AAP Guidelines — The Backlash Grows, Part 7

As Dr. Pretlow teaches, it is a lot better to treat the underlying cause of a problem than to treat the symptoms. One reason for this is, treating the symptoms is just not practical. Symptoms are rarely eliminated. They may hide, show up in disguise, or pull some other trick. But the smart money says, get rid of the basic reason for the problem. And that is a very strong incentive to back up and start at the source.

There is another quite convincing reason to work from the ground up. In the early stages, the preferred treatment for an eating disorder is on the behavioral level. Because all humans are fallible, mistakes may be made, but at least they don’t yet involve the routinization of drugs, or the amputation of body parts.

The best reason of all to take it slow is because these are minors. There is some legal stuff involved, to the point where healthcare professionals, administrators, institutions, and even parents might someday find themselves on the wrong side of a jury box. Some things cannot be done to an adult without fully informed consent. But parents can sign a form on their child’s behalf, and that is a mixed blessing that can be either a life-saver or a life-destroyer.

Upcoming professionals

Medical Students for Size Inclusivity is a grassroots advocacy group for which member Jessica Mui writes,

Weight loss surgeries take healthy, functioning organs and put them into a permanent disease state by reducing digestive hormone production, absorption of nutrients, and result in frequent complications. If we recommend these life-altering surgeries that come with a constellation of health risks for vulnerable youth as young as 13, we as medical providers are acting in direct opposition to our duty to “do no harm.” We cannot ask adolescents, who lack the ability to fully consent and manage their bodily autonomy, to risk their lives and well-being in an attempt to make their bodies smaller.

Some individuals fear a nightmare scenario where the authorities could capture a person and remove a big hunk of their stomach for that person’s own good — just as authorities can now capture and confine someone who is preparing to take their own life. In another, much more frequent example, a child who is bleeding out or drowning may be saved by anyone who is prepared to do it — even if neither parent is on the scene to sign a consent form. And certainly, the imperiled child is not offered a document and a pen.

Deep questions

Water inhalation and rapid exsanguination are life-threatening situations, where the response must be swift and decisive, so legal niceties can be put aside. Morbid obesity is a life-threatening condition, only on a longer timescale. Does that make it okay for adults, even parents or legal guardians, to step in and authorize the almost-total removal of a stomach? Some people say no, and many of those who theoretically approve would like to see more forethought exercised.

If a 13-year-old can consent to bariatric surgery, should they also be permitted to consent to other procedures, with or without parental consent?

Irreversible surgery on a minor child does seem to raise some ethical debate points, although it happens every day in the case of, for instance, routine neonatal circumcision. And if a child is born with a cleft lip or palate, parental permission is enough.

Dr. Danielle P. Burton writes of bariatric surgery,

Can a thirteen-year-old truly consent to the lifelong undernourishment caused by such a radical procedure? Can they consent to the increased risk of suicide? While it is great to minimize the risk of potential future disease, it cannot be at the cost of premature death. A key factor in helping our children grow into healthy adults is making sure they live long enough to become one.

Your responses and feedback are welcome!

Source: “Size-inclusive medicine: a response to AAP’s guidelines for the treatment of children and adolescents with obesity,” KevinMD.com, 03/01/23
Source: “The Hidden Danger in the AAP’s New Obesity Guidelines,” PsychologyToday.com, 03/04/23
Image by NIH Image Gallery/Public Domain

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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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