AAP Guidelines and Backlash, Part 7

As the previous post mentioned, although many parents and health practitioners prefer working with the diet plus exercise method of controlling childhood obesity, official policies will now support that model to a much lesser extent.

As Gina Kolata reported for The New York Times, some major research projects have been less than encouraging. Back in the 1990s, the National Institutes of Health sponsored two very sizable and careful studies. Could weight gain in children be prevented at school, through the expansion of physical education programs? How about cafeteria meals designed to be more nutritious?

What if students were taught more intensively about good eating and lots of exercise? What if parents were also brought into the picture? Kolata writes,

One study, an eight-year, $20 million project sponsored by the National Heart, Lung and Blood Institute, followed 1,704 third graders in 41 elementary schools in the Southwest… Some schools got intensive intervention, while others were left alone.

In the intervention schools, students changed their eating habits to include slightly less fat, but not much else happened. The investigators had to regretfully declare that body weights had not noticeably shrunk. However, there still is no universal agreement on the failure of diet and exercise. Kolata’s article also included some paragraphs that cast a shadow over the controversial new AAP proposals:

It takes years for doctors to start using new guidelines, noted Dr. Louis Aronne, an obesity medicine specialist at Weill Cornell Medicine in New York. “The ones for adult obesity have never really been adhered to,” he noted. “Adults with obesity are already advised to get surgery or drug treatment, but just 2 percent ever do.”

For The Washington Post, Ariana Eunjung Cha listed the three most important new guideline concepts that the public is meant to grasp:

1. Obesity is a chronic medical condition, not primarily a consequence of lifestyle choices.
2. Medications are a tool that can be used in children 12 and older in a safe manner. Bariatric surgery can also be considered for severe obesity in children 13 and older.
3. More must be done to ensure access to treatments for all children who need them.

Many health professionals and laypersons would prefer to stick with emphasizing healthy eating and increased exercise, ideas which although now relegated to an inferior position, are not entirely abandoned. The new guidelines still include them in the preferred method of first resort, known as Intensive Health Behavior Lifestyle Treatment, or IHBLT.

As summarized by Claire McCarthy, M.D.:

This involves face-to-face, family-based, multidisciplinary counseling on nutrition and physical activity, preferably based in your community and connected to community resources. To make a difference, it should involve at least 26 hours over at least three to 12 months.

This will be discussed further.

(To be continued…)

Your responses and feedback are welcome!

Source: “Why Experts Are Urging Swifter Treatment for Children With Obesity,” NYTimes.com, 01/27/23
Source: “What you need to know about the new childhood obesity guidelines,” WashingtonPost.com, 01/20/23
Source: “New pediatric guidelines on obesity in children and teens,” Harvard.edu, 01/24/23
Image by U.S. Dept of Agriculture/Public Domain

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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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