AAP 2023 Pediatric Obesity Guidelines: A Parent's Plain-Language Summary

The AAP 2023 pediatric obesity guidelines are the American Academy of Pediatrics' first full guide for treating obesity in kids and teens. (The AAP is the American Academy of Pediatrics, the main U.S. group of children's doctors.) The guide came out in January 2023. This page explains what it says, in plain words.

Here is the short version. Doctors should check a child's BMI every year, starting at age 2. The main treatment is a coaching program on food and activity. For teens 12 and older who meet the rules, doctors should also offer weight-loss medicine. For teens 13 and older with severe obesity, doctors should offer a referral to a comprehensive multidisciplinary metabolic and bariatric surgery center for a check-up.

BMI stands for body mass index. It is a number based on height and weight. Doctors use it to track how a child is growing.

What the AAP 2023 guideline actually says

Here is the guide at a glance:

The guide came out on January 9, 2023, in the journal Pediatrics (Hampl SE et al.). It is the AAP's first full treatment guide for pediatric obesity. It builds on an earlier AAP report (Barlow 2007).

The guide follows four main ideas:

• Treat childhood obesity as a long-term condition that needs steady care.
• Treat the whole child, not just the BMI number. This includes mental health, family support, and social factors.
• Act early once treatment is offered, instead of waiting and watching.
• Remove weight stigma from care.

You can read the exact guideline wording in the reference section near the end of this page.

How the AAP defines overweight, obesity, and severe obesity

Direct answer: Overweight is a BMI from the 85th to under the 95th percentile. Obesity is a BMI at or above the 95th percentile. Severe obesity is a BMI at or above 120 percent of the 95th percentile for age and sex.

What does percentile mean? Doctors compare your child's BMI to other kids the same age and sex. They use the CDC growth charts to do this. A BMI at the 95th percentile is higher than 95 out of 100 kids the same age and sex.

Here are the three groups:

• Overweight: a BMI from the 85th up to (but not including) the 95th percentile.
• Obesity: a BMI at or above the 95th percentile.
• Severe obesity: a BMI at or above 120 percent of the 95th percentile for age and sex.

Severe obesity has two classes:

• Class 2: a BMI of 120 to under 140 percent of the 95th percentile. Or a BMI of 35 to under 39 kg/m2, whichever number is lower for the child's age and sex.
• Class 3: a BMI at or above 140 percent of the 95th percentile. Or a BMI at or above 40 kg/m2, whichever is lower.

Severe obesity is set by BMI alone. The guide does not require any other health problem to be present.

IHBLT: the coaching program that comes first

Direct answer: The guide says a coaching program on food and activity is the first treatment for kids 6 and older who are overweight or have obesity. The best results come from 26 or more hours of coaching over 3 to 12 months.

IHBLT stands for intensive health behavior and lifestyle treatment. In plain terms, it is a coaching program for the whole family. It covers healthy eating, staying active, building new habits, and support for parents.

The guide says doctors should offer this program to kids 6 and older. It also says doctors may offer it to younger children, ages 2 to 5.

The guide points to 26 or more hours of coaching over 3 to 12 months. That threshold comes from a systematic review done for the U.S. Preventive Services Task Force (O'Connor 2017), which linked this much coaching to better, longer-lasting results.

Programs that reached 26 or more hours helped kids lower their BMI and keep it down. Shorter programs did not produce meaningful, lasting BMI reduction. The Task Force confirmed this in its 2024 recommendation statement.

The coaching program is the base under every other step. Medicine and surgery, when they are used, are added on top of it. They do not replace it.

When the AAP recommends considering medication

Direct answer: For teens 12 and older with obesity (a BMI at or above the 95th percentile), the guide says doctors should offer weight-loss medicine. It is added to the coaching program, based on each drug's uses, risks, and benefits, with the family sharing in the choice.

Two points often get missed.

First, the guide says to offer the option. It does not say to prescribe a drug automatically. The decision is made with the family, case by case.

Second, what makes a teen eligible is age and BMI, not another health problem. The guide does tell doctors to check for and treat obesity-related conditions. These include type 2 diabetes, high blood pressure, high cholesterol or other blood-fat problems (called dyslipidemia), fatty liver, sleep apnea, and others. But those conditions are not required before a teen can be offered medicine.

One study behind this is the STEP TEENS trial of once-weekly semaglutide (Weghuber 2022). In that study, 201 teens ages 12 to under 18 with obesity were treated for 68 weeks. Teens who took weekly semaglutide plus lifestyle support lowered their BMI by 16.1 percent on average. Teens who took a placebo plus the same support saw their BMI go up by 0.6 percent.

The guide also names other medicines: metformin, phentermine-topiramate, liraglutide, and orlistat. Each one has its own FDA-approved age, uses, risks, and benefits.

When the AAP recommends a surgery-evaluation referral

Direct answer: For teens 13 and older with severe obesity, the guide says doctors should offer a referral for a check-up. The referral goes to a comprehensive multidisciplinary pediatric metabolic and bariatric surgery center (a weight-loss surgery center). It is for a check-up, not for surgery itself.

The wording matters. It is a referral to a comprehensive multidisciplinary center, not a decision to operate. A team of specialists looks at whether surgery is the right next step. This takes months. They weigh medical, nutrition, mental-health, and family factors. Severe obesity here is set by BMI alone (Class 2 or Class 3), not by another health problem.

One source is the Teen-LABS study (Inge 2016). Three years after surgery, teens lost about 27 percent of their weight on average. Many also saw their health improve. Type 2 diabetes went into remission (blood sugar returned to a healthy range and stayed there during the study) in 95 percent of cases. Prediabetes went into remission in 76 percent. High blood pressure went into remission in 74 percent.

Five years after surgery, teens who had gastric bypass had higher remission rates than adults for two conditions. Type 2 diabetes went into remission in 86 percent of teens, versus 53 percent of adults. High blood pressure went into remission in 68 percent of teens, versus 41 percent of adults.

The five-year numbers above are for one type of surgery. It is called Roux-en-Y gastric bypass (Inge 2019). The study also found teens had higher rates of low vitamin and mineral levels. The two main surgeries for teens today are Roux-en-Y gastric bypass and vertical sleeve gastrectomy. Both have strong long-term results in the Teen-LABS study.

Surgery is a serious choice, and the guide reflects that. It calls for a referral to a comprehensive multidisciplinary center that can guide the family through the check-up.

What the AAP names as foundational: equity, stigma, and mental-health screening

Direct answer: The guide treats fairness (equity), weight stigma, and mental-health checks as core parts of obesity care, not as extras. This includes checks for eating problems. The guide is built on a family-centered, non-stigmatizing approach.

The guide tells doctors to screen for mental-health concerns as part of routine obesity care. This includes depression, anxiety, and disordered eating. Disordered eating means unhealthy eating patterns, such as an eating disorder.

Some parents worry that intensive treatment could raise the risk of an eating disorder. The guide takes this on directly. It says to screen for that risk and care for it, rather than delay treatment. It also tells doctors to use respectful, person-first language and to work with families as partners.

Common parent concerns about the 2023 guide are not ignored. These include worries about over-treating, the age cutoffs, surgery for teens, stigma, and eating-disorder risk. The guide names each one. The advice sits on top of that foundation.

How the 2023 guideline differs from the 2007 recommendations

Direct answer: The 2023 guide replaces the 2007 version, which used a "wait and watch," step-by-step approach. The 2023 guide says to check and act sooner.

The 2007 approach used four stages. A child moved to the next stage only after a set trial at the stage before. The 2023 guide drops the "wait and watch" model. It says to offer a check-up and treatment as soon as a child meets the rules. The intensity is matched to the child's BMI group, age, and health.

The guide has not had a major change since it came out. In January 2024, a "Statement of Correction" fixed one reference in the source list (Pediatrics 2024;153(1):e2023064612). It did not change any advice. Every Key Action Statement stayed the same.

How Blueberry Balance implements the AAP framework

Direct answer: Blueberry Balance is one way to put the AAP framework into practice. It is built around the coaching-program base layer, with a specialist-led check-up and, when it is clinically appropriate, a step-by-step look at medicine. For surgery check-ups, Balance refers families to comprehensive multidisciplinary in-person centers.

The Balance plan lines up with the AAP steps. The unlimited-coaching base layer is built to meet or beat the 26-hour bar from KAS 11. A pediatrician with special training in obesity medicine (a DABOM credential) leads the medical check-up. When it is clinically appropriate, that doctor leads the talk about medicine under KAS 12. Balance does not do surgery. When a surgery-check referral (KAS 13) is clinically appropriate, Balance helps support it. Balance is a pediatric obesity-medicine layer. It works alongside your child's regular pediatrician.

Frequently asked questions

Does the AAP recommend Wegovy for 12-year-olds?

The 2023 guide says doctors should offer weight-loss medicine to teens 12 and older with obesity. Obesity here means a BMI at or above the 95th percentile. The medicine is added to the coaching program, based on each drug's uses, risks, and benefits. The guide does not name any one brand. Wegovy (semaglutide) is one option in this group. It is backed by the STEP TEENS study (Weghuber 2022). Whether it is right for a certain teen depends on a medical check-up and a shared choice.

Does the AAP recommend weight-loss surgery for 13-year-olds?

The guide recommends a referral for a check-up, not surgery itself. This is for teens 13 and older with severe obesity. Severe obesity here means a BMI at or above 120 percent of the 95th percentile for age and sex. The guide says to offer a referral to a comprehensive multidisciplinary pediatric metabolic and bariatric surgery center (a weight-loss surgery center). There, a multidisciplinary team decides whether surgery is the right next step. Most teens who are referred do not go straight to surgery. The check-up alone takes months.

Did the AAP retract or revise the 2023 guideline?

No. The guide has not been pulled back or changed in a major way. One "Statement of Correction" came out in January 2024. It fixed one reference (number 505) in the source list. No advice wording changed. No Key Action Statement changed.

How does the AAP guideline address eating-disorder risk?

The guide says to screen for disordered eating as part of routine obesity care. It takes on the worry that intensive treatment could raise eating-disorder risk. It does this by screening for and treating that risk within care, not by delaying treatment. It also tells doctors to use person-first language and a non-stigmatizing, family-centered approach.

Is Blueberry Balance an AAP-recommended program?

The AAP does not endorse specific programs. Balance is one way to put the AAP framework into practice. The Balance plan is built around the coaching-program base layer from KAS 11. It adds a specialist-led check-up and a step-by-step look at medicine when it is clinically appropriate.

Does the AAP still recommend watchful waiting?

No. The 2023 guide replaces the 2007 "wait and watch" model. KAS 11 says doctors should provide or refer kids 6 and older with obesity to the coaching program once they meet the rules. They should not wait through staged trials to move ahead.

Where can I read the full AAP guideline myself?

The official guide is published in the journal Pediatrics (Hampl SE et al., 2023; doi:10.1542/peds.2022-060640). The AAP also puts out a Summary of Key Action Statements PDF. Both are linked in the Sources section below. This page explains the guide in plain language. It is not the official guide. It is not a substitute for reading the source.

Next steps

Do you want a pediatric obesity-medicine specialist to help you and your teen use the AAP framework? You can start a Blueberry Balance visit. Balance works alongside your child's regular pediatrician. Our team is led by board-certified pediatricians with DABOM credentialing. The plan maps right onto the framework above.

Exact guideline wording (Key Action Statements)

If you'd like to see the exact wording, here are the Key Action Statements, quoted directly from the guideline. The earlier sections on this page explain what each one means in plain language.

KAS 1: "Pediatricians and other PHCPs should measure height and weight, calculate BMI, and assess BMI percentile using age- and sex-specific CDC growth charts or growth charts for children with severe obesity at least annually for all children 2 to 18 years of age to screen for overweight (BMI ≥85th percentile to <95th percentile), obesity (BMI ≥95th percentile), and severe obesity (BMI ≥120% of the 95th percentile for age and sex)."

KAS 9: "Pediatricians and other PHCPs should treat overweight (BMI ≥85th percentile to <95th percentile) and obesity (BMI ≥95th percentile) in children and adolescents, following the principles of the medical home and the chronic care model, using a family-centered and nonstigmatizing approach that acknowledges obesity's biologic, social, and structural drivers."

KAS 11: "Pediatricians and other PHCPs should provide or refer children 6 years and older (Grade B) and may provide or refer children 2 through 5 years of age (Grade C) with overweight (BMI ≥85th percentile to <95th percentile) and obesity (BMI ≥95th percentile) to intensive health behavior and lifestyle treatment. Health behavior and lifestyle treatment is more effective with greater contact hours; the most effective treatment includes 26 or more hours of face-to-face, family-based, multicomponent treatment over a 3- to 12-month period."

KAS 12: "Pediatricians and other PHCPs should offer adolescents 12 years and older with obesity (BMI ≥95th percentile) weight loss pharmacotherapy, according to medication indications, risks, and benefits, as an adjunct to health behavior and lifestyle treatment."

KAS 13 (excerpt): "...adolescents 13 years and older with severe obesity (BMI ≥120% of the 95th percentile for age and sex) for evaluation for metabolic and bariatric surgery..."

Sources

• Hampl SE, Hassink SG, Skinner AC, Fox CK, Joseph PR, Jordan T, et al. Clinical Practice Guideline for the Evaluation and Treatment of Children and Adolescents With Obesity. Pediatrics. 2023;151(2):e2022060640. doi:10.1542/peds.2022-060640. Full text.
• Statement of Correction: Obesity Clinical Practice Guideline. Pediatrics. 2024;153(1):e2023064612.
• US Preventive Services Task Force; Nicholson WK, Silverstein M, Wong JB, et al. Interventions for High Body Mass Index in Children and Adolescents: US Preventive Services Task Force Recommendation Statement. JAMA. 2024;332(3):226 to 232. doi:10.1001/jama.2024.11146.
• O'Connor EA, Evans CV, Burda BU, Walsh ES, Eder M, Lozano P. Screening for Obesity and Intervention for Weight Management in Children and Adolescents: Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA. 2017;317(23):2427 to 2444.
• Weghuber D, Barrett T, Barrientos-Pérez M, et al. Once-Weekly Semaglutide in Adolescents with Obesity. N Engl J Med. 2022;387(24):2245 to 2257. doi:10.1056/NEJMoa2208601.
• Inge TH, Courcoulas AP, Jenkins TM, et al. Weight Loss and Health Status 3 Years after Bariatric Surgery in Adolescents. N Engl J Med. 2016;374(2):113 to 123.
• Inge TH, Courcoulas AP, Jenkins TM, et al. Five-Year Outcomes of Gastric Bypass in Adolescents as Compared with Adults. N Engl J Med. 2019;380(22):2136 to 2145.
• Barlow SE; Expert Committee. Expert Committee Recommendations Regarding the Prevention, Assessment, and Treatment of Child and Adolescent Overweight and Obesity: Summary Report. Pediatrics. 2007;120(Suppl 4):S164 to S192.
• American Academy of Pediatrics. Summary of Key Action Statements (PDF).