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

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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.

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