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

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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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