Reeling in Serenity

The previous post, about Reeling in Recovery, was the prologue to the recent and exciting occasion (March 13) of the nonprofit group’s name change to Reeling in Serenity. The press release issued on that date affirmed the basic tenets of the 501c3 organization:

Reeling in Serenity celebrates life free from drug and alcohol addiction by embracing nature and the spiritual connection that fly fishing has brought so many. We do this through free fly fishing retreats that are open to those who have chosen to live their personal truth — a life without alcohol and drugs. We also serve as a safe space and resource for the sober fly angler who is doing the work one day at a time.

The group can be found on Facebook and of course, has its own website, where various other declarations, affirmations, and mission statements can be found. Healing comes from spending time among healthy people, and some are guided to Reeling in Serenity by their recovery mentor or sponsor.

New members do not need any previous experience with fly fishing. The whole point is to tune in to something new that can displace the unsatisfactory result the person had received from their addiction. Even more, rewards can be reaped by volunteering their services to the organization in some capacity.

But let’s get down to cases, beginning with that of Founder and Executive Director Becca Sue Klein, for whom committing to recovery and the discovery of fishing were almost simultaneous life events. In 2019, she wrote under the pseudonym of “A Greatfull Recovering Alcoholic” about coming to the realization that fishing was the best therapy she could have wished for:

In recovery, we learn that our physical health — in addition to emotional sobriety, a spiritual connection, and good mental health — is so important to our program. And all are connected. They are like the four corners of a chair. If we lose sight of one of these elements, we topple over.

As the AA program puts it, Klein was sick and tired of being sick and tired, and desperately wanted change, but knew she could not do it on her own. Rather than someone who only wanted to stay up all night partying, she became the person who went to bed early to get up and go fishing. She recommends to others a short film called “One Cast at a Time.”

A couple of years later, Klein told journalist Kim Ranella,

Fly fishing soon replaced my daily whiskey and wine consumption. It was a reprieve from the stresses of my day-to-day life, and showed me the importance of slowing down. When I’m fly fishing, I’m not thinking about my lists of things to do, money or family struggles, or my stage IV breast cancer diagnosis. When I’m standing in a stream I’m able to live in the moment… [S]omething I could never do in my days of active addiction.

Klein had been participating in environmental work since 2007 and later connected with Casting for Recovery, a group that “brought women managing a breast cancer diagnosis out for fly fishing retreats.” Her concerns also encompassed the importance of leading women and girls to a consciousness of the importance of conservation efforts that would preserve America’s waterways for both fish and humans. This led to the founding of Reeling in Recovery in 2022.

(To be continued…)

Source: “Reeling,” DunMagazine.com, 12/05/19
Source: “Women Who Make a Difference,” MissMayfly.com, 09/08/22
Image by Intermountain Forest Service/Public Domain

Reeling in Recovery

Reeling in Recovery is a new national non-profit organization based in Georgia that helps recovering substance abusers by teaching them, at specially organized retreats, how to fish. In some cases, the participants not only add a fascinating new dimension to their own lives but take it a big important step further by joining up as volunteers. When that happens, they pass along the benefit by teaching others to fish by spreading the word, and by helping to gather the donations that keep the program going.

The non-profit has its own website, along with a presence on Facebook, Instagram, and other social media. This is about a particular kind of fishing, fly angling, the kind where a person puts on waterproof gear and stands around in a river. But there is a lot more to it! On the practical side, several skills are involved — preparing the gear, knowing how to put on the waders and boots, how to handle the rod and reel, and how to cast. Participants do not need previous experience and can proceed at their own pace. (Also recommended are the elementary online courses offered by the group United Women on the Fly.)

Georgia Skuza, Reeling in Recovery’s communications director, told a journalist,

Those in recovery talk about needing a routine, and in fly fishing there is a routine… You put your rod together, you put your reel on, you get dressed, you have your months in which it’s really good to fish and that routine and that consistency helps a lot of people stay grounded. When you’re on the water, everything else just melts away.

The program (which apparently is also known as Reeling in Serenity) works by helping former drug and alcohol abusers to maintain their sobriety, something that such individuals do not always find easy. It is a way to supplement their membership in the 12-step programs they have committed to. Former substance abusers need to associate with others on the path, but not just by sitting around in rooms sharing the stories of their previous and ongoing experiences.

Reeling in Recovery adds to that relationship with fellow addicts another whole dimension. It also benefits community members who are moved to help fellow humans struggle with addiction — often because they have lost family members and friends to the disease.

How does it work?

The nonprofit organization was founded by avid anglers, some in active recovery from alcohol or drug abuse. It holds free retreats for the participants, though they do have to pay their own way to the locations. A retreat class is limited to 10 participants and journalist Brian Whipkey explains,

[T]he participants will see fly-tying demonstrations, casting demonstrations, apparel instructions and a presentation from a nature-informed therapist who will combine recovery, nature and fly fishing and of course, go fishing… The organization attempts to supply anglers with gear or they can bring their own.

Since time immemorial, rivers have helped us humans feel our deep connection with nature. There are rivers in practically every part of the world, and corporate greed has not managed to ruin all of them quite yet. Just about any interaction with a river can be healthful, productive, engaging, and fun, a natural high whose therapeutic value is to provide an escape from everyday cares without drugs or alcohol. Tomorrow’s post will go into more detail about this!

Your responses and feedback are welcome!

Source: “How fly fishing in PA will help people recovering from substance abuse,” GoErie.com, 02/07/23
Image by Mobilus In Mobili/CC BY-SA 2.0

Guidelines, Quibbles and Quirks — Part 7

This continues the discussion of the thorny question of consent, where surgery is concerned. The American Academy of Pediatrics describes its goal as caring for the “whole child.”

On the surface, how could fault be found in that ambition? But many citizens see it as a ploy to make public schools into brainwashing centers, whose goal is “to make government-run schools, not the family or the home, the central tenet of a child’s life.” (For this discussion, let’s leave aside the incorrect use of the word “tenet,” which is a principle or a belief. A school is neither of those things, but an institution.)

Apparently, massive numbers of Americans see public schools as mind control tools, whose purpose is to sneakily convert their children into socialists or collectivists. Others suspect that the medical establishment (as supported by the schools) is being run by pharmacological interests and surgery clinics for the financial benefit of stockholders in those industries.

There are many other objections to the system of public schools. One bunch of critics says:

Two aspects of the “whole child” agenda go together. The first is the push to rely on medical intervention over lifestyle changes and counseling. The second is the willingness to take decision-making power from parents and give it to unelected, unaccountable administrators.

AAP’s report on child obesity focuses on medical interventions and school-based care. Moreover, they are careful to mention the supportive, not primary, role of parents.

When it comes to effective “whole-child” healthcare, the parents are relegated to fourth place.

In any case, and regardless of where the suspicion originates, unease over the consent factor provides a very strong argument for treating the underlying cause of a child’s problem, rather than attempting to merely eliminate the symptoms. Because mistakes can be made, and serious consequences can occur regardless of the technical legality of whatever consent has been obtained.

Dr. Danielle P. Burton wrote,

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: “Forget Parents, Here’s What This “Whole Child” Ideology Really Promotes,” Heritage.org, 03/13/23
Source: “The Hidden Danger in the AAP’s New Obesity Guidelines,” PsychologyToday.com, 03/04/23
Image by Caitlin Childs/CC BY-SA 2.0

Guidelines, Quibbles and Quirks — Part 6

In the debates over the January news from the American Academy of Pediatrics, some serious points of contention exist. It is not enough that certain physical benchmarks be checked off the list to make major surgery permissible. Certain other factors need to be in place also, like the patient’s fully informed consent.

As things stand, 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. Water aspiration and rapid exsanguination are examples of life-threatening situations, where the response must be swift and decisive, so legal niceties can be put aside.

How is this different?

The argument is made that morbid obesity is also a life-threatening condition, only on a longer timescale. But does that make it acceptable for adults, even parents or legal guardians, to step in and authorize the almost-total removal of an irreplaceable major organ?

If a child is born with an orofacial cleft, parental permission is enough to proceed with reconstruction, and no one has a problem with that. Irreversible surgery on a minor child happens every day in the case of routine neonatal circumcision, for which there is much less justification than for what used to be called a harelip. However, surgery without the patient’s fully informed consent does raise some ethical questions.

Currently, law enforcement officers may capture and confine a person who intends and prepares to take their own life. Some individuals fear a nightmare scenario where the authorities could just take anyone into custody and remove most of their stomach for that person’s own good. Even among advocates of bariatric surgery for the young, many of those who theoretically approve would like to see more forethought exercised on a case-by-case basis.

How far is too far?

We mentioned Medical Students for Size Inclusivity, whose spokesperson Jessica Mui also wrote of the absurdity of expecting adolescents to “risk their lives and well-being in an attempt to make their bodies smaller”:

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.”

(To be continued…)

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
Image by Photo by Jason Rosewell on Unsplash

Guidelines, Quibbles and Quirks — Part 5

Some things never change. There is very little likelihood that the United States will ever adopt the metric system for general use. Blue jeans will always be in style. And probably, the Body Mass Index will continue to be how the establishment decides whether or not a human is fat.

The BMI standard has always been controversial. Dr. Danielle P. Burton recently called it an antiquated system and explained,

BMI was never intended to be used as a measurement for health, and our current growth charts are based on data from the 1960s through the early 1990s. Are these outdated measurements truly the best measure of health?

A widely-held position is that obesity should not be determined by a lone data point, but by an array of them. Most things in life are on a spectrum, and ideal body weight is no exception. Gyms are full of living proof there is no exact cutoff point between fitness and the shame of being unacceptably big. A desperate need is felt for the culture to at least admit the possibility that size diversity and health could co-exist. When surgery is recommended, especially for kids, there is a hunger for evaluations that include the patient’s mental health status.

Stirring the pot

Meanwhile, policies uttered by the American Academy of Pediatrics at the beginning of this year focused intense attention on BMI once again. One expert who reacted is Dr. Kim Dennis, co-founder and medical officer at SunCloud Health, who says,

I think we do more harm than good when we […] say, ‘Based on the fact that your BMI is, you know, 28 or 30, you have a disease. By pushing people to get into this normal weight range, we’re only causing eating disorder behaviors.

It is no wonder that the recent news has been met with questions, concern, and outrage from practitioners and parents alike. Childhood Obesity News explored the concept of iatrogenesis. Many critics have mentioned ways in which the ideas could be dangerous for kids:

[T]he AAP released guidelines that recommend actions that are known top risk factors for eating disorders with almost no reference to how discussing weight and BMI can increase eating disorder risk. It is not helpful to reduce the number of children with obesity if they are driven toward the top risk factors for the second most deadly mental health illness.

Speaking on behalf of the grassroots advocacy organization Medical Students for Size Inclusivity, Jessica Mui noted that by focusing on the “flawed tool” of BMI, the AAP guidelines “are based on science that grossly misrepresents the complex relationship between weight and health.” To insist that weight loss is the chief measure of health is to “further stigmatize the bodies of children whose environments are likely already rampant with weight bias.” Mui adds,

The evidence remains elusive as to whether increased BMI alone is causative of increased morbidity and mortality. This outdated tool does not consider genetic, ethnic, and epigenetic variation or significant factors like poverty, racism, trauma, environment, chronic stress, and weight stigma, all of which negatively affect health outcomes in and of themselves.

When surgery is considered, a high BMI is what is known in logic as a necessary condition, but not a sufficient condition. In other words, a big number signifies that a person is obese enough to be medically qualified for bariatric surgery, but that alone is not enough. In making the recommendation, weight is just one factor, and needs to be regarded in the context of total health.

Your responses and feedback are welcome!

Source: “The Hidden Danger in the AAP’s New Obesity Guidelines,” PsychologyToday.com, 03/04/23
Source: “Eating disorder specialists ‘horrified’ by child obesity guidelines,” ScrippsNews.com, 03/07/23
Source: “The AAP’s new childhood obesity guidelines are dangerous. Here’s what to do,” Inergency.com, 03/01/23
Source: “Size-inclusive medicine: a response to AAP’s guidelines for the treatment of children and adolescents with obesity,” KevinMD.com, 03/01/23
Image by Ambuj Saxena/CC BY 2.0

AAP Guidelines — The Backlash Grows, Part 10

The childhood obesity world is still feeling the repercussions of how the American Academy of Pediatrics greeted the new year by releasing new guidelines that inspired reactions like this one from Dr. Catherine Devlin:

I am horrified, alarmed and concerned… First of all, I think that these guidelines need to just be completely thrown out.

The founder of Birch Tree Psychotherapy is not the only expert whose feeling could be described as outrage. Among other specifics, Dr. Devlin points out that the regimen demanded after bariatric surgery (and for the remainder of life) is very difficult for adults, and for children and teens, strict adherence must be closer to “a nightmare.”

Journalist Meg Hilling also consulted eating disorder specialist Nooshin Kiankhooy, whom we have previously quoted on the matter of inadequate evaluations before recommending surgery. This is not the only potential damage, says the founder of Empowering You. Kiankhooy told the reporter,

I have had some clients that have been put on diets at very, very young ages. Then they come to my office 10, 15 years later because they are put on weight loss at the age of 12, or they went to some clinic at a local hospital where they were told that carbs were bad.

Some authorities are even rehashing earlier controversies, like when the American Medical Association, a decade ago, recognized obesity as a disease, or further back when the National Institutes of Health said, “Obesity is a complex multifactorial chronic disease.”

There are reasons, like eligibility for insurance coverage, why this is good. But on the other hand, points out Dr. Kim Davis, some kids are being made to feel as if they themselves are a disease, and this is massively counterproductive.

In an interview with Pharmacy Times, Sheldon Litwin, M.D., pointed out, as so many have, that there is not much data on the use of weight-loss drugs on children and adolescents, since “we’ve only been using them really for 5 to 10 years, and the high potency ones probably about 5 years or so.” On the other hand, incretin mimetic drugs appear to be safe because they are analogs of naturally occurring hormones.

“It’s not really something exogenous, it’s just giving you a pharmacologic type of effect as opposed to a physiologic dose.” On the third hand, the same could be said of cannabinoids, which are naturally produced by the human brain, and yet many people are serving time in penal institutions for using plant-derived versions of them.

Your responses and feedback are welcome!

Source: “Eating disorder specialists ‘horrified’ by child obesity guidelines,” ScrippsNews.com, 03/07/23
Source: “Regarding Obesity as a Disease: Evolving Policies and Their Implications,” NIH.gov, 09/01/17
Source: “Expert: Risks, Benefits Must be Considered When Using Potent Anti-Obesity Drugs in Youth,” PharmacyTimes.com, 03/10/23

AAP Guidelines — The Backlash Grows, Part 9

We left off by talking about Body Mass Index and the significance thereof. In 1972, BMI had been deemed the best measurement method. In 1985, the U.S. National Institutes of Health concurred, and in 1997 the World Health Organization did too. What could be wrong with any of that? Well, apparently, BMI measurement does not distinguish between fat and muscle, which are, after all, two very different substances. Also,

BMI can also underestimate the threat for people who are “skinny fat,” as some doctors call those who tend to be fit, but have big bellies. Studies show that this belly fat can be more dangerous for health than any other kind.

The BMI measurements used for children are weighted for age, but when boys go through puberty, they add muscle at a rapid rate; girls add fat. BMI tends to miss these nuances.

And this is no small matter: More accurate methods are too costly for general use.

Jessica Mui reports that the grassroots advocacy organization Medical Students for Size Inclusivity believed that…

The AAP guidelines intensify the focus on BMI and weight loss as measures of overall health and further stigmatize the bodies of children whose environments are likely already rampant with weight bias. As a result of these guidelines, children will learn that their bodies are a pathology… The new AAP guidelines are based on science that grossly misrepresents the complex relationship between weight and health.

Mui pointed out that dieting and a poor self-image are known risk factors in the eating disorder realm, and labeled BMI measurement a “flawed tool.” Not only that, but nobody was absolutely positive that BMI alone causes greater morbidity and mortality. Furthermore,

This outdated tool does not consider genetic, ethnic, and epigenetic variation or significant factors like poverty, racism, trauma, environment, chronic stress, and weight stigma, all of which negatively affect health outcomes in and of themselves.

When surgery is considered, a high BMI is what is known in logic as a necessary condition, but not a sufficient condition. In other words, a big number signifies that a person is obese enough to be medically qualified for bariatric surgery, but that alone is not enough. This year, the recently issued guidelines were met with questions, concern, and outrage by practitioners and parents alike. We have spoken here of iatrogenesis, and this article brings up two reasons why the guidelines are dangerous for children:

The AAP released guidelines that recommend actions that are known top risk factors for eating disorders with almost no reference to how discussing weight and BMI can increase eating disorder risk. It is not helpful to reduce the number of children with obesity if they are driven toward the top risk factors for the second most deadly mental health illness.

Another source confirmed that BMI was never intended to be used as a measurement for health. Weight can be a helpful data point, but it needs to be evaluated in the context of overall health.

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 AAP’s new childhood obesity guidelines are dangerous. Here’s what to do,” Inergency.com, 03/01/23
Source: “The Hidden Danger in the AAP’s New Obesity Guidelines,” PsychologyToday.com, 03/04/23
Image by A Quiverful of Fotos/CC BY 2.0

AAP Guidelines — The Backlash Grows, Part 8

Body Mass Index measurement has been a bone of contention in many debates. More than 10 years ago, a study of nearly 15,000 young people led the British publication mirror.co.uk to print,

Health experts said yesterday that using Body Mass Index to calculate whether youngsters are obese is unreliable, especially for girls.

A 2013 article revealed this nugget:

Investigators […] analyzed data on people whose BMI and waist-to-height ratio were measured during the 1980s, looking at death rates a generation later… [T]hey found waist-to-height ratio was a better predictor of life expectancy.

In 2014, blogger Rodney Steadman wrote,

The BMI has become a big problem for some researchers… BMI does not accurately measure body fat in individuals with a high level of lean body mass (body weight minus the fat) and some ethnic groups. Furthermore, the BMI can be difficult to calculate in field settings when body weight cannot be accurately measured.

Meanwhile, parents who just did not like the whole idea argued with schools, and some questioned the ultimate usefulness of BMI information. As TorontoSun.com described in 2015, cultural factors were involved:

[…] BMI information alone may not be enough to help parents in high poverty areas where fresh produce and safe playgrounds to encourage exercise may not be available.

Around the same time, a study found that BMI measurement failed to identify “as many as 25% of children, age 4 to 18 years, who have excess body fat.” The Mayo Clinic’s director of preventive cardiology, Francisco Lopez-Jimenez, said, “BMI is not capturing everybody who needs to be labeled as obese.”

He also said, “That’s because it does have real limitations.”

Your responses and feedback are welcome!

Source: “What is Food Addiction?,” AnonymousOne.com
Source: “Hidden danger: UK’s childhood obesity could be worse than feared,” Mirror.co.uk, 06/18/12
Source: “Is BMI Outdated?,” MedicalDaily.com, 05/14/13
Source: “Absurd, but True?,” WordPress.com, 07/15/14
Source: “Screening teens for obesity may not help them lose weight,” TorontoSun.com, 07/03/15
Source: “Obesity Is Undercounted in Children, Study Finds,” WSJ, 06/23/14
Source: “Calling BS on BMI: How can we tell how fat we are?,” GantDaily.com, 08/16/17
Image by Todd Huffman/CC BY 2.0

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

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