How do you feel about offering prescription diet medications to 12 year olds? Permanent weight loss surgery to a 13 year old? Weight loss counseling to a toddler?
Yes, I’ve taken the obesity interventions recommended by the American Academy of Pediatricians (AAP) to their extreme conclusions, but those really are are part of their guidelines. Read on to see both sides of this important issue. Or, look at the AAP’s 100 page report here: https://publications.aap.org/pediatrics/article/151/2/e2022060640/190443/Clinical-Practice-Guideline-for-the-Evaluation-and?autologincheck=redirected
Against These Interventions?
There certainly are cases of morbid obesity in adolescents that should be addressed promptly. But these interventions – other than counseling – seem to be extreme and carry the possibility of harm. We have seen so much abuse of diet drugs and surgeries over the years – do we want to risk our children’s health and psyches with practices that have been rarely used with this age category? What will the long term use of diet medications be on a growing youth? Could bariatric surgery have unintentional consequences on the development of a young person? Are these interventions more likely to contribute to eating disorders, as some specialists in the field predict (1)?
This just feels wrong, as we already know that these interventions often aren’t successful in the long term for adults. But on the other hand, doing nothing to address adolescent obesity also carries risk. And the scope of this problem is astounding – 1 in 5 children in the United States is obese based upon BMI (2).
For more information about BMI (and its flaws as an obesity standard) see my post BMI, Waist Circumference & Waist-to-Hip Ratios here: https://lindawbrowning.com/2023/02/16/body-measurements-waist-to-hip-ratios/
The Forbes article, “New Guidelines On Childhood Obesity Are Met With Some Resistance” by Nina Shapiro makes some excellent points. “Increased physical activity, stress management and better education should obviate the need for medications or surgery” (3). Yet, even though there has been more education in these areas, overweight and obesity numbers continue to rise. So what is the solution?
Against Watchful Waiting?
With 14.4 million children and adolescents living with obesity in the United States (4), we can see that the old philosophy of “watchful waiting” hasn’t been particularly effective. The AAP has finally addressed this serious problem in their Clinical Practice Guideline for the Evaluation and Treatment of Children and Adolescents With Obesity which includes supplemental technical reports supporting their diagnostic and treatment recommendations.
It’s likely that most of us are aware that obesity is actually classified as a disease. Is there any other disease where doctors just say something like, “Oh, I see that you have a disease that over time will greatly decrease your quality of life and likely shorten your lifespan. Let’s just sit back and see how it progresses”? I question the appropriateness of the guideline – but I’m glad that obesity in children and adolescents is getting the attention it deserves.
It’s important to point out that the AAP’s guidance for interventions is based upon the severity of the disease (5). It’s easy to create sensational headlines that are misleading. Yes, in some cases surgery can be discussed with a young teen, but this is only in severe cases, and after many diagnostic tests have been evaluated.
In an interview of Dr. Raquel Hernandez, Medical Director at Johns Hopkins All Children’s Healthy Weight Initiative, it was explained that:
“[Treatment] choices very much match severity. For patients who do not have health-related issues from their weight, or who are low severity, medication and surgery probably wouldn’t be the immediate recommendation. But for children who start to meet the criteria of what we call class two and class three levels of obesity, those choices actually become more a part of the treatment plan” (6).
With such an important and controversial topic, it’s very likely that our opinions will differ on how to find solutions. Perhaps you have a personal experience that has informed your ideas about the treatment of childhood and adolescent obesity.
Share your thoughts in the comments below. Let’s continue to learn from others about these issues in the news.
(1). https://www.npr.org/2023/02/15/1155521908/eating-disorder-obesity-guidance-risk-weight-loss
(2). https://www.nytimes.com/2023/01/20/well/family/childhood-obesity-guidelines.html
Maintain Weight Loss 