Guidelines Backlash, the Biggies — Access and Cost, Part 2

Becoming too enthusiastic about weight-loss pharmaceuticals or surgery, or even about intensive therapy, could cost a ton of money — which may not be forthcoming from the sources that the most hopeful proponents look to for funding.

Some optimists have suggested that the new recommendations in the AAP guidelines might incentivize insurers, including the government through Medicaid, to willingly open their wallets and pour out payments. Other professionals are not so sanguine in their expectations, like Dr. Katy Miller, who works with teenagers experiencing eating disorders. She says,

We are proposing treatment strategies that are expensive and even in the best circumstances are often unsuccessful. How can we ask someone to diet when we’re not addressing things like poverty, food scarcity and housing instability?

Journalist Sara Monetta met with a mother of three who was enthused about her healthy cooking support group (a YMCA project.) This mom believed in healthy eating and plenty of exercise, and lamented the lack of sports programs and other exercise opportunities for children. She would consider weight-loss drugs or surgery “only if I had tried everything.”

On the question of expenses for any of the options, a Washington Post article said this:

Insurance can be tricky to navigate. Doctors say bariatric surgery for those who are severely obese is usually covered. But only a few states mandate reimbursement for medication and behavioral treatments under Medicaid and private plans vary in their coverage.

Apparently, an anti-obesity bill was introduced to Congress 10 years ago that would have provided coverage under Medicaid, not only for prescription drugs, but also for profound and extensive behavioral therapy. But introduction was as far as the acquaintance went. There was no second date.

More angles

Jason Wachob of wrote about the relative short-term and long-term costs, predicting that…

[…] pharmaceuticals and surgeries will dwarf the costs of changing school curriculums to reflect our dire need to get our kids and our future generations thriving… what would be required for an overhaul of our education system…

He then went on to suggest some audacious policy changes:

What if we subsidized vegetables, fruits, and nutrient-dense animal products, instead of just corn and soy?

Journalist Ariana Eunjung Cha noted the probability of unequal access to treatment, and added another concern, namely, “worry that earlier medical interventions may create more fat-shaming of vulnerable children.” Meanwhile, other critics have other reasons to object, chiefly because they believe that making this sort of help too easy to get will encourage children to persist in their poor lifestyle choices, i.e. eating too much. Cha wrote,

People on both sides express uneasiness about the potential long-term consequences of putting millions of children on drugs or under the knife, instead of doing more to prevent the condition in the first place.

Your responses and feedback are welcome!

Source: New US childhood obesity guidelines criticised by families,”, 01/29/23
Source: “What you need to know about the new childhood obesity guidelines,”, 01/20/23
Source: “The New AAP Childhood Obesity Guidelines Are Setting Kids Up To Fail,”, 01/17/23
Source: “Aggressive treatment guidelines for childhood obesity getting backlash,”, 01/20/23
Image by Pictures of money/CC BY 2.0

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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.

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