Kids On the Move: Protecting Future Generations from Obesity

Leading pediatric endocrinologist and recipient of the Endocrine Society’s 2025 Outstanding Leadership in Endocrinology Laureate Award, Ilene Fennoy, MD, talks with Endocrine News about the potential of GLP-1s and long-term solutions for childhood obesity. She says a good place to start is creating more programs in schools to help kids eat better and incorporate more movement into their daily lives.

Ilene Fennoy, MD, has always been passionate about improving the health of children. Between treating patients, directing several programs at Columbia University, and balancing her work with different medical associations, she is a prime example of an outstanding leader in pediatric endocrinology who goes above and beyond for both her patients and her community.

“One of the main reasons I entered the field of pediatric endocrinology was to learn more about the medical risks associated with size at birth, partially because of my desire to help African Americans, who are more likely to be small for gestational age,” Fennoy says. “I have always been interested in growth and became increasingly interested in childhood obesity and how we can manage it and try and prevent the progression to type 2 diabetes.”

Fennoy has been a pediatric endocrinologist and a professor at Columbia University in New York for over 20 years where she directs key programs focused on obesity and related cardiovascular morbidity, with a particular emphasis on care for underserved populations.

She recently won the Society’s Laureate Award for Outstanding Leadership in Endocrinology for being a pioneer, innovator and leader in the field of pediatric obesity and in the realm of diversity, equity, and inclusion.

Childhood obesity affects almost 20% of children in the United States. A new generation of anti-obesity medications have the potential to change the treatment landscape for children and teens with obesity, but their safety has come into question. Access to care and lack of long-term studies on their efficacy also remain a major roadblock.

“We still have a lot of unknown areas, and these are relatively new medications, so we do not have the data of long-term effects, meaning we should be cautious with them,” Fennoy says. “It’s great that we now have something that really works, but I don’t expect these medications to work for everyone, which is clear from the adult data, so we need to figure out when is the optimal time to intervene.”

“Nevertheless, we are seeing more children with severe obesity who have comorbid conditions for whom medication or surgery is important because they’re getting complications that are going to keep them from functioning optimally in life,” she adds.

Access to Care

There are GLP-1s that are FDA approved for adolescents with obesity who are 12 years or older, but insurance rarely covers them making it difficult for patients to access their medication. Medicare and Medicaid do not pay for weight loss medications unless you have certain comorbidities like diabetes or major cardiovascular events, which are not as common in the pediatric age group. These medications can cost up to $1,000 per month, making access for those without insurance coverage nearly impossible. The drugs are more likely to be covered and prescribed in patients with type 2 diabetes as they were originally designed for diabetes care and were secondarily found to have a profound effect on weight.

“There are a number of studies on the benefits of educating youth on nutrition and exercise including improvements in cardio fitness and preventing weight gain. The most economical way of providing education about nutrition to a large number of children is in schools.” — Ilene Fennoy, MD, MPH, professor of pediatrics, Columbia University’s Valegos College of Physicians & Surgeons, New York, N.Y.

Another roadblock to access to care is the lack of long-term data. Fennoy believes more doctors will prescribe weight loss medications to children and teens as we continue to see the long-term benefits. Fennoy explains that lifestyle interventions can take about 26 visits over the course of a year to be successful, which is hard for families and practitioners to fit into their schedules. Furthermore, they rarely result in the type of weight loss that families and children with severe obesity are looking for or that can be achieved with these new weight loss medications.

Type 2 Diabetes and Childhood Obesity

According to the CDC, an estimated 193,000 children younger than 20 years old have been diagnosed with type 1 or type 2 diabetes. Type 2 diabetes most often develops in people 45 or older, but more and more children are developing it. It is very common for people with obesity to develop type 2 diabetes.

Kids who get type 2 diabetes have a more rapidly progressive disorder than adults, resulting in long-term complications in their 20’s and 30’s, compared to adults who get it at age 45 and do not start seeing long-term complications until their 60’s and 70’s.

“This is really scary because you’re going to have a young population that can’t work because of loss of limbs, blindness, and heart disease due to diabetes secondary to obesity. Yet, we can’t treat them until they get to be diabetic in many states,” Fennoy says.

When Bariatric Surgery Comes into Play

There is increasing data to show bariatric or weight loss surgery is very effective in adolescents with severe obesity as it can prevent secondary complications from obesity and help with weight loss. Severe obesity in children is defined as a body mass index (BMI) at or above the 99th percentile for their age and gender. In the United States, about 6% of children and adolescents ages 2–19 have severe obesity.

“Research shows people with severe obesity have not been very successful at losing more than 10-15% of their body weight from diet and exercise alone,” Fennoy says.

“Losing only 10% to 15% of one’s body weight only makes a dent for teens who are, for example, over 300 pounds with a BMI over 40. They’re only losing about 30 pounds, and their emotional and psychological well-being continues to suffer in addition to their physical health. It makes it very difficult for these children to interact with others and get them to be successful with lifestyle changes alone, so bariatric surgery is a great option,” she adds.

Interventions in Schools

The CDC recommends children and teens aged 6–17 should get at least 60 minutes of physical activity every day, but only 20% to 28% of children meet this recommendation. Even though many schools have started incorporating more physical activity into kids’ daily routine, there are still many schools that are not educating children on nutrition or providing enough opportunities for exercise.

“There are a number of studies on the benefits of educating youth on nutrition and exercise including improvements in cardio fitness and preventing weight gain,” Fennoy explains. “The most economical way of providing education about nutrition to a large number of children is in schools.”

Workforce Challenges

Forty percent of people in the United States have obesity, and there are not enough doctors and nutritionists to meet their treatment needs. Plus, many practices do not have access to appropriate nutrition services, and insurance rarely covers these services.

“One of the main reasons I entered the field of pediatric endocrinology was to learn more about the medical risks associated with size at birth, partially because of my desire to help African Americans, who are more likely to be small for gestational age. I have always been interested in growth and became increasingly interested in childhood obesity and how we can manage it and try and prevent the progression to type 2 diabetes.” — Ilene Fennoy, MD, MPH, professor of pediatrics, Columbia University’s Valegos College of Physicians & Surgeons, New York, N.Y.

“We don’t have the money to fund all the nutritionists we need, so we are trying to push more diet and exercise education or obesity treatment lifestyle education into primary care,” Fennoy says. “We need baseline general knowledge in the community about living a healthy lifestyle and greater access to nutritionists in the outpatient setting.”

Leading the Change

Fennoy and other pediatric endocrinologists play an important role in leading the change to make treatment for childhood obesity more accessible and creating more programs to improve the quality of life for more children living with obesity.

Fennoy is a member of the Endocrine Society’s Pediatric Obesity Guidelines Committee and has collaborated with the Endocrine Society’s Commitment to Diversity, Equity, and Inclusion (CoDI). She is also a co-chair of the Pediatric Endocrine Society’s Equity, Diversity, and Inclusion (EDI) Task Force.

She believes the first step to improving the health and well-being of children is incorporating more nutritional education and physical activity in schools. Even though there is a new generation of medications approved and available to treat childhood obesity, it is up to insurance companies to start covering them so more patients can afford their medication. Only then can we even hope to see the tide of the childhood obesity epidemic start to ebb. 

Williams is the Endocrine Society’s associate director of Communications and Media Relations and has written often about the Society’s events and programs on the pages of Endocrine News and elsewhere.