We are pleased to introduce the Paediatric COM ‘Rikscentrum Barnobesitas’ (National Childhood Obesity Centre) based in Karolinska University Hospital, Stockholm, Sweden. This COM is co-led by two experts in childhood obesity: Dr. Annika Janson, Associate Professor, Senior Consultant, and Specialist in Paediatrics and Adolescent Medicine, and Dr. Sara Leeb, paediatrician and Head of Section at the National Childhood Obesity Centre. The centre provides intensive health behaviour and lifestyle treatment, pharmacological obesity treatment and assessment before bariatric surgery. This multidisciplinary COM team comprises 12 professionals, including paediatricians, paediatric nurses, dietitians, physiotherapists, a psychologist, and a counsellor. Three members hold PhDs. The expertise of this team spans neuropsychiatry, child psychiatry, developmental psychology, binge eating disorder (BED) treatment, cognitive behavioural therapy, parenting support, and research. The team also bring diverse life experiences, including work in developing countries and years of social work. Beyond professional commitments, team members are passionate about horse riding, hiking, gaming, skiing, and language studies – with one colleague even being a master of Japanese tea ceremonies!
Welcome, Dr Janson and Dr Leeb. We would appreciate an update on your COM activities during the past 12 months. Would you be able to share any recent developments or key achievements?
In 2024, Dr. Annika Janson received the prestigious “Olle Söder Award” for her research and advocacy work in childhood obesity. Dr. Janson also presented on metabolic and bariatric surgery (MBS) at the 2024 EASO COM Summit in Santiago de Compostela, Spain, and co-authored several publications based on the AMOS2 multicentre randomised controlled trial on MBS in adolescents:
- Järvholm et al., The Lancet Child & Adolescent Health, 2023 (org/10.1016/S2352-4642(22)00373-X)
- Järvholm et al., eClinicalMedicine, 2024 (org/10.1016/j.eclinm.2024.102505)
- Järvholm et al., Scandinavian Journal of Surgery, 2024 (org/10.1177/14574969241297517)
Dr. Anna Ek, PhD and Registered Dietitian, joined our team part-time in 2023 and holds a senior researcher position at Karolinska Institute (KI). Anna’s work focuses on early obesity treatment and parenting. She recently published a four-year follow-up of the “More and Less” (ML) trial, a parent support program for early obesity, which you can read about in the International Journal of Obesity (IJO), here (doi.org/10.1038/s41366-023-01373-7). Anna continues to provide training to ML group leaders through KI, and this program will now be tested in school-aged children within a new RCT in Stockholm. Patient perspective is a very important part of our centre’s treatment – Anna also co-authored a study on parental perceptions of weight-related discussions with children following obesity treatment (doi.org/10.1186/s12889-024-19195-1)
Our clinic recently began offering GLP-1 receptor agonist treatment for adolescents. To ensure equitable access, we fund this pharmacological therapy until patients reach 18 years of age. In January 2025, we celebrated supporting our 100th patient with GLP-1 therapy! Additionally, we provide exercise and physical activity training in a gym for adolescents, and swimming sessions for younger children. These programs foster physical activity in a supportive, social environment under the guidance of our physiotherapists.
Thank you for these interesting and exciting updates! Please could you tell us about the specific obesity treatments and services your COM offers, and your patient care approach?
The foundation of our treatment is family-based combined lifestyle behaviour modification training, which includes support in child eating habits, physical activity, sleep, and other everyday routines. In addition, we offer pharmacotherapy to a growing number of patients, evaluation and referral to surgical interventions, and psychological evaluation and support in behaviour change and parenting, as well as counselling support. Group-based physiotherapy is available in the gym and swimming pool. We use digital tools (video and mobile-based applications) alongside physical visits to facilitate communication with patients. This is especially valuable when pharmacological treatment is initiated and closer follow-up is required. We are a dynamic group, forming small teams as needed for each child and adolescent. We cooperate with schools when specific support is needed—such as guidance around complex lunch situations—and with social services when children face great challenges or live away from their parents. Unfortunately, children with obesity commonly experience weight bias and stigma, including in school settings. If bullying is reported, we work with school nurses and headmasters to educate on the impact of this behaviour and ensure appropriate action is taken.
Openness and respect are key in our approach. Too many of our patients express shame about themselves and their situation—our aim is to lift this burden off their shoulders. We take a holistic approach to obesity, considering eating habits, physical activity, sleep quality, and psychosocial wellbeing as interconnected aspects of health. Patients set their own goals for health improvement. Obesity is complex but treatable; we ensure our patients know that change takes time and that every step towards better health counts. Our patients come from diverse cultural backgrounds, with different languages, traditions, and home environments, which we approach with respect. Many adolescents also struggle with their identity, so we avoid heteronormative language and assumptions. We work as a team, with each profession contributing equally. Patients may be seen individually or in teams, and we involve families, school staff, and social services when needed – obesity management includes more than the individual patient alone.
What are the main challenges your COM currently faces? What are the main goals and plans for your COM during the next 3-5 years?
The introduction of GLP-1 medications for patients as young as 12 years old is a game changer in obesity treatment. However, it puts other demands on the team when planning for how and when to treat patients with them. This new opportunity also requires us to keep track of medications, and evaluate what is on the market. The financing of the drugs for the families has so far been taken care of by our clinic; however, in other clinics patients must pay for the drugs themselves, which is a high cost for most families. For more patients to receive adequate care with GLP-1 medications, there need to be a change in how society sees obesity, namely as a treatable disease that has nothing to do with patients “will power”.
Swedish healthcare is relying more and more on digital tools as part of treatment, and we have found that patients appreciate the ability to participate in video calls if possible. The Stockholm region has developed a mobile phone-based app that we are using at our COM, and the chat function has been a great success. Currently, we use the app to communicate with patients receiving GLP-1 medication – patients communicate regularly with our nurses about side effects of the medication and adjustment of dose.
Another challenge is recruiting staff with a special interest and knowledge about obesity – today and tomorrow. The clinic needs to grow, and clinics that are treating our children at a “lower” medical level before they come to us need to enhance their methods and get more support in doing so. We are energised by our many new team members and remain committed to advancing comprehensive, patient-centred obesity care in the years to come. For the next few years, we will work together to implement the new tools we now have to improve our treatment, strengthen collaborations with other clinical units and also conduct more research using our data.
The National Childhood Obesity Centre at Karolinska University Hospital, led by Dr. Annika Janson and Dr. Sara Leeb, offers comprehensive, patient-centred care for children and adolescents with obesity. Their multidisciplinary team provides family-based lifestyle interventions, pharmacotherapy, psychological support, and referrals for bariatric surgery. Recent advancements include offering GLP-1 receptor agonist treatment for adolescents and integrating digital health tools into management. This COM team is committed to reducing obesity stigma, fostering collaborative care with schools and social services, and advancing research on early obesity treatment. Future goals focus on collaboration, improving treatment and conducting more research in paediatric obesity. Thank you for participating in the Meet the COMs initiative!