At the 2025 Society for Pediatric Dermatology annual meeting, Alaina Vidmar, MD, a pediatric endocrinologist at Children’s Hospital Los Angeles, delivered a compelling presentation on the evolving landscape of pediatric obesity treatment. Her talk emphasized the complexity of obesity as a chronic disease and encouraged integration of care across all pediatric specialties, including dermatology.1
Vidmar began by acknowledging the pervasive stigma faced by children in larger bodies, underlining that the greatest tool against this bias is effective, evidence-based treatment. She referenced the 2023 American Academy of Pediatrics (AAP) guidelines—its first comprehensive update on pediatric obesity in 15 years—which emphasize a multimodal, chronic disease approach to treatment. These guidelines advocate for treating obesity with the same rigor and customization as other chronic conditions such as asthma or type 1 diabetes.2
A key message of the presentation was that pediatric obesity is not the fault of the child or their family, but a biologically and environmentally influenced disease involving neurohormonal changes that affect appetite regulation and metabolism. The condition has wide-ranging effects across pediatric subspecialties, including dermatology, where skin conditions like acanthosis nigricans frequently present as early signs of insulin resistance.
Vidmar stressed that treatment should be matched to the severity of the disease. For example, lifestyle modification may be appropriate for a child who needs modest weight reduction, while more advanced treatment—such as pharmacotherapy or bariatric surgery—is necessary for those with severe obesity and its related complications.
She also noted that pharmacologic therapies have expanded significantly in recent years. The GLP-1 receptor agonists, such as liraglutide and semaglutide, are currently the most effective medications available, yielding an average 16% reduction in body weight over a year. These agents also show improvements in obesity-related comorbidities such as type 2 diabetes and hypertension. While effective, they can be expensive and often limited by insurance coverage and geographic access.
Newer agents, such as tirzepatide, a GLP-1/GIP dual agonist, offer even greater weight loss—approaching that seen with bariatric surgery—with fewer gastrointestinal adverse effects. Although these drugs are only FDA-approved for individuals 18 and older, many pediatric clinicians use them off-label with success. Vidmar noted that in her own practice of nearly 900 pediatric patients on anti-obesity medications, serious adverse effects have been rare.
She also highlighted the value of more accessible oral agents like phentermine and topiramate, either individually or in combination (as in the FDA-approved phentermine and topiramate extended-release (Qsymia)). These medications are especially helpful for children with hyperphagic phenotypes and are typically easier to prescribe due to lower costs and broader availability.
Metformin, while not particularly effective for weight loss, remains a useful adjunct in patients with prediabetes, polycystic ovarian syndrome, or insulin resistance-related skin changes.
Vidmar also addressed the underutilization of bariatric surgery in adolescents. Despite data supporting its safety and efficacy, only a small fraction of eligible patients undergo the procedure—largely due to misinformation or lack of referral from pediatric providers. The 2023 AAP guidelines now recommend considering bariatric surgery as first-line therapy for children with class II or III obesity. Vidmar encouraged clinicians to reframe the narrative around surgery, noting that laparoscopic sleeve gastrectomy is well-tolerated, minimally invasive, and does not interfere with growth or puberty.
Importantly, Vidmar stressed that access—not culture—is often the true barrier to care. At CHLA, a safety-net hospital serving mostly Hispanic, publicly insured patients, the establishment of an accessible bariatric surgery program yielded over 300 referrals in just 3 months. This experience underscores the need for health care systems to design culturally sensitive, flexible, and decentralized care models that meet families where they are.
To end her talk, Vidmar urged all pediatric clinicians—dermatologists included—to recognize obesity as a chronic disease and understand their role in a team-based treatment model. Whether through early detection, referral, or shared decision-making, pediatric subspecialists can help break down barriers and improve long-term outcomes for children living with obesity.
References
- Vidmar A. Managing obesity with an eye toward dermatology. Oral presentation at: Society for Pediatric Dermatology 2025; July 23-26, 2025. Seattle, Washington.
- Hampl SE, Hassink SG, Skinner AC, 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