures performed annually.

While John was fortunate enough to receive surgical treatment, less than 1% of children who qualify for metabolic surgery undergo the procedure, according to experts.

The cost of the treatment, which ranges from $20,000 to $100,000, can be prohibitively high for families or insurance schemes. However, John’s procedure was covered by Medi-Cal, California’s Medicaid program, which supports children between the ages of 11 and 17.

In the United States, Medicaid coverage for weight-loss surgery among children varies significantly among states.

On average, studies suggest that children who undergo weight-loss surgery lose between a quarter and a third of their body weight. However, approximately one-quarter of children regain weight and must undergo additional treatment, according to Pratt.

Adolescents have lost approximately 16% of their body weight over nearly 16 months in clinical trials of Wegovy, but research has shown that individuals taking obesity drugs tend to regain weight after discontinuing the medication, and some may experience serious side effects like gallstones and inflammation of the pancreas. Despite these issues, requests for obesity drugs, such as Wegovy, have risen sharply both at Stanford and across the country.

Edward Kent’s mother has reported that her son has responded positively to the obesity medication, with the drug eliminating his voracious appetite “like a light switch.” However, it was also noted that at times, some individuals taking these medications can experience severe side effects, leading to conditions such as inflammation of the pancreas and gallstones.

In contrast, John Simon, who has reduced his weight by around 35% in under a year, has experienced a significant improvement in his health, including better functioning liver and decreased insulin resistance. John’s arthritis has also declined, and he is now sleeping and moving more comfortably.

Sadly, John’s struggles with bullying at school persist, with teachers now assigned to accompany him as he moves between classes. Despite the challenges, Charles Griffin III, John’s pastor at DaySpring Christian Church, hopes that he will ultimately emerge stronger and more resilient.

John recently graduated from middle school, but school officials declined to comment on the steps they took to address the issue of bullying. Nevertheless, John’s mother hopes that he will encounter more compassionate treatment at the smaller charter high school he will attend next year.

At 15, John is looking ahead to the future, focusing on health and building a bright career. He has learned how to cook healthy meals and enjoys working out regularly at a nearby gym, logging up to 18,000 steps per day on his pedometer.

He aims to study diligently in hopes of securing his dream job as an automotive engineer, all while striving to live a happy and healthy life free from pain and obesity.