AAP Guidelines and Backlash, Part 5

New York Times journalist Catherine Pearson wrote,

The American Academy of Pediatrics released new guidance last week about how to evaluate and treat children who are overweight or obese, issuing a 73-page document that argues obesity should no longer be stigmatized as simply the result of personal choices…

… Which kind of oversimplifies matters. Up to this moment in time, theoreticians and researchers have suggested over 100 possible causes of obesity, ranging from genetics to gut microbes to air pollution to electronic screens. Harvard’s Dr. Claire McCarthy set out some pertinent statistics:

Hovering around 5% in 1963 to 1965, rates of obesity had more than tripled to 19% by 2017 to 2019. Early data suggest childhood obesity rates continued climbing during the pandemic. If these trends continue, 57% of children currently ages 2 to 19 will have obesity as adults in 2050.

She makes the point that obesity is typically stigmatized as a personal choice issue, or if not precisely “choice,” at least a matter of individual responsibility, which is a hard sell when a baby pops out of the womb weighing 16 pounds. But as time goes on and evidence piles up, it may not be just bad eating habits, low-quality food, or lack of exercise. The factors that contribute to childhood obesity include genetic, physiologic, socio-economic, and environmental, among many other possibly more peripheral factors.

And each one is complicated. For instance,

Prenatal factors, such as maternal weight gain or gestational diabetes, increase risk before a child is even born. We are just beginning to understand genetic factors, many of which can be further affected by the child’s environment. There are ways that systemic racism and deeply embedded socioeconomic factors play a role.

At any rate, the AAP invested a lot of verbal energy in preparing the nation for its bombshell recommendations — drugs and bariatric surgery for teens and even children. The reaction to these two concepts has been clamorous. In the case of acceptable drugs, one is said to have helped adolescents reduce their Body Mass Index number by around 15%.

Another is said to age the face at the top of a newly-slimmed body, reminiscent of a quip attributed to Zsa Zsa Gabor: “After a certain age, a woman has to choose between her face and her fanny.” More will be said about these and other suggested pharmaceuticals. Among many other loud voices are those which insist that the pharmaceutical research to date is nowhere close to adequate.

Also, it seems that many professionals and members of the public have misunderstood the AAP’s intention, which is to recommend drugs and surgery as extreme measures to be taken only after serious lifestyle intervention has been tried. The organization has also acknowledged that some prejudice and stigmatization, unfortunately, come from doctors and other medical professionals. There is a belief that using gentler language will help, for instance not saying “obese child” but instead, “child with obesity.”

Maybe; maybe not. Pearson quotes adolescent medicine specialist Dr. Jason Nagata:

He has worked on studies showing that disordered eating behaviors like fasting or vomiting are common in children with obesity. Even if parents and doctors are careful to use person-first language and focus discussions on health, not weight, a child may only hear “you’re telling me I’m too fat, I need to lose weight,” he cautioned.

Your responses and feedback are welcome!

Source: “New Guidelines Underscore How Complicated Childhood Obesity Is for Patients and Providers,” NYTimes.com, 01/20/23
Source: “New pediatric guidelines on obesity in children and teens.” harvard.edu, 01/24/23
Image by Howard Lake/CC BY-SA 2.0

AAP Guidelines and Backlash, Part 4

In the past few weeks the new anti-obesity guidelines issued by the American Academy of Pediatrics, revised for the first time in 15 years, have caused quite a flurry. Previous posts have discussed some of the angles, but the worst is yet to come.

Background: Contrary to long-held hopes, young people rarely “outgrow” childhood obesity, but rather just bring it along into their adolescence, where it coexists with such typical problems as skin eruptions, sexual anxiety, and academic challenges. Then, they simply carry the excess weight into adulthood, along with a whole array of new physical, social and emotional issues.

One doctor’s view

Dr. Sarah Armstrong is the AAP’s obesity section chairperson, as well as a Duke University professor of pediatrics. We have already referenced some of the information that journalist Caroline Kee obtained by interviewing her, and there is more to say. Dr. Armstrong recommends a “whole child” approach and believes that parents and healthcare professionals should no longer wait for the situation to worsen because the overwhelming odds are that both obesity and co-morbidities will increase over time. With longevity, every problem becomes more difficult to treat.

Starting at age six, the at-risk child should receive at least a year of intensive treatment, including face-to-face counseling and lifestyle modification training. If no progress is made, patients in their teens, or approaching their teens — or even younger — might reasonably be prescribed one of six weight-loss medications that have been deemed safe. Even then, pharmaceuticals should not be expected to take the place of lifestyle modifications. Whichever drug is chosen should be used simultaneously with the cultivation of good everyday, real-life habits.


Also quoted is pediatrician Dr. Sarah Hampl, another co-author of the revised guidelines:

The evidence suggests that you should treat children as early as obesity is identified and with the highest available intensity of treatment that is appropriate, given their age and the severity of their obesity. Different risk factors influence a child’s weight, (including) things we can’t control, such as genetics.

But that is not all. After intensive case evaluation, weight-loss surgery is now seen as acceptable for individuals as young as 13. It took a 73-page report to introduce these new recommendations, which have been met with reactions ranging from disbelief to outrage. The AAP tried to soften the concepts and show them as reasonable and in many cases necessary.

New York Times journalist Catherine Pearson wrote that the organization…

[…] argues obesity should no longer be stigmatized as simply the result of personal choices, but understood as a complex disease with short- and long-term health implications… [T]here is no evidence to support delaying treatment for children with obesity in the hope that they will outgrow it.

This is very caring, but do others, including experts and parents, have more to say about all these ideas? You bet they do!

(To be continued…)

Your responses and feedback are welcome!

Source: “New AAP childhood obesity guidance includes medication, surgery: What parents should know,” Today.com, 01/11/23
Source: “New Guidelines Underscore How Complicated Childhood Obesity Is for Patients and Providers,” NYTimes.com, 01/20/23
Image by Toho Scope/CC BY-SA 2.0

AAP Guidelines and Backlash, Part 3

The previous post left off with Dr. Nicole McLean speaking of how pediatricians and other healthcare providers need to avoid stigmatizing language when talking with parents and children. Along with language, racial disparity is an enormous area of concern.

The first, having to do with the tone and precise phrasing of weight-related discussions, is very much under the control of individual practitioners. The second is of course partly controllable by health care providers, but the influence they can exert is quite small when stacked up against an imposing historical background and a societal mindset that often seems to be intractable.

We also mentioned how talk therapy has not been particularly effective, which is not totally due to the choice of language. Yet at present, a formula that includes a lot of talk seems to be the best thing on offer. For The New York Times, Catherine Pearson reported on what has been described as “the most effective behavioral treatment for children with obesity who are six and older,” which is enrollment into an intensive program concentrating on health behavior and lifestyle treatment.

Such programs are found in community hospitals, specialized obesity treatment clinics, and medical centers connected with universities. The specialists involved include, naturally, nutritionists, along with social workers and exercise physiologists. The ideal course of treatment must include at least 26 hours of in-person counseling with the whole family.

The fly in this ointment is that such programs are scarce, and even if they are available, few families have the resources to devote that much time, or to organize the travel arrangements. There was even a question about whether to include this item in the AAP recommendations at all, since it was felt that the majority of families would not be able to find an appropriate program or manage the logistics of attendance.

On the other hand, it is the organization’s responsibility to recommend whatever seems to be the best course of action. Dr. Sarah Hampl of Children’s Mercy Hospital is quoted as saying, “We have to lead with the evidence, because that is what we were charged to do.”

Journalist Caroline Kee interviewed and quoted Dr. Sarah Armstrong of the American Academy of Pediatrics:

“Childhood obesity has been continuing to increase almost in all age groups, races/ethnicities and sexes for the past 30 years.” Existing racial and ethnic disparities in obesity prevalence have also widened over time, and the pandemic was like a “magnifying lens” on these trends, she adds. “We saw greater year-to-year increases in the prevalence of obesity for all children during the pandemic years than we had in the previous 20 years combined.

Your responses and feedback are welcome!

Source: “Children with obesity should get proactive treatment,” 6abc.com, 01/10/23
Source: “New Guidelines Underscore How Complicated Childhood Obesity Is for Patients and Providers,” NYTimes.com, 01/20/23
Source: “New AAP childhood obesity guidance includes medication, surgery: What parents should know.” Today.com, 01/11/23
Image by Quinn Dombrowski/CC BY-SA 2.0

AAP Guidelines and Backlash, Part 2

This post is continued from the previous one. American Academy of Pediatrics Guidelines co-author Dr. Sarah Hampl, a pediatrician and weight management specialist, said, “Our kids need the medical support, understanding and resources we can provide within a treatment plan that involves the whole family.”

And that in itself is a problem. In the area of behavior “modeling,” previously known as setting a good example, not much progress seems to have been made in the past decades. Even in families where a good example is set, a very harmful condition known as Oppositional Defiant Disorder tends to crop up. In other words, anything that parents demonstrate or suggest is impossibly lame, and not to be adopted under any circumstances, just because some kids enjoy saying “No” more than anything.

An article written by Dr. Nicole McLean says,

Overweight means having BMI 85% greater than others their age and gender, while obese children are at or above 95%. BMI is an imperfect tool…

By this logic, in theory, the criterion of normalcy can continue to spiral upward toward infinity. If a child weighs 300 pounds, that’s okay as long as 15% of the other children are even heavier. Aside from the obvious problems like not being able to find cool clothes or fit into a classroom desk, obese children are at higher risk for all kinds of physical and psychological ailments like sleep apnea, heart disease, type 2 diabetes, hypertension, high cholesterol, fatty liver disease, arthritis, depression, and social malfunction.

Meanwhile, the AAP casts a rosy, optimistic glow over its recommendations:

All services for children and teens should also be carried out in a way that is mindful of patients’ culture and language preference, the guidelines say. By working with families to identify personal beliefs, risk factors, and challenges, pediatricians can provide a personalized plan for treatment.

Dr. McLean also wrote,

The new AAP guidelines call on pediatricians and other health care providers to avoid stigmatizing language when discussing weight with patients. The organization is also calling for policy changes that could help reduce racial disparities in childhood obesity, including improving access to healthy foods and treatments for groups at greatest risk.

In the actual world, where parents face increasingly difficult challenges to just keep their children housed and fed, how often does this ideal service scenario line up with reality? Some doubters speak of the expense and scarce availability of the type and duration of treatment that is recommended.

Some say that even under the best circumstances, talk therapy, especially in a family setting, is not spectacularly successful. The next post will go into more detail about the specifics. And no matter what, young people are setting out on a rough road, in challenging relationships with bodies that experience the increasing risk of serious medical conditions with every day that passes.

(To be continued…)

Your responses and feedback are welcome!

Source: “Children with obesity should get proactive treatment,” 6abc.com, 01/10/23
Image by GollyGforce/CC BY 2.0

AAP Guidelines and Backlash, Part 1

This year began with news that many felt was shocking and even scandalous. After a 15-year pause, the American Academy of Pediatrics issued a new set of childhood obesity guidelines. “Watchful waiting,” or giving children time to outgrow obesity, is not doing the trick. As Kaitlyn Radde reported for National Public Radio, “The group is now advising pediatricians to ‘offer treatment options early and at the highest available intensity’.” To some, those words have an ominous ring.

The new guidelines were authored by, among others, the vice chair of the AAP’s Clinical Practice Guideline Subcommittee on Obesity, Dr. Sandra Hassink. For children age six and older, but in extreme cases for those as young as two, the journalist wrote:

The most effective interventions require upwards of 26 hours over three to 12 months of intense, in-person behavior and lifestyle treatment from health care providers. Such treatment includes coaching on nutrition, physical activity and changes in behavior, such as role modeling by parents.

The preference is for those conversations to be couched in the “motivational interviewing” technique. This is where the clinician asks open-ended questions to try and understand the different family members’ perspectives. It is not difficult to imagine this leading to privacy issues, religious issues, distrust of governmental authority, and other undesirable reactions, but presumably, avoiding this is part of the training that professionals receive. On the other hand, one school of thought tends to believe that many patients and families will improve spontaneously, because the mere knowledge that someone cares and takes an interest, is beneficial.

A heavy schedule

All of this is, as the saying goes, “a lot,” especially for families with limited means. Even though the majority of Americans want to believe that COVID-19 and its numerous variants are in the rear-view mirror, those nasty critters are very much with us. People are still sick, and people are still unemployed, and some are both. If they have the time for these interventions, they don’t have the money — and vice-versa.

Those whose lives were least changed by the pandemic are the extremely disadvantaged, who did not use to have cars or childcare options or an extra dime to spare, and they still don’t. Seemingly ordinary amenities like well-child checkups are luxuries far beyond their means. But the recommendations for obesity abatement do not end with expensive and time-consuming appointments. Radde describes the next steps:

After this intensive therapy, weight loss drugs should be considered for adolescents as young as 12, the AAP says, while teens 13 and older with severe obesity should be evaluated for weight loss surgery.

But then, for young teens, the situation becomes even more problematic, because getting the recommended weekly injection of a drug called Wegovy is dicey, “due to recent shortages and insurance companies declining to cover it.”

Currently in the United States, more than 14 million children, or one in five humans in that age group, are officially obese. With regard to the objections that some critics have voiced, the organization also says that…

[C]hildhood obesity is a disease with genetic, social and environmental factors — not something caused by individual choices — and that it shouldn’t be stigmatized by health care providers.

(To be continued…)

Your responses and feedback are welcome!

Source: “Childhood obesity requires early, aggressive treatment, new guidelines say,” NPR.org, 01/09/23
Source: “Children with obesity should get proactive treatment,” 6abc.com, 01/10/23
Image by franchise opportunities/CC BY-SA 2.0

Intuitive Eating, Part 3

From the two previous posts we might have guessed that few medical professionals in the obesity field are on board with Intuitive Eating, but in this mixed-up world of today, that could always change.

Not surprisingly, Elyse Resch, one of the Intuitive Eating pioneers had, in her 30s, alternated between self-starvation and binging. Journalist Michelle Ruiz quoted her:

“I would try not to eat lunch, and in the afternoon, I couldn’t take it anymore and I’d eat something and then feel so guilty that I’d broken my ‘willpower,’” Ms. Resch said, adding that controlling her food had been an escape from her strained first marriage.

That is an interesting fact. In a troubled relationship, the most affected partner does not know whether to fight, flee, surrender, or lie down and die. So this sounds like displacement behavior, something to drain off excess brain energy. Ruiz also says,

Intuitive eating practitioners work on their own or with a dietitian; there are 2,000 certified intuitive eating counselors across 40 countries.

For followers of this philosophy, success seems largely to depend on a person’s ability to tune in to their own body’s signals of both hunger and satiation. This is not a widely-shared talent, especially among people who enjoy alcohol before, during, or after their meals. One negative experience is related by Adina Kish, a woman in her early 20s who gave it her best shot for a year and a half. Ruiz writes,

Trying intuitive eating for 18 months between 2020 and 2021 led her to “essentially binge eating,” Ms. Kish said, summarizing her resulting mentality as, “I should be able to eat anything, so I’m going to eat everything.” For some, intuitive eating amounts to an oversimplification — an ineffective response to the complex ways so many people relate to food.

At Michigan Medicine, Andrew Kraftson bears the long title of clinical associate professor of metabolism, endocrinology and diabetes, along with being director of the weight navigation program. In his view, the body is not always a reliable advisor regarding what should be fed into it, because “there is hormonal, neurobiological and metabolic dysregulation that can happen.”

Furthermore, a seemingly small weight change can bring about disproportionate benefits. For instance, for people in a pre-diabetic state, “if they lose 5 percent to 7 percent of their weight, they reduce their chance of developing full-blown diabetes by 60 percent.” People with hypertension and sleep apnea can also benefit greatly from seemingly small reductions.

Ms. Ruiz also spoke with a registered dietitian nutritionist, Liz Brinkman, who also became certified as an intuitive eating counselor. But over time, she has come to feel that its principles are based on some unstated assumptions about people that are not often true; for example, that they are “adequately resourced with time, money, and a sense of agency.” Sadly, these qualities apply to a quite small and inordinately privileged sub-group of humanity.

Many other professionals, including Dr. Pretlow, wish that people would “Honor your body” and “Honor your health,” but do not mean the same thing by it that the Intuitive Eating proponents do.

Your responses and feedback are welcome!

Source: “They Rejected Diet Culture 30 Years Ago. Then They Went Mainstream,” NYTimes.com, 01/18/23
Source: “10 Principles of Intuitive Eating,” IntuitiveEating.org, undated
Image by Fernando de Sousa/CC BY-SA 2.0

Intuitive Eating, Part 2

This continues a discussion of Intuitive Eating, so please catch up by checking out the previous post. To continue with the 10 principles of intuitive eating, Precept #8 is “Respect Your Body” but for dietitians and book authors Elyse Resch and Evelyn Tribole, those words seem to hold meaning slightly different from what we might expect:

Accept your genetic blueprint. Just as a person with a shoe size of eight would not expect to realistically squeeze into a size six, it is equally futile (and uncomfortable) to have a similar expectation about body size.

Next comes “Movement — Feel the Difference,” and what this advises is to focus on how movement feels, rather than how many reps you still owe or how many calories an app says you have burned. It actually is excellent advice.

A person who seeks to feel pampered and spoiled can decide not to pursue that sensation of specialness and fulfillment by eating food. Instead, they can choose the most agreeable kind of movement, and proceed to spend time, money, and whatever other resources are necessary, to include that pleasure in their life. If swimming feels great, do what you have to, to gain access. It’s silly to spend $1,000 for a mattress, where all you do is just lie there, but to deny yourself membership in a health club with a pool.

Last on the list of 10 is “Honor Your Health — Gentle Nutrition.” Make food choices that honor your health and taste buds while making you feel good. Remember that you don’t have to eat perfectly to be healthy. You will not suddenly get a nutrient deficiency or become unhealthy, from one snack, one meal, or one day of eating. It’s what you eat consistently over time that matters. Progress, not perfection, is what counts.

The hitch is that our sneaky, self-sabotaging brains will want to interpret all of that in a different manner. An intuitive eating enthusiast might hear it this way: “Eat what makes you feel good! Nobody’s perfect, right? You’re not gonna die. Nobody ever died from one pancake. The busybodies are just trying to scare us, because they despise fat people. They hate us for our freedom!”

This is one reason why it is such a good idea and so effective to band together with others for group support — as happens through Weigh2Rock, Dr. Pretlow’s interactive website for kids. It’s all too easy to deceive ourselves, especially about our problem areas. But in a like-minded group, others will notice our stinkin’ thinkin’ and call us on it. Also, when we see other people’s rationalizations and attempts to fool themselves, sometimes we have a flash of insight and realize, “Oh wait, I do that too.”

What does the science say?

Journalist Michelle Ruiz writes,

A longitudinal study published in 2021 found that intuitive eating led to better psychological and behavioral health among people with anorexia and bulimia, and to lower odds of binge eating, fasting, taking diet pills and vomiting.

That sounds promising. Ruiz then goes on to say that in 2021 a meta-analysis of intuitive eating studies was published which “found that the method was positively linked to participants’ body image, self-esteem and psychological well-being.” By then there had been, in all, more than 100 academic papers on the subject, some suggesting that intuitive eating could lead to “improved blood sugar and cholesterol levels and increased intake of fruits and vegetables.”

(To be continued…)

Your responses and feedback are welcome!

Source: “10 Principles of Intuitive Eating,” IntuitiveEating.org, undated
Source: “They Rejected Diet Culture 30 Years Ago. Then They Went Mainstream,” NYTimes.com, 01/18/23
Image by Mike Licht/CC BY 2.0

Intuitive Eating — Bad Idea, or Terrible Idea?

Probably, most of us just sailed right past January 20, the International Day of Acceptance, without awareness. It was designed to bring attention to the fact that many people have special needs that in a civilized society must be not only accepted but accommodated. Diversity is good, and that includes those who are differently abled.

But then, there are always people who are felt by others to be pushing it too far. Dietitians and book authors Elyse Resch and Evelyn Tribole are the most enthusiastic proponents of “intuitive eating,” about which they published a book in 1995. Now, almost 30 years down the road, their brainchild is still going strong. Incidentally, it comes as no shock to learn that intuitive eating and the Health at Every Size movement form a mutual admiration society, and might both be said to practice a bit too much acceptance.

The doctrine rests on 10 principles, presented in quotation marks and commented upon here:

If you allow even one small hope to linger that a new and better diet or food plan might be lurking around the corner, it will prevent you from being free to rediscover Intuitive Eating.

That warning to “Reject the Diet Mentality” encourages followers to get angry at the so-called diet culture. But “diet” and “food plan” are both basically terms that comprise everything a person eats, so that is a pretty broad criticism. It seems that eating “intuitively” would also come under both of those headings.

To “Honor Your Hunger” apparently means eating lots of carbohydrates in order to prevent yourself from eating carbohydrates. To “Make Peace with Food” means to “give yourself unconditional permission to eat,” and while becoming a pacifist in that area, you must at the same time also “Challenge the Food Police.” In other words, it all seems completely in tune with the old saying (and drinking toast), “A short life and a merry one!” which is attributed to the most illustrious Welsh pirate of them all, Black Bart, aka Bartholomew Roberts.

Seek satisfaction?

“Discover the Satisfaction Factor” is a very optimistic suggestion indeed. Allegedly, by providing yourself with this experience, “you will find that it takes just the right amount of food for you to decide you’ve had ‘enough.'” However, going by the experience of many thousands of humans, this does not always work out as planned. “Feel Your Fullness” means taking care to observe the body’s signals of fullness. Doesn’t it seem like, if it were that easy, people would already be doing it?

A long paragraph expanding on the principle “Cope with Your Emotions with Kindness” emphasizes the importance of finding emotional satisfaction in other things than food, and that would be very difficult to disagree with!

Anxiety, loneliness, boredom, and anger are emotions we all experience throughout life. Each has its own trigger, and each has its own appeasement. Food won’t fix any of these feelings. It may comfort in the short term, distract from the pain, or even numb you. But food won’t solve the problem. If anything, eating for an emotional hunger may only make you feel worse in the long run. You’ll ultimately have to deal with the source of the emotion.

This is all absolutely true, and finding ways to deal with those emotions is one of the goals of Dr. Pretlow’s current project. Not everyone needs years of talk therapy. A great many people can benefit from the practices being developed by Dr. Pretlow and his team.

(To be continued…)

Your responses and feedback are welcome!

Source: “They Rejected Diet Culture 30 Years Ago. Then They Went Mainstream,” NYTimes.com, 01/18/23
Source: “10 Principles of Intuitive Eating,” IntuitiveEating.org, undated
Image by Artlessly, Arielle/CC BY-ND 2.0

What Needs to be Said?

A social media site recently included a story by a plus-size person who ordered a certain treat at a restaurant. Reportedly the server asked, “Do you really need that? It’s fried and so unhealthy. I don’t think you should order that.” The customer immediately called the manager, who apologized, and together they agreed that the staff member would not only bring the treat, but pay for it herself, and not receive a tip from that table.

The customer was happy to see the accused fat-shamer being shamed and reprimanded, which seems to be a sentiment shared by many. Nicole Saphier, M.D., has some things to say about the trend. Sure, she lays accountability for the current high rate of child obesity on electronic devices and pandemic precautions, but doctors also come in for a share of censure because they are now, allegedly, afraid to discuss the matter with their patients on account of the fear that they will be accused of fat-shaming. She says,

Doctors have been told to refrain from using words such as “overweight” and “obese,” widely accepted medical terms, and to instead replace them with phrases like “above a healthy weight” in an effort not to make someone feel bad about excess weight.

The American Academy of Pediatrics urges avoidance of shaming and asks for sensitive and non-stigmatizing language to be used, which in Dr. Saphier’s opinion, does nobody any favors. In her view, this tip-toeing around focuses more on the potential emotional damage that children might suffer from being told they are fat, and ignores the importance of doing something about their ballooning weight statistics. She warns against social media influencers who attempt to “cultivate a platform to promote plus-sized bodies,” and has stern words for “the trending movement advocating for body positivity and self-love.”

She advocates better access to unprocessed foods and is in favor of a home-based approach to reducing childhood obesity, which should include improved eating and exercise habits among the entire family.

Dr. Saphier also mentions a convoluted mini-conspiracy theory apparently shared by others. This consists of a notion that the body-positivity people are denigrating exercise because it was first suggested to Americans as a way to protect themselves against the flood of immigrants who arrived in the early 1900s. According to this mindset, people are being brainwashed into thinking that exercise is a white supremacist activity (remember, Hitler was all for it!) so now, weak-minded Americans have been persuaded that it is better for them to get fat than to appear racist.

While acknowledging that body positivity is important for individual mental health, the writer says,

The key message should not be fat versus thin, rather, the focus should be on lowering the risk of preventable chronic conditions… Ultimately, it is vital to acknowledge excess body fat is risky… From a medical standpoint, the normalizing of obesity must end to prevent the overwhelming amount of chronic illness that is sure to ensue.

The doctor does have a point, in that people’s opinions on these issues have become increasingly polarized, as exemplified by this anonymous social media protest:

If you somehow think that fatphobia isn’t as bad as other types of oppression and don’t even realize how it’s literally intertwined with racism, sexiism, classism, homophobia, etc. please just do this world a favor and leave.

Source: “I’m a mom and a physician. ‘Fat-shaming’ fears are putting our kids in danger,” FoxNews.com, 01/10/23
Images by Tadson Bussey and heymrleej/CC BY-SA 2.0

No Name-Calling, Please!

The illustration expresses an emotion felt by many overweight people. Some who are not even obese, but just a bit hefty, are very sensitive about public taunts. Today is the last day of this year’s National No Name-Calling Week. The exact dates change annually, but everywhere and all the time, people are called names and subjected to many sorts of bullying, for far too many reasons. Not surprisingly, Childhood Obesity News concentrates on the plight of obese children.

What should not even need to be stated, is that every week ought to be devoid of name-calling, fat-shaming, teasing, bullying, and the entire spectrum of behavior that involves making someone feel “less than” for being “more than.”

In 2004, the Week was founded by students and teachers, of kindergarten through the senior year of high school, with the goal of ending bullying and name-calling. Parents can help too, by looking up the how-to-take-action ideas.

Dr. Erica Lee, a psychologist at Boston Children’s Hospital, talks about the impact that childhood obesity can have on a child’s mental and overall health:

Weight and physical attractiveness are pretty strongly linked here in America and there’s a lot of negative stigma around being overweight or obese… This means there’s a lot of pressure and often negative attention on kids who are overweight or don’t fit that typical mold.

For any child, she recommends conversation about healthy habits. For those already experiencing weight problems,

Try to shift the conversation away from appearance or comparison to other people. Rather than focusing on a child’s weight or appearance, try to teach kids things like engaging in regular exercise and trying to have a relatively balanced diet… You can try to link it to whatever their goals are. If kids talk about wanting to be taller or doing better in school, you can explain to them that they need to eat lots of fruits and vegetables, and exercise.

Regularly acknowledge that their feelings are real. Try to avoid making any negative comments about your own weight or other people’s weight, and help your kids build strong self-esteem that has absolutely nothing at all to do with their appearance.

But objections to perceived fatphobia can go too far, as shown by an anonymous social media entry by a mother who took a group of children to a trampoline park. To use the equipment, a person had to weigh in at less than 250 pounds. This woman was livid with rage at being excluded, and warned her readers, “Thin privilege is a real thing! Stop saying it doesn’t exist!”

Perhaps, but the laws of physics do exist, despite our feelings about them. If a trampoline (or Ferris wheel seat, or bicycle, or pogo stick) is determined by its manufacturer to be unsafe for anyone above a certain weight, shouldn’t we all just relax and be grateful that regulations are in place to guarantee that we are warned about such safety hazards?

Your responses and feedback are welcome!

Source: “National No Name-Calling Week,” OK2bMe.ca, undated
Source: “No Name-Calling Week Activity Guide,” UnitedWayBroward.org, undated
Source: “Mass. psychologist on emotional impact on childhood obesity,” WCVB.com, 01/09/23
Image: Public Domain

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Profiles: Kids Struggling with Weight

Profiles: Kids Struggling with Obesity top bottom

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:


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