AAP Guidelines and Backlash, Part 9

When people praise the new AAP guidelines they often say, “Effective treatment, in the form of drugs or surgery, is available. So, why not opt for one of those methods?” Of similar mind is pediatric surgeon Ann O’Connor of the San Antonio Children’s Hospital, who is quoted as saying, “One of the things we know for sure is that as children with obesity get older, they get bigger and bigger and sicker and sicker, and their medical problems get worse.”

Among other possible outcomes of waiting, there is lifelong chronic illness. Endocrinologist Grace Kim (Seattle Children’s Hospital) warns that while it may take a decade for an adult to progress from prediabetes to diabetes, this can happen to a child in as short a time as two years.

Journalist Christopher Curley has pointed out that an increasing number of professionals now have a fundamentally different view of obesity, tending more to regard it as “a chronic, refractory, relapsing disease,” meaning that a wait-and-see approach cannot be satisfactory.

Uncomfortable truths

Dr. Jennifer Woo Baidal of Columbia University reminds us that bias is one of the prominent factors that prevent progress, especially when bias refuses to recognize that obesity is a very complex problem. This is true of professionals and laypersons alike. Dr. Baidal told the press:

Many people think children can just lose weight on their own, but it’s hard to make changes if there is limited access to affordable, healthy food and exercise. I think the guidance calls this out and gives support and instruction for providers on how to handle those factors.

Writer Catherine Pearson quoted Prof. Rebecca Puhl, deputy director of the Rudd Center for Food Policy and Health at the University of Connecticut, who said, “Physicians are not immune to societal weight bias that is prevalent in our culture… Weight bias is rarely, if ever, addressed in medical school training.”

Jason Wachob of MindBodyGreen.com writes that he is not against surgery or medication, but suggests that before considering either of those routes, the medical team should be totally convinced that the less intrusive possibilities for lifestyle modification have been exhausted. He mentions a thing that some find strange, that the AAP’s new recommendations were released before the same institution’s statement on obesity prevention, and adds:

While we need to act urgently to treat the mounting childhood obesity epidemic in this country, I think the order of these two publications is telling. The medical system is taking drastic measures to “treat” the signs of an issue before fully considering its root cause.

Wachob quotes family medicine physician Bindiya Gandhi, M.D., who reiterates that before considering bariatric surgery on pediatric patients, many other interventions can and should be utilized. According to this worldview, particular attention should be paid to eliminating sugar and hyper-processed foods, and to encouraging a meaningful amount of physical activity.

Also quoted is family physician Madiha Saeed, M.D., who confirms what has been known or suspected all along: “I was taught no nutrition and almost no lifestyle strategies to aid my patient care.” Dr. Saeed believes that more resources should be devoted to weight management education, and characterizes the new recommendations as “horrifying.”

Your responses and feedback are welcome!

Source: “Criticism Emerges Over New AAP Guidelines for Childhood Obesity,” Healthline.com, 01/20/23
Source: “What Parents and Caregivers Need to Know,” NYP.org, undated
Source: “New Guidelines Underscore How Complicated Childhood Obesity Is for Patients and Providers,” NYTimes.com, 01/20/23
Source: “The New AAP Childhood Obesity Guidelines Are Setting Kids Up To Fail,” MindBodyGreen.com, 01/17/23
Image by Jernej Furman/CC BY 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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