June 17 (Reuters) - For many U.S. parents seeking help

for a child with obesity, the most widely-endorsed treatment is

out of reach - and it's not the popular weight-loss drug Wegovy.

Leading medical groups recommend intensive behavioral

counseling - 26 hours within one year - to teach children and

their families practical ways to eat healthier and move more.

But these programs are not widely available, and wait lists

can run for several months. They are often not covered by health

insurance and require a time commitment that is difficult for

many families to make, according to interviews with more than a

dozen doctors and parents.

As a result, fewer than 1% of the nearly 15 million U.S.

children with obesity get this type of structured care, the U.S.

Centers for Disease Control and Prevention told Reuters. Efforts

by the CDC and others to expand insurance coverage have stalled,

doctors involved in the process told Reuters.

"The coverage for these programs was never good, and we're

not seeing any movement toward improvement," said Dr. Joseph

Skelton, a professor of pediatrics and an obesity medicine

specialist at Wake Forest University School of Medicine.

The prevalence of obesity among U.S. children has steadily

increased, from 5% in 1980 to nearly 20% now, according to the

CDC.

Novo Nordisk's Wegovy was approved for adults in

2021 and for adolescents in late 2022, offering a highly

effective way to lose weight for the first time. Novo still

cannot meet demand for the drug among adults, with at least

25,000 first-time prescriptions dispensed each week.

A much smaller, but growing, number of families are seeking

the drug for their adolescents, Reuters found in February. Many

doctors and parents are wary of using the medication without

data on whether Wegovy can affect a child's development, or pose

other long-term risks.

CHANGING HABITS

Ruth Medina of Holyoke, Massachusetts, wanted to see if a

change in family habits, rather than medication, could help her

15-year-old daughter, Jelainie, when she reached 200 pounds this

year. The family has a history of type 2 diabetes, she said, a

condition exacerbated by excess weight.

"I don't want to go down that path. That's when I got

scared," Medina said.

Jelainie's pediatrician recommended the healthy weight

program at Holyoke Health Center where children and their

parents come for visits with a dietician and community health

worker to set individual goals, plus group sessions about

cooking, deciphering nutritional labels and other lifestyle

changes.

Dr. Vinny Biggs, who oversees the program, said families

face a four-month wait to enroll. Medina and her daughter's

participation is covered, in part, by the state Medicaid health

insurance program, Biggs said.

At the family's first session this month, Jelainie cut up

cauliflower, carrots and other vegetables to prepare a paella

dish alongside her instructors. Mother and daughter said they

liked the meal and took home leftovers and the recipe.

Jelainie has lost some weight. She started walking more,

playing tennis and snacking on fruits and vegetables. Her mother

still worries about the appeal of the many fast-food restaurants

close to their home.

"We walk by so many temptations," Medina said. "I want to do

whatever I can to get her to a healthy weight."

RED LIGHT, GREEN LIGHT

The U.S. Preventive Services Task Force, an influential

federal panel of experts, says it's better to stick to lifestyle

changes for adolescents with obesity until more data on the

long-term safety and effectiveness of the drugs are available,

according to a draft recommendation published in December.

The American Academy of Pediatrics says that youth aged 12

and older should be offered medications for obesity, but only as

an "adjunct to health behavior and lifestyle treatment."

The task force examined clinical trials involving intensive

behavioral programs for children and found that, on average,

children lost 5.7 pounds.

But Wegovy and similar drugs helped people lose pounds more

dramatically - 15% or more of their body weight in clinical

trials. That track record, and a lack of insurance coverage for

counseling, are likely to convince more families to try the

medicines in the future.

Some doctors say that wider Wegovy use by youth will make it

even more essential for children to learn healthy-eating habits

for the long run. They worry that reliance on the drugs alone

could contribute to nutritional deficiencies or eating

disorders.

"Many of us believe it would make sense to offer behavioral

counseling along with the drug," said Dr. Thomas Robinson, a

professor of pediatrics and director of the Center for Healthy

Weight at Stanford Medicine Children's Health in Palo Alto,

California. "These drugs are very effective at reducing weight

and health risks, but you don't all of a sudden adopt a healthy

diet or become more physically active."

At Stanford's lifestyle-counseling program, instructors give

parents and their children long-established lessons about eating

wisely: High-calorie foods, such as ice cream or even almonds,

are "red-light" foods that should be eaten sparingly. Vegetables

are a "green light" - and can be consumed in unlimited

quantities. Most foods are yellow and fall somewhere in between,

Robinson said.

Health insurance doesn't cover Stanford's program, so

families pay out-of-pocket or receive financial assistance from

the hospital, Robinson said. The full cost is $3,500.

Since 2022, the CDC, American Academy of Pediatrics and

other key experts have pushed for better coverage of obesity

counseling. In September, an American Medical Association (AMA)

panel rejected one of those efforts: a request for a dedicated

medical code for the 26-hour program that would help providers

bill for their services.

In a statement, the AMA told Reuters the application didn't

meet the panel's criteria, without providing further details. In

general, new codes may not be approved if they include

non-clinical services, such as cooking classes, according to the

AMA. Even if a code is granted, health insurers can still refuse

to pay for medical services.

In a statement to Reuters, the CDC said that ensuring

equitable access to both obesity medications and lifestyle

treatment "is pivotal so that families have access to multiple

options to address child obesity and support optimal health."