Guidelines Backlash, the Biggies — Access and Cost, Part 3

Among others heard from on the subject is bioethicist Arthur Caplan who has called obesity one of the biggest moral challenges that contemporary America is up against. He describes both medication and surgery as “Band-Aids” in the sense of being alleged answers that provide the illusion of doing something, but which really do not accomplish much, and in fact, may even worsen the underlying problem.

Brian Castrucci, who heads a nonprofit foundation, has publicly said that more progress needs to be made, instead, with “the policies and environments that can produce better health.” Another concerned professional interviewed by Christopher Curley is pediatric endocrinologist Dr. Sissi Emperatriz Cossio:

If [patients] do not have health insurance, the costs are too high, and if they do, a great deal of paperwork is required to get the procedures approved. As with many maladies that doctors treat, the insurance approval and payment hurdles are among the chief sources of disparity of care quality between wealthier and poorer communities.

As with most issues in the USA, race and ethnicity enter into the controversy. Curley also reported that studies show how obese minority children “vastly underutilize available treatments, from drugs to counseling to surgery, because of these financial and logistical barriers. He quoted the executive report that accompanied the new guidelines:

Targeted policies are needed to purposefully address the structural racism in our society that drives the alarming and persistent disparities in childhood obesity and obesity-related comorbidities.

The AAP guidelines document itself says,

Inequalities in poverty, unemployment, and homeownership attributable to structural racism have been linked to increased obesity rates. Racism experienced in everyday life has also been associated with increased obesity prevalence. Youth with overweight and obesity have been found to be at increased risk… In adults, studies have found positive associations between self-reported discrimination and waist circumference, visceral adiposity, and BMI in both non-Latino and Latino populations.

Fatima Cody Stanford told a journalist…

[…] studies show that Black girls and boys are less likely to get treatment, compared with children of other races, despite having higher rates of the disease. Even those covered by Medicaid are less likely to be treated. “We find biases in who gets referred. If you don’t get the diagnosis, you don’t get the treatment,” she said.

Your responses and feedback are welcome!

Source: “Aggressive treatment guidelines for childhood obesity getting backlash,”, 01/20/23
Source: “Criticism Emerges Over New AAP Guidelines for Childhood Obesity,”, 01/20/23
Source: “Clinical Practice Guideline for the Evaluation and Treatment of Children and Adolescents With Obesity,”, February 2023
Image by Got Credit/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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