Obesity Guidelines Differ Between Adults and Children

Obesity is a growing health concern that often begins in childhood and continues into later life. Half of children with obesity stay obese into their teen years, and about 80% of those teens carry it into adulthood.

Despite the long-term nature of obesity, current clinical guidelines are usually split into rigid age categories. A recent review in Obesity Reviews analyzed existing obesity guidelines and found both overlaps and notable differences between recommendations for adults and children. The review looked at 39 guidelines issued between 2017 and 2023, containing a total of 1,248 specific recommendations.

The researchers found a lack of robust, adolescent-specific recommendations. This age group, caught between childhood and adulthood, often falls through the cracks.

Guideline differences

One major difference lies in how BMI is evaluated. Children’s BMI is measured using percentile curves that change with age and development, while adults use fixed BMI thresholds. For exercise, adults are advised to do both aerobic and strength training, while adolescents are typically only guided toward aerobic activity. Likewise, adults are given dietary options like low-calorie and low-carb diets or meal replacements, but these are largely absent — or even discouraged — for adolescents.

One reason for the limited dietary recommendations for teens is concern about how restrictive diets might impact growth. Still, a 2019 meta-analysis suggests such diets can work for adolescents, though more long-term research is needed.

When it comes to setting goals, pediatric guidelines recommend a slow and steady decrease in BMI, whereas adult guidelines often aim for a 5-10% reduction in body weight within six months. For children and teens, family involvement plays a big role in success, while adult patients are encouraged to focus on personal responsibility and education around health.

The report also highlighted a gap in guidance around metabolic and bariatric surgery (MBS) for teens. While surgery is suggested for teens with a BMI over 50, adults qualify at a BMI of 40. Few adolescent-specific recommendations exist due to a lack of research, though the authors expect more data to emerge in the coming years as obesity rates among teens rise.

The common ground

Despite these gaps, the review did identify some common ground. Both age groups are advised to have annual BMI screenings, undergo assessments for eating disorders and other obesity-linked conditions, and consider cognitive behavioral therapy. When surgery is being considered, both sets of guidelines support a team-based, multidisciplinary approach.

Your responses and feedback are welcome!

Source: “Obesity Guidelines Differ for Adult, Pediatric Patients,” AJMC, 6/13/25
Source: “Discrepancies Between Recommendations in Evidence-Based Guidelines for the Management of Obesity in Adolescents and Adults: An Evidence Map,” Obesity Reviews, 5/27/25
Image by Moe Magners/Pexels

GLP-1 and Akkermansia

One of the interesting challenges taken up by scientists in the past few years has been how to convince a body to make more GLP-1 on its own, so overweight people do not have to spend enormous sums on monthly drug buys. And clues have been found. Take, for instance, this highly technical quotation indicating progress in that direction:

The newly identified protein P9 is secreted by Akkermansia muciniphila and binds to ICAM-2 to directly trigger the secretion of GLP-1 by the L cells, while P9-stimulated IL-6 secretion by macrophages and/or intestinal epithelial cells (via an unclear mechanism) further promotes GLP-1 secretion.

A more recent and more approachable piece of reportage brings us up to date on progress in this area:

Emerging research indicates that the metabolites produced by Akkermansia […] may play a role in modulating the secretion of GLP-1… This interplay highlights the potential for Akkermansia to indirectly affect glucose metabolism and appetite regulation, offering a novel approach to addressing metabolic disorders.

Imagine us having the power to stop food cravings before they even start, right there in our own digestive tracts! Instead of swallowing or injecting medicine, why not simply manufacture it from our own innate inner resources? How do we set up the ideal conditions to facilitate that process?

Fiber is the raw material that needs to be present for metabolizing into a bunch of different stuff that all facilitates the production of GLP-1 inside a person. Then the pancreas makes insulin, which directs the brain to tell the mouth to stop eating. It also tells the stomach to hang onto the latest meal, and savor that full feeling.

What we need the body to do is to facilitate the flourishing of the prime types of gut bacteria, like Clostridium butyricum. But above all, attention is focusing on the rock-star known as Akkermansia muciniphila, which has been making quite a name for itself, and is being strenuously marketed as an over-the-counter supplement that consumers may choose at will. As we have noted here before, “Gut bacteria can significantly impact weight, independent of genes. Transplanting the microbiome from an obese twin drives obesity. Conversely, transplanting the microbiome from a healthy twin drives weight loss.”

The popularity of RYGB (roux-en-y gastric bypass surgery) has led to interesting observations and hints about what goes on inside a person after this type of surgery:

A decrease in adiposity and body weight without a change in food intake suggests that the RYGB-associated microbiota may either reduce the ability to harvest energy from the diet or produce signals regulating energy expenditure and/or lipid metabolism.

As we have seen, the gastric bypass, or Roux-en-Y procedure, used for morbidly obese people, is an irreversible combination of restrictive and malabsorptive methods. Part of the stomach is cordoned off and the very minimalist remainder of it is routed directly to the small intestine, drastically reducing the amount of food the body can absorb. This can lead to some weird results, as detailed in an article about discoveries at the Cleveland Clinic related to Type 2 diabetes:

As a treatment for obesity, Roux-en-Y is effective. As a treatment for diabetes, it is extraordinary. In 80% of cases the condition vanishes within days. Experiments conducted on mice […] show that Roux-en-Y causes the composition of the gut microbiome to change. Dr Nicholson thinks this explains the sudden disappearance of diabetes.

DiabetesJournals.org said,

[A] possibility remains that the improvement of glucose homeostasis observed following bariatric surgery is mediated by a change in gut microbiota, leading to an enhancement of nutrient-sensing mechanisms in the jejunum and an improvement in glucose tolerance…

As more surgeons investigated associations between the successful post-op maintenance of weight loss after bariatric surgery and changes in gut bacteria and functional brain activity, the gut microbiome began to be perceived as a significant regulator of obesity.

All sorts of interesting observations began to appear in the literature. From UCLA came a report by Emeran A. Mayer, M.D., about the various mechanisms by which weight-loss surgery accomplished its purpose:

We know from several studies that surgically reducing the size of the stomach is not the main mechanism for weight loss. Surprisingly, several studies have demonstrated that weight loss surgery produces changes in food preferences and appetite. Our research aims to find out what causes these unexpected changes…

What was the brain doing about weight loss, appetite reduction and changes in food preferences in response to surgery? How could this information lead to the long‐term goal of finding non-invasive treatment “capable of reproducing these brain changes and associated reductions in appetite without surgical intervention”?

Akkermansia is an enriched bacterial group that can “work independently or interdependently to influence host metabolic improvements.” Several authors from the Obesity, Metabolism & Nutrition Institute and Gastrointestinal Unit, Massachusetts General Hospital, wrote of how the probiotic Akkermansia muciniphila is a beneficial strain that is alleged to increase GLP-1 production:

[I]t is possible that Akkermansia may have a substantial role in regulating host adiposity and weight loss. Akkermansia can use mucus as a sole source of carbon and nitrogen in times of health and particularly in times of caloric restriction…

It strengthens the gut lining and improves health by reducing permeability. In this region of the body, permeable is a dirty word. We have heard the slogan, “What happens in Las Vegas, stays in Las Vegas,” and the same ought to be true of the human intestine. What belongs in there should remain in there, not go leaking all over the place.

Your responses and feedback are welcome!

Source: “A newly identified protein from Akkermansia muciniphila stimulates GLP-1 secretion,” ScienceDirect.com, 06/01/21
Source: “Akkermansia’s Impact on GLP-1 and Gut Microbiota Dynamics,” BiologyInsights.com, 04/29/25
Source: “Conserved Shifts in the Gut Microbiota Due to Gastric Bypass Reduce Host Weight and Adiposity,” NIH.gov, 05/13/13
Source: “Me, myself, us,” Economist.com, 08/18/12
Source: “Nutrient-Sensing Mechanisms in the Gut as Therapeutic Targets for Diabetes…,” DiabetesJournals.org, September 2013
Source: “From the Desk of Emeran A. Mayer, MD,” UCLA.edu, Spring 2014
Source: “Conserved Shifts in the Gut Microbiota Due to Gastric Bypass Reduce Host Weight and Adiposity,” ScienceMag.org, March 2013
Source: ‘Getting To Know Your Gut Bugs: Akkermansia Muciniphila,” DrHyman.com, 07/25/21
Image by SamuelFJohanns/Pixabay

If It’s Not the Calories, What Is It?

In relation to the food our kids eat every day of their lives, we do not like to associate such a phrase as “dirty little secret,” and yet over at Tufts School of Nutrition Science and Policy, a high official named Dariush Mozaffarian did that exact thing. As stated to journalist Dhruv Khullar, the quotation goes like this:

The dirty little secret is that no one really knows what caused the obesity epidemic. It’s the biggest change to human biology in modern history. But we still don’t have a good handle on why.

These days, any theory that embraces calories as the sole cause is likely to be rejected. But Mozaffarian offers a couple of possibilities:

Our bodies process carbs differently from fats, for instance; a calorie from corn leads your body to secrete more insulin than a calorie from cheese. Certain food additives seem to activate genes associated with weight gain, and things like weight loss and exercise can reset the body’s metabolic rate.

Dean Mozaffarian has also pointed out that with the relatively new concept of ultra-processed foods, various factions against sugary drinks, fast food, and harmful additives can join forces under one convenient banner.

A few details

If the obesity rate is falling here and there, it is likely not due to any improvement in the food or some enlightened practices, but because of the widespread use of GLP-1 drugs. Nevertheless, Americans are more overweight than their peers in other similar countries. In pursuit of knowledge, increasing numbers of researchers are looking not at what goes into the body, but what comes out. When traversing the environment of the gut, various foods leave bacterial signatures that reveal a lot.

A bug called B. theta is supposed to digest fiber, but if it doesn’t have enough fiber to work on, it will happily start digesting the mucus that forms the gut lining. Artificial sweeteners, along with a whole lot of other things, affect the microbiome. No one is quite sure of the details yet, but apparently humans have a lot fewer species of gut bugs than we used to, and this is not good.

Some experts say, maybe this is because we have changed. Others say, on an evolutionary timescale, not enough time has passed for us to have changed quite so much. So, it must be that the food itself is to blame. Foods do change our individual biology. They don’t just go in and then out in a different form. Along the way, they change our actual biology and our ability to cope with them and with other foods.

Another multifactorial field

A lot of things could be happening, and probably are. The additives that make food qualify as “highly processed” could be ruining the delicate taste receptors, which become confused and think they are encountering some nutritious substance, which turns out to actually be just fattening garbage. Feeling the lack, we struggle to make up for it by seeking (largely non-existent) nutritional value in yet more food. Dr. Chris van Tulleken describes overeating as probably “searching for that nutrition that never arrived.”

Research pioneer Kevin Hall, whose much-quoted study influenced the field tremendously, demonstrated for the first time that our metabolic health is disrupted by ultra-processed foods. He has pointed out such miscellaneous facts as, for instance, that a certain brand of vitamin water is sold as a health drink although a 20-ounce bottle of it contains almost as much sugar as a can of Coca-Cola. In regard to another point, it seems increasingly apparent that a food additive does not need to be physically addictive, but only needs to be irresistible enough to enable a behavioral addiction.

Nutritionist and molecular biologist Marion Nestle created the USA’s first academic food-studies program. She taught that during WWII, when many prospective soldiers had to be rejected because of health issues stemming from malnutrition during the Great Depression, the army became very concerned about nutrition — just as it did much more recently, when so many recruits were rejected because of obesity. That was when the Army, the National Academy of Sciences, and the National Research Council got together and published the first table of recommended amounts of various nutrients.

Your responses and feedback are welcome!

Source: “Why Is the American Diet So Deadly?,” NewYorker.com, 01/06/25
Image by Mateuszg89/Pixabay

Maximizing GLP-1 Treatment Success

A new joint advisory from four major clinical organizations provides a much-needed roadmap to help patients get the most out of GLP-1 medications for obesity. While GLP-1 receptor agonists like semaglutide (Ozempic, Wegovy) and tirzepatide (Zepbound) have gained popularity for their powerful effects on weight loss, this new guidance stresses that medical therapy alone isn’t enough. Nutrition and lifestyle changes are key to long-term success.

The Obesity Society, American College of Lifestyle Medicine, American Society for Nutrition, and Obesity Medicine Association came together to publish a unified advisory titled “Nutritional Priorities to Support GLP-1 Therapy for Obesity.” Drawing on a broad base of clinical and research expertise, the team reviewed current evidence and developed eight core strategies to help clinicians support patients receiving GLP-1 medications:

(1) Patient-centered initiation of therapy; (2) careful baseline nutritional assessment; (3) management of GI side effects, (4) personalized, nutrient-dense, minimally processed diets; (5) prevention of micronutrient deficiencies; (6) adequate protein intake and strength training to preserve lean mass; (7) leveraging a good diet to maximize weight reduction; and (8) promoting other lifestyle changes around activity, sleep, mental stress, substance use, and social connections to maximize long-term success.

The clinical advisory, led by Advisory Chair Dariush Mozaffarian, M.D., DrPH, of Tufts University, Boston, was published simultaneously in Obesity, American Journal of Lifestyle Medicine, The American Journal of Clinical Nutrition, and Obesity Pillars.

The guidelines in more detail

Clinical trials show that GLP-1s can reduce body weight by 5% to 18%, with multiple benefits such as improved blood sugar levels and cardiovascular risk reduction. However, real-world results tend to be more modest, and several challenges can stand in the way of long-term success. These include side effects like nausea and vomiting, nutritional deficiencies due to reduced food intake, and loss of lean muscle and bone mass. Additionally, many patients struggle with adherence over time, often regaining lost weight once treatment stops.

To address these issues, the expert panel emphasized the importance of a patient-centered approach starting from the initiation of therapy. A thorough nutritional assessment should be done at the beginning of treatment to identify any pre-existing deficiencies or health risks. Managing gastrointestinal side effects early on is essential for helping patients stick with the medication.

When it comes to diet, the group recommends moving away from restrictive eating patterns and instead focusing on nutrient-dense, minimally processed foods tailored to each patient’s preferences and needs. Ensuring adequate intake of vitamins, minerals, and protein is especially important for preserving muscle and bone health during weight loss. In addition to proper nutrition, strength training and physical activity should be prioritized to support lean mass retention.

The advisory also encourages clinicians to look beyond diet and exercise. Sleep quality, mental health, substance use, and social support all play a role in achieving and maintaining healthy weight loss. By taking a holistic view, healthcare providers can create a more sustainable and supportive plan for patients on GLP-1 therapy.

Dr. Marc-Andre Cornier, President of The Obesity Society, said:

This guidance lays a nutrition roadmap to help providers support their patients on sustainable and lasting weight reduction journeys… It underscores the importance of nutrition on quality of life and is an important contribution to the literature about incorporating lifestyle interventions into obesity care.

For patients and providers alike, the message is clear: GLP-1 medications are a powerful tool, but their true potential is only realized when paired with smart, personalized lifestyle support.

Your responses and feedback are welcome!

Source: “Advisory: Nutrition Priorities for GLP-1 Use in Obesity,” Medscape, 6/4/25
Source: “Nutritional priorities to support GLP-1 therapy for obesity…,” PubMed, 5/30/25
Image by Pavel Danilyuk/Pexels

 

Deliver Us From Ethanol

No matter how you slice it, high-fructose corn syrup (HFCS) is a thing that humanity would be better off without. Consequently, the state of Indiana decided to ban it as a food ingredient. On the surface, this is an odd and impractical choice, because Indiana grows a lot of corn. But it mainly winds up being changed into animal feed, and fuel, via ethanol, which has psychoactive properties, and is also used in processing vanilla beans into vanilla extract.

Additionally, ethanol can be made into both gasoline and antifreeze. And also into HFCS. Some people simply don’t want to be feeding their kids anything related to jet fuel.

The Indiana attempt to put a leash on HFCS failed. A couple of years back, New York tried to ban a bunch of food additives, and Pennsylvania did too. In the latter state, Rep. Natalie Mihalek dryly remarked, “It is not asking too much for consumers to have a reasonable expectation that the foods they are eating are safe.” It appears that objectionable food additives are sometimes “grandfathered in,” just because they have been allowed for so long, even though no one has ever bothered to look into their composition or calculate the probable harm caused to humans.

Picky about prohibition

Many voters wish that the U.S. Food and Drug Administration would fix things by banning various substances on a nationwide basis, to save the trouble and expense of each state needing to fight the battle. But some states don’t really care very much, and many Americans value the freedom-of-choice principle over any other consideration.

In many cases, the problem is not so much in the composition of the product itself, but in the passion that children feel for it. Even if any one ingredient could be indisputably proven not dangerous and not addictive, there will always be a certain number of kids who react to it as if it were both. They attract the attention of journalists, and sometimes other interested parties. Professionals on both sides of the issue are forced into defending their positions.

Folks get upset. They defend their positions, and with good reason. Here is one issue, stated in practical terms. As previously noted,

Many adults feel that when a child acts addicted, she or he is as difficult to deal with as a physically addicted child would be. Whatever is in that snack or cereal may be potent enough in some way to stoke up a behavioral addiction, which sells product quite as effectively as a literal, molecular-level addictive ingredient could.

A hopped-up speed freak and a child who acts like a hopped-up speed freak are both troubling propositions, especially if the child is overweight and capable of causing more damage because of it.

This is the sort of problem that the protests attempt to bring to an end. Everyone has better things to do than argue about the obvious. Foods without all kinds of detritus mixed up in them should be just as easily available as the other kind. Or maybe the objectionable substances should not be available at all. Some folks are in favor of banning bad stuff for everybody.

Others cherish the right to pursue perdition in their own ways. At the same time, they may be willing to do what is best for everyone. In their view, research is fine, but until the results come in, leave us alone. Plenty of folks are reluctant to violate the rights of others, while at the same time endeavoring to peacefully change laws they do not like.

GRAS means “generally recognized as safe”

A while back, California assemblymember Jesse Gabriel said,

The [FDA] has increasingly avoided its responsibility to rigorously evaluate proposed food chemicals by allowing food manufacturers to self-certify that a chemical is generally recognized as safe to be used in food. Between 2000 and 2022, manufacturers have been allowed to self-certify almost 99% of the 756 new chemicals used in food.

The terms “99%” and “self-certify”, appearing in such proximity, send cold chills up the spines of many citizens. Reportedly, the whole determination process is being rethought. In September 2024, the Food and Drug Administration held a public hearing where officials announced that they recognize the need to conduct post-market assessments of the presence of chemicals in food, and are developing a “systematic process” for that purpose.

We really need to know what the substances are doing to our kids (and us). Does a certain ingredient make children obese? Even if the answer is no, what else does it do to the human body, especially to one that belongs to a still-growing and not totally formed young person? Many parents and others have a keen interest in finding out more about these issues, and in defining the rules pertaining to who gets to write the rules.

Your responses and feedback are welcome!

Source: “15 uses of Ethanol,” AllUsesOf.com, 06/13/21
Source: “How State-Led Ingredient Bans Are Reshaping Food Manufacturing Regulations,” HartDesign.com, 02/14/25
Image by fietzfotos/Pixabay

The Cancer Is Just As Real

Last year, California passed a couple of laws (including specific deadlines) to ban certain food additives suspected of being harmful. As a consequence, starting in about a year and a half, the state will ban red dye No. 3, brominated vegetable oil, potassium bromate and propylparaben from all food sales under its jurisdiction, and assess fines of “up to $5,000 for a first violation and up to $10,000 each for subsequent violations.”

The Red 3 was a tough one. Its tendency to associate with cancer has been studied since the 1980s, with no legal restraint in sight. But the Center for Science in the Public Interest and many other experts kept at it, and in 2023, California banned it.

Another substance, titanium dioxide (TiO2), also had been banned, but that order was rescinded. Still, progress was made when the California School Food Safety Act was passed to forbid public schools from serving foods containing half a dozen different food dyes. A while later, the Food and Drug Administration kicked out brominated vegetable oil on a national basis, and that goes into effect a couple of months from now, in August.

An ocean’s width

It’s funny how the Europeans manage to keep harmful stuff out of their groceries, proving that it can be done. But over here, powerful forces insist that such precautions need not and should not be taken. There is another issue, as explained by California Assemblymember Jesse Gabriel, who told HART Design,

Even if the FDA has conducted a thorough review of a proposed food chemical, the agency does not conduct periodic reviews to assess whether old safety determinations remain valid. As a result, many food chemicals have not been reviewed by the FDA since the 1960s or 1970s. The original evaluations frequently fail to reflect both modern toxicology and modern levels of consumption.

Citizens would like to know where to turn if they want to have similar rules to California’s, or even if they do not want to. There is debate about who should be in charge of these matters, and uncertainty about who is currently responsible. As this uncredited author inquires, “Is it a federal agency charged with keeping current around risks in foods? Or is it a state which has significantly fewer resources and is not charged with protecting public health across the entire country?”

A good example

In 2023, activists in four other states aspired to get some food laws, but failed. Still, activists in those and more states who are still trying say that the California precedent helps their efforts. It seems like the public is unable to obtain straight answers about important aspects of grocery shopping. A responsible adult who pauses to read the label on a box or can of alleged food might experience disturbing thoughts. For instance, “The government that regulates alcohol, nicotine, and certain recreational drugs so thoroughly and definitively, why is this same government unable to keep weird chemicals out of the food?”

Apparently, bureaucracy is flexible enough to move with relative alacrity under some circumstances, and with glacial slowness in other situations. Why has the tug-of-war over food additives marketed to kids been dragging on for so long? There is plenty of evidence that they can affect childhood obesity in a causal relationship. The dirty little secret in this case seems to be that such a product does not need to contain literally addictive ingredients. And besides, good dope is expensive.

No, it is quite sufficient to sell children snacks laced with ingredients that stimulate addictive behavior. And yes, having kids act like junkies is a big deal for most parents, as well as imposing a lot of stress on other family members, teachers, babysitters, dentists, and anyone else who comes in contact with the minor in question. If some weird additive causes cancer, that cancer is just as real as one brought on by smoking.

There is such a thing as behavioral addiction. Many adults feel that when a child acts addicted, she or he is as difficult to deal with as a physically addicted child would be. Whatever is in that snack or cereal may be potent enough in some way to stoke up a behavioral addiction, which sells product quite as effectively as a literal, molecular-level addictive ingredient could.

Your responses and feedback are welcome!

Source: “How State-Led Ingredient Bans Are Reshaping Food Manufacturing Regulations,” HARTDesign.com, 02/14/25
Image by Alexas_Fotos/Pixabay

The MAHA Report’s Shortcomings and Mistakes

In a bold and sweeping move, the Trump administration released the “MAHA Report: Make Our Children Healthy Again,” a 72-page document outlining the rise of chronic illnesses among America’s youth. Spearheaded by Health Secretary Robert F. Kennedy, Jr., the report zeroes in on an urgent public health crisis — one that includes high rates of obesity, asthma, behavioral health disorders, and autoimmune conditions. Among these concerns, childhood obesity stands out as both emblematic of broader systemic issues and as a pressing problem that demands real solutions.

While the report identifies compelling drivers such as poor diet, environmental toxins, lack of physical activity, and chronic stress, experts argue that its proposed solutions fall short. The diagnosis is clear. The treatment? Frustratingly vague.

A real and rising epidemic

The numbers are hard to ignore. According to the Centers for Disease Control and Prevention (CDC), roughly one in five children in the U.S. is obese. Obesity in childhood is not just about weight; it significantly increases the risk of developing type 2 diabetes, cardiovascular disease, and mental health challenges later in life.

The MAHA report acknowledges this epidemic, pointing to dietary patterns dominated by ultra-processed foods, lack of exercise, and toxic environmental exposures as major contributors. And many experts agree. Dr. William Dietz of George Washington University noted that targeting ultra-processed foods is an important step, though it needs nuance and depth, not just broad condemnation.

Yet, while the report shines a spotlight on known issues, it seems to sidestep a critical aspect of the obesity conversation: socioeconomic inequality.

Poverty, processed foods, and missed opportunities

One of the most glaring oversights in the MAHA report is its limited engagement with poverty as a root cause. Processed foods are cheaper and more accessible than fresh, nutrient-rich alternatives, especially in underserved communities where food deserts persist. Families grappling with low incomes may rely on inexpensive, calorie-dense foods simply to feed their children.

Rather than addressing this systemic problem through programs like expanded school meal funding or subsidies for fresh produce, the report offers proposals that critics describe as “splashy,” such as removing food dyes or funding small-scale research trials — steps that may look good in headlines but lack the structural force needed to shift real-world outcomes.

Mixed messages on prevention and research

The MAHA report calls for a shift toward preventive medicine, urging NIH and FDA to support more research into the health effects of diet and chemicals. On paper, this looks promising. However, in practice, the Trump administration has simultaneously enacted cuts that directly undermine these goals.

Thousands of federal employees have been laid off, and budget cuts have hit agencies such as the CDC and NIH — organizations tasked with the very research and data collection the report claims to champion. Dr. Dietz warns that such cuts may erode our ability to monitor obesity trends, making it harder to assess progress over time.

This contradiction raises the question: Can we fight an epidemic without the tools to measure and understand it?

Overmedicalization and lifestyle solutions

Another area of focus in the report is “overmedicalization”— the idea that the healthcare system is too focused on treating disease rather than preventing it. On this point, there’s widespread agreement. Childhood obesity cannot be solved with a prescription pad alone.

Instead, a comprehensive prevention model would include:

  • Parent-infant training in emotional regulation
  • Robust nutrition education in schools
  • Community-based fitness initiatives
  • Subsidized access to whole, unprocessed foods
  • Improved urban planning to ensure walkable neighborhoods and safe parks
  • Policies addressing environmental pollutants

 

And while the report mentions lifestyle medicine and surveillance of pediatric drugs, it doesn’t go far enough in proposing how such a shift would be funded or implemented at scale.

What else is missing?

Ultimately, the MAHA report highlights an urgent problem but falls short of a strategy to fix it. Childhood obesity isn’t just a matter of bad personal choices or isolated environmental exposures. It’s the result of systemic forces: poverty, inequality, food industry lobbying, and crumbling public health infrastructure.

Lauren Wisk from UCLA points out that real progress will come from social policies that address root causes, not just from banning food dyes or launching a few more studies. For instance, universal school meal programs, expanded SNAP (food stamp) benefits, and tighter regulations on junk food marketing to kids could move the needle far more than flashy headlines.

If the administration is serious about “making our children healthy again,” it must follow up this report with policies that put science, equity, and prevention at the forefront. Otherwise, this report may end up as just another diagnosis without a cure.

AI only makes it worse

In a follow-up development, the Trump administration has issued corrections to the report after journalists discovered several flawed and nonexistent citations, casting doubt on the report’s scientific integrity. Investigations by a nonprofit NOTUS and NBC News revealed that at least four referenced studies do not exist, including one falsely attributed to epidemiologist Katherine Keyes.

Dr. Keyes commented:

I can confirm that I, and my co-authors, did not write that paper… I was surprised to see what seems to be an error in the citation of my work in the report, and it does make me concerned given that citation practices are an important part of conducting and reporting rigorous science.

The report’s credibility has come under further scrutiny due to its anonymous authorship, limited medical representation among commission members, and questionable interpretation of cited research. Out of 522 total references, seven could not be verified, and some included URLs containing “oaicite,” suggesting that generative AI may have played a role in compiling sources.

Additionally, researchers like Mariana Figueiro, a professor at the Icahn School of Medicine at Mount Sinai, have stated that their studies were misrepresented. Her work on melatonin suppression in college students was incorrectly cited as evidence about children’s sleep and screen time. She said:

The conclusions in the MAHA report are incorrect and misrepresented our finding… We looked at melatonin suppression, not sleep onset. We also used college students, not children as subjects. Finally, the journal name was incorrect.

Unsurprisingly, these errors have sparked criticism over the report’s scientific validity and its use in shaping national health policy.

Your responses and feedback are welcome!

Source: “MAHA Commission report paints a dark picture of U.S. children’s health,” NPR, 5/22/25
Source: “Trump admin corrects RFK Jr.’s MAHA report after citation errors,” NBC News, 5/30/25
Source: “The MAHA Report Cites Studies That Don’t Exist,” NOTUS.org, 5/29/25
Image by Markus Winkler/Pexels

Killer Diet on the Loose

In “Why is the American Diet So Deadly,” Dhruv Khullar mentions a Frenchman, Guillaume Raineri, who moved to Maryland, USA, and experienced a particularly personal form of culture shock. Every meal seemed to contain too much sugar, too much salt, and too much food, period. So he became a human lab rat, participating in an official scientific study.

This involved spending a month in an environment that could be described as monastic, or perhaps even carceral, learning firsthand that the entire secret of a successful animal study is to control as many variables as possible:

He was not allowed to go outside unsupervised, owing to the risk that he might sneak a few morsels of unsanctioned food.

Over the course of the trials, he was given both extremely nutritious, sensible meals, and, at other times, a plethora of calorie-dense, processed foods. Results were meticulously recorded, and the whole story is pretty interesting. But sadly, most Americans will never have the opportunity to understand so much about the damage we do to ourselves through incautious eating habits. Who devises these complicated research projects?

It needed to be faced

At the point in history when it started to become apparent that more Americans were overweight than ever before, sugar-sweetened beverages and saturated fat quickly became the “usual suspects.” But an investigator for the National Institutes of Health, Kevin Hall, pointed the finger directly at a third possibility: ultra-processed food, informally known as UPF. He suspected that equally as important as the “what” is the “how.” Industrial techniques and chemical modifications seemed the likely culprits.

In a study published in 2019, Hall invited twenty people to spend a month at the NIH Clinical Center, where his team measured how their bodies responded to different types of food. (Many researchers rely instead on surveys of what people recall eating.) For two weeks, participants ate a minimally processed diet, mostly consisting of “Group 1” foods such as salmon and brown rice; for the other two weeks, they ate an ultra-processed or “Group 4” diet, in which at least 80% of the calories came from the most objectional food choices.

When participants were on the ultra-processed diet, they ate 500 calories more per day and put on an average of two pounds. They ate meals faster; their bodies secreted more insulin; their blood contained more glucose. When participants were on the minimally processed diet, they lost about two pounds. Researchers observed a rise in levels of an appetite-suppressing hormone and a decline in the one that makes us feel hungry.

It was not clear why ultra-processed diets led people to eat more, or what exactly these foods did to their bodies. Still, a few factors stood out. The first was energy density, measured in calories per gram of food. Dehydration, which increases shelf life and lowers transport costs, makes many ultra-processed foods (chips, jerky, pork rinds) energy-dense.

A little surprise

The second, hyper-palatability, was a focus of one of Hall’s collaborators, Tera Fazzino. Long ago, evolution trained us to like sweet, salty, and rich foods because, on the most basic level, they help us survive. Hyper-palatable foods — those esoteric combinations of fat and sugar, or fat and salt, or salt and carbs — cater to these tastes, but are rare in nature. A grape is high in sugar but low in fat, and the typical person can stop eating after one, leading to a suspicion that maybe sugar is not so blameworthy after all. A slice of cheesecake is high in both sugar and fat, and the typical person feels compelled to devour it.

Your responses and feedback are welcome!

Source: “Why Is the American Diet So Deadly?”, The New Yorker, 01/06/25
Photo by Alexander Grey/Pexels

New Study Links Childhood Weight Patterns Before Age 9 to Obesity Risk

Children don’t all grow the same way. A recent study from the NIH-funded Environmental Influences on Child Health Outcomes (ECHO) Program, reported in JAMA Network Open, sheds light on how early weight trends can signal future health concerns. Researchers tracked nearly 9,500 children’s body mass index (BMI) from infancy through age 9 and identified two distinct growth patterns.

Most kids (about 89%) followed a typical growth curve where BMI naturally dropped between ages 1 and 6, then gradually increased again. However, about 11% showed a different trend — their BMI remained stable from ages 1 to 3.5, then climbed sharply through age 9. Children in this group were significantly more likely to have obesity by age 9, with BMI measurements above the 99th percentile.

The study also found that certain early-life factors may raise the risk of obesity later on. These include being born with a high birthweight, maternal smoking during pregnancy, having a mother with a high BMI before pregnancy, and excessive weight gain during pregnancy.

Childhood obesity, defined as a BMI at or above the 95th percentile for a child’s age and sex, often results from excess body fat and can lead to serious health problems like heart disease and type 2 diabetes later in life. Without intervention, kids who follow these higher-risk growth patterns may continue to struggle with weight into adolescence and adulthood.

To better understand these trends, researchers used data from medical records, parent-reported measurements, and both in-person and at-home evaluations. Their goal was to track how BMI changed over time and uncover any links to early childhood experiences.

Lead researcher Chang Liu, an assistant professor of psychology at Washington State University, said in a news release:

The fact that we can identify unusual BMI patterns as early as age 3.5 shows how critical early childhood is for preventing obesity… Our findings suggest there are important opportunities to reduce childhood obesity, such as helping pregnant women quit smoking and manage healthy weight gain, as well as closely monitoring children who show early signs of rapid weight gain.

Your responses and feedback are welcome!

Source: “Early childhood weight patterns linked to future obesity risk,” News Medical, 5/22/25
Source: “Preschool BMI Can Predict Childhood Obesity Risk,” HealthDay News, 5/28/25
Image by Nataliya Vaitkevich/Pexels

Target of Influence

A recent post described how in 2019, The New York Times reporter Andrew Jacobs exposed some of the doings of the International Life Sciences Institute, otherwise known as ILSI. During that year, the director-general of the World Health Organization was Dr. Margaret Chan, and ILSI founder Alex Malaspina aimed to discover how to influence her thinking, and bend it away from any impulse to critique his organization.

“This threat to our business is serious,” he said, which puzzled some listeners because ILSI was allegedly a legitimate nonprofit organization whose only mission was to help. Jacobs wrote,

In addition to its far-flung offices, ILSI runs a research foundation and an institute focused on health and environmental issues that is largely funded by the chemical industry. It also publishes the academic journal Nutrition Reviews and organizes scores of scientific conferences around the world.

But more was going on than met the eye. Monsanto and other less-than-ethical companies donated boatloads of money to ILSI, whose whole funding system looked kind of shady. In countries where it established a presence, its behavior was neither straightforward nor impartial. In India, for instance, it infiltrated government bodies that were supposed to prevent too many additives in processed foods. The processed food industry was rumored to be more powerful than even the tobacco industry, and that is a pretty serious indictment.

Meanwhile, with all kinds of shady maneuvers going on, India saw alarming increases in obesity, diabetes, and heart disease. In 2012, reacting to a Public Interest Litigation suit that had been filed by concerned citizens, the Delhi High Court directed that guidelines be drawn up to ensure that school children had access to wholesome, nutritious, safe, and hygienic foods.

Action taken

A rule was made for the whole country that edible items high in fat, salt, and sugar could not be sold within 50 meters of any school. Other guidelines were established, and officials charged with carrying out the new orders were pleased to find that some schools had already acted on their own to keep a stricter eye on what the students were being fed.

By 2015, almost one-third of the country’s teenagers were in the obese category. Still, rural areas were less affected than the cities — which strongly hinted that readily available highly processed foods laced with additives probably had something to do with the disparity. It was estimated that the urban areas alone held more than 15 million obese children, helping to make India the third most obese country on the planet.

In the same year, officials added up the operations performed to excise fat, and the news said,

The number of bariatric surgeries performed in the country has increased almost ten times over the last decade, with over 10,000 such surgeries performed in the previous year.

Medical conference attendees emphasized the importance of teaching parents that a chubby child is not necessarily a healthy one. The worst culprits were seen to be “shortcut” meals and, you guessed it, highly processed foods. Around the same time a study confirmed that India’s affluent class was plagued by obesity, but the same societal and environmental factors impacted folks of all kinds, which implied that unless corrective action was taken, future conditions would be “serious.” Some authorities claimed that other authorities underestimated the childhood obesity rate, and that the upper classes were still in worse shape than was previously admitted.

One philosophy held that obesity was caused by the environment, rather than by socio-economic conditions; although it could be argued that the environment itself is a socio-economic condition, and vice versa. Not surprisingly, obesity also correlated with a lack of playgrounds. The fact that schools where unhealthful snacks were served had more obese students was an observable reality.

The epigenetic theory was popular, suggesting that the ability to retain fat is a useful survival trait bestowed by the “thrifty phenotype” widely shared by natives of the subcontinent. In 2016, when India’s first obesity clinic for adolescents opened, the situation was dire:

[A] a recent survey in Pune and Mumbai found that 18 per cent of the school-going children suffer from obesity, 32 per cent are over-weight and 52 per cent of the students are potential diabetics.

In 2017, the government slapped sugar-sweetened soda with a 40% tax.

Your responses and feedback are welcome!

Source: “A Shadowy Industry Group Shapes Food Policy Around the World,” NYTimes.com, 09/16/19
Source: “Obesity among Indian teens swells,” IndiaTimes.com, 07/04/14
Source: “India sees 10 time increase in bariatric surgeries in last decade: OSSI,” IndiaTimes.com/ 07/17/15
Source: “India’s quiet tide of childhood obesity,” Scroll.in, 05/07/16
Source: “First obesity clinic for adolescents in India opens in Mumbai,” TheHealthSite.com, 10/09/16
Image by Waldemar_RU/Pixabay

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Profiles: Kids Struggling with Weight

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The Book

OVERWEIGHT: What Kids Say explores the obesity problem from the often-overlooked perspective of children struggling with being overweight.

About Dr. Robert A. Pretlow

Dr. Robert A. Pretlow is a pediatrician and childhood obesity specialist. He has been researching and spreading awareness on the childhood obesity epidemic in the US for more than a decade.
You can contact Dr. Pretlow at:

Presentations

Dr. Pretlow’s invited presentation at the American Society of Animal Science 2020 Conference
What’s Causing Obesity in Companion Animals and What Can We Do About It

Dr. Pretlow’s invited presentation at the World Obesity Federation 2019 Conference:
Food/Eating Addiction and the Displacement Mechanism

Dr. Pretlow’s Multi-Center Clinical Trial Kick-off Speech 2018:
Obesity: Tackling the Root Cause

Dr. Pretlow’s 2017 Workshop on
Treatment of Obesity Using the Addiction Model

Dr. Pretlow’s invited presentation for
TEC and UNC 2016

Dr. Pretlow’s invited presentation at the 2015 Obesity Summit in London, UK.

Dr. Pretlow’s invited keynote at the 2014 European Childhood Obesity Group Congress in Salzburg, Austria.

Dr. Pretlow’s presentation at the 2013 European Congress on Obesity in Liverpool, UK.

Dr. Pretlow’s presentation at the 2011 International Conference on Childhood Obesity in Lisbon, Portugal.

Dr. Pretlow’s presentation at the 2010 Uniting Against Childhood Obesity Conference in Houston, TX.

Food & Health Resources