Guidelines, Quibbles and Quirks — Part 1

Much has been said about the newest batch of guidelines from the American Association of Pediatrics. Before moving on to what is regarded as the most egregious ruling, the acceptability of bariatric surgery for very young humans, let’s catch up on some of the details, footnotes, and side issues that have been pulled into this conversation.

We have mentioned the burdensome cost of the new generation of weight-loss drugs, whether taken by adults or young people. The traditional choices, appetite suppressants like phentermine and topiramate, are available in generic versions that may cost as little as $30 a month, or a dollar per day. But the newer injectable GLP-1 agonists can run as much as $1,200 per month, or a daily tab of $40.

Insurers don’t want to pay that much, and who can blame them? Not when common sense and years of indoctrination have taught that the problem could be solved by saying no to the Big Mac and yes to running around the track a few times. It has so far proven difficult to convince insurance companies to foot the bill. They ask, quite reasonably, whether there is a medical necessity and whether that urgency could be met in some other way.

A great if unachievable goal

To quell childhood obesity, the AAP would prefer that the first resort be Intensive Health Behavior Lifestyle Treatment, or IHBLT. This means that parents and child(ren) all must be available to travel, sometimes a long way, to attend at least 26 hours of in-person therapy sessions together within three to 12 months. If each session is one hour, that means every other week. And even if weight-loss medication is prescribed for the child, the meetings are meant to continue.

At the Yale New Haven Children’s Hospital, a team headed by the associate director for pediatric obesity Maria Savoye developed the Bright Bodies Program. The AAP greatly admires the program, and this is where the ideal quota of 26 hours per year originated. Family therapy is not simply a finite program completed during a single year; not just a one-and-done proposition. It is recommended to continue indefinitely, which is a fine idea in theory, but how are people supposed to actually comply?

Psychiatrist and eating disorder specialist Kimberly Dennis says,

Because the therapy normally lasts from 3 to 12 months, dropout rates are high. Accessibility is a major problem, especially in socioeconomically disadvantaged communities.

Other views are held by others, like Nancy Ellen Abrams who wrote for the opinion page of The New York Times that overeating can be symptomatic of self-loathing and reminded her fellow grownups, “For children, food is the only numbing drug available.” She wrote,

What children need is a bigger picture that reveals the subtle cruelty of impossible physical expectations. They need a path to self-love, a simple practice of three meals a day and a peer group to discuss how hard — yet possible — it is to find peace with food. The peer group is essential; no one heals from a largely socially caused disease alone.

Your responses and feedback are welcome!

Source: “What you need to know about the new childhood obesity guidelines,”, 01/20/23
Source: “A Critical Look at New Guidelines for Kids With Higher BMIs,”, 02/11/23
Source: “Childhood Obesity: What to Do?,, 02/11/23
Image by Cajsa Lilliehook/CC BY-SA 2.0

Leave a Reply

Your email address will not be published. Required fields are marked *

FAQs and Media Requests: Click here…

Profiles: Kids Struggling with Weight

Profiles: Kids Struggling with Obesity top bottom

The Book

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.

Food & Health Resources