AAP Guidelines — The Backlash Grows, Part 6

Dr. Pretlow is by no means alone in preferring prevention over cure. Just as a random example, see Dr. Daisy & Co, where the file title “Resource Page for Harmful AAP Guidelines” kind of gives it away.

While not claiming to hold the only answer, the dietitians there treat not “obesity,” but eating problems. They remind us that “Safe, successful and evidenced-based nutrition interventions exist for pediatric eating concerns.” They reject aggressive treatment, restrictive diets, appetite suppression meds (beyond a certain point), or stomach surgery. Like so many others, they point to the lack of long-term research. And they call the American Academy of Pediatrics guidelines “a step backwards.”

Two key words: forethought and evaluation

Psychiatrist Kimberly Dennis, who specializes in treating addictions, eating disorders, and co-occurring disorders, says:

As for referring certain kids 13 years or older for bariatric surgery, my main concern is that there is little data on the long-term physical and mental health effects of this drastic and expensive procedure when performed on young people.

A Swedish study followed up 81 severely obese teens for five post-op years and:

[…] 20 test subjects (25 percent) ended up requiring follow-up surgery because of complications from the original procedure, and 58 subjects (72 percent) showed some type of nutritional deficiency at the five-year follow-up. No mental health screens were listed as having been done.

That last part, about the absence of mental health screening, disturbs not only Dr. Dennis, but Dr. Pretlow and plenty of others. Let’s hear from Dr. Mélanie Henderson, a pediatric endocrinologist and researcher in Canada (which is also developing new obesity treatment guidelines). In that country, at present, a teen may be considered eligible for weight-loss surgery after two years of behavioral intervention.

Dr. Henderson cites the “alarming” rise in obesity that “has led to a greater need for surgery for teens whose mental and physical suffering typically worsens into adulthood.” According to this point of view, there should be more emphasis on not only mental health but on other quality-of-life issues and interventions about which, incidentally, “We don’t have a lot of data.” The report continues,

[A] review of studies over the last decade suggests evaluations of anxiety and depression, for example, are lacking even though those issues are addressed in various intervention programs… Obese children are at three times the risk of depression compared with their non-obese peers due to the stigma and shame…

Medical writer Virginia Sole-Smith makes a strong argument for improvement at the forethought stage, rather than just measuring a child’s BMI and jumping to the conclusion that surgery must be scheduled. She writes,

The step that a lot of people are skipping is the evaluation component… The guidelines talk about an extensive physical laboratory evaluation, evaluation for eating disorders, evaluation for mental health problems. And based upon that evaluation, then we have an individualized treatment plan for that individual.

Nooshin Kiankhooy is an eating disorder specialist and founder of a therapy practice, who spoke with the popular program All Things Considered about clinicians who make evaluations under the current rules:

[W]hat I understand is these evaluations are very short, maybe an hour long, and they’re kind of put on a timeline by the physician or even by the insurance company, right? And that is not at all an amount of time, I think, that can allow for a proper evaluation.

Your responses and feedback are welcome!

Source: “New AAP Guidelines for Childhood and Adolescent treatment of ‘obesity’ Resource Page,” DrDaisy.com, undated
Source: “A Critical Look at New Guidelines for Kids With Higher BMIs,” PsychologyToday.com, 02/11/23
Source: “Ahead of new childhood obesity guidelines, doctors say surgery is an important option,” CoastReporter.net, 02/17/23
Source: “Why the New Obesity Guidelines for Kids Terrify Me,” NYTimes.com, 01/26/23
Source: “This eating disorder expert is worried by new guidelines to treat childhood obesity,” WVIA.org, 02/17/23
Image by michellereyntjens/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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