Everything You Know About Fussy Eating Is Wrong

What is a fussy eater? One who consumes only a limited range of foods, and has a tendency to avoid newly introduced ones. This might also be called picky, faddy, choosy, or selective eating. Spoiler alert:

It is largely a phenomenon of developed countries and involves a complex set of interactions between parents/carers and children… There is no agreement on a formal definition of picky eating…

To add further complication, there are a variety of tools used for the assessment of picky eating and consequently there is a wide range of prevalence reported. The ’causes’ and ‘consequences’ of picky eating are not well understood because of these inconsistencies and because of heterogeneity in study designs.

There is evidence that the child’s diet helps to form its microbiome, and also evidence that the microbiome helps to form the diet — in other words, that the gut bugs are telling the child to consume what they prefer and to reject what they don’t want:

Sugar/carb obsession and going alarmingly long periods between meals are two big clues picky eating is gut-related.

There are theories about how when a baby is delivered by C-section, rather than being covered with its mother’s native micro-organisms, it picks up bugs from random hospital personnel, which colonize its gut and which may express different food preferences than the parents — hence, “picky eater.”

In Australia, as in the U.S., fussy eating is seen as a problem, and with good reason. Parents who are on board with the idea of feeding their kids vegetables and whatever else they deem healthy are frustrated by babies who refuse to eat the good stuff. According to Dr. Georgie Russell of the Centre for Advanced Sensory Science, between 13% and 50% of children are fussy eaters at some point. Mostly the problem affects kids of preschool age, but some continue until around age 10.

Of course, when the teen years are reached, young people can get away with being fussy eaters because they are not so closely monitored, and for the rest of their lives, adults can be as picky as they please and even, like James Bond, demand that their martinis be shaken, not stirred. Dr. Russell is quoted as saying,

Fussier children also tend not to enjoy eating, they eat slowly and tend to get full up quickly.

One might wonder why these two traits are considered problematic. After all, when people look into ideas about how to lose weight, they are specifically instructed to eat slowly and to consciously savor their food with every bite. Many people do find that when they really take the time and focus their attention, they tend to eat less overall. And feeling full quickly, isn’t that a good outcome? The hottest weight-loss drugs are effective because they help create a sensation of fullness.

So, this is confusing.

Your responses and feedback are welcome!

Source: “Picky eating in children: causes and consequences,” NIH.gov, 11/05/18
Source: “Quick Change Tastebuds, Slow Biology, & Why Gut Health May Impact Picky Eating,” KidsCookRealFood.com, 02/01/22
Source: “Deakin research to determine if fussy kids are touch sensitive,” MirageNews.com, 01/16/20
Image by Aaron Vowels/CC BY 2.0

Our Own Mouths Betray Us

In the previous post, we saw how babies arrive with an innate love of sweetness, which generally does not fade with age, but all too often grows more extreme. As the author Michael Moss points out, along with sweetness we also crave variety, so it is no surprise that a grocery store’s cereal aisle contains a couple of hundred permutations of grain-based, air-expanded, hyper-sweetened products with which to start our days.

The thing is, sugar is packed with calories, and evolution has taught us to associate calories with staving off death — even if, in truth, the individual already weighs 300 pounds. Our oldest impulses are based on very simple principles, like “fuel equals life.” Moss says,

We have sensors in the gut and possibly in the mouth that tell us how many calories we’re eating, and the more calories there are, the more excited the brain gets, which makes us vulnerable to the processed-food industry’s snacks, jam-packed as they are with a day’s worth of calories we can eat in one sitting.

We previously mentioned another work by Moss, The Extraordinary Science of Addictive Junk Food, wherein the author revealed that one fast-food company alone employed 500 chemists, technicians, and psychologists devoted to studying the crunchiness, mouth feel, and the perfect snapping point of a chip in order to get us to consume more of their hyper-processed pseudo-foods.

More dark magic

Moss also explained how we are hypnotized by a factor called vanishing caloric density, where if something melts quickly in the mouth, the brain does not register that it is actually fuel. Since, like the body, the brain needs fuel, it gives the okay to just keep eating that stuff all day long.

The book Salt Sugar Fat, which Moss published in 2013, spilled all the secrets about how clever chemists conspire to render us helpless before their products. The public became familiar with such erudite terms as “mouth feel” and “bliss point.” In another context, Moss wrote about the sneaky allure of a fat/sugar combination, saying,

I couldn’t resist drawing an analogy to the realm of narcotics. If sugar is the amphetamine of processed food ingredients, with its high-speed blunt assault on our brains, then fat is the opiate, a smooth operator whose effects are less obvious but no less powerful.

Fat, sugar, and salt all can influence the brain’s chemistry in the direction of overeating, says epidemiologist Dr. Adam Drewnowski, who directs the University of Washington’s Center for Obesity Research. To a recent textbook, Dr. Drewnowski contributed a chapter titled “Human Perceptions and Preferences for Fat-Rich Foods.” Jed Diamond says,

He found that eating foods that are high in fat content, particularly those that also were sweet and salty, stimulated the same brain centers as drugs like heroin. In fact, the same drugs that block the desire for heroin block the desire for fatty foods.

As Dr. Drewnowski noted, the generic drug naloxone, typically used to reverse an opiate overdose, can also suppress a person’s desire for opiates. In the same way, it can even reverse or suppress a person’s taste preference for sugar/fat mixtures.

This is interesting in light of the fact that just this week, the Food and Drug Administration okayed its sale (brand name Narcan) without a prescription. Will we now see droves of overweight people crowding the pharmacies in search of naloxone in hopes of squelching their food cravings?

Your responses and feedback are welcome!

Source: “Op-Ed: Big Food wants us addicted to junk food,” LATimes.com, 06/06/21
Source: “Are Fat, Sugar, and Salt the New Heroin, Meth, and Cocaine?” Medium.com, 09/22/20
Image by mroach/CC BY-SA 2.0

Babies With Bad Taste

That’s a pun of course — because can anyone who refuses to eat perfectly good vegetables be said to have good taste? Unfortunately, taste (in the oral sense) is entirely subjective. When it comes to addiction to food, or addiction to the act of eating, in many cases taste has a lot to do with it, and a certain amount of the problem is simply inborn.

Here are some words from Lisa Bodnar of the University of Pittsburgh Health Sciences:

I remember a decade ago sitting in front of my 9-month-old daughter […] trying to spoon-feed her a pureed green vegetable. It didn’t matter if it was peas, green beans or something else, because the outcome was the same: I spooned it into her mouth, and it came right back out.

Compare this with feeding her applesauce, for which she would open her mouth after each bite and almost bounce in her chair with pleasure. I nearly danced along with her. This was easier! Let’s just keep doing this!

But of course, for the conscientious adult, “Let’s just keep doing this” is not an option. While the sentiment is counterintuitive to us totally logical elders, some babies just don’t like the taste of fresh, pure, health-giving foods. No matter how devotedly a grownup mashes peas into a pulp, they are still peas.

And you can’t fool a kid by making a clownie face and going, “Mmmmmmmm, yum yum!” They know you are lying, and are insulted by your insistence that they deny the evidence of their own senses. After this, how can they ever trust you again?

A mystery

Unfortunately, some mean things are done to newborn babies in hospitals. A baby gets stuck in the heel to obtain blood for testing, and long ago a staff member noticed that the baby would cry less if some sugar water was dribbled into its mouth at the same time. Twenty years ago, Dr. Neal D. Barnard wrote,

As sugar touches the tongue, the taste buds send a nerve impulse to the brain, causing opiates to be released. In turn, these opiates trigger the release of dopamine, the brain’s ultimate pleasure chemical.

One might logically wonder, why does the child not then associate the sweet taste with being needle-pierced, and proceed into infancy adamantly opposed to sweetness? Why doesn’t the child hate sugar, instead of peas? And that is the insidious power of the substance. Desire for sugar can even overcome its association with the trauma of being stabbed. Or, later in life, can defeat sugar’s connection with weighing 300 pounds.

Knowledge has two faces

In Melbourne, the Deakin’s Center for Advanced Sensory Science did research to discover why about 50% of babies are so darn picky. Lead researcher Dr. Georgie Russell told the press about oral sensitivity, that “food texture, mouthfeel and fussiness are still quite unexplored.” Dr. Russell went on to say,

Depending on how a food is prepared, this can affect the texture. Children might like raw crunchy carrots, but not like them if they’re cooked until they’re soggy… We can also see this with preferences for processed foods with simple textures, compared with whole foods with more complex textures…

The sense of touch is an important one. It is our oldest, most primitive and pervasive sense yet we know little about the sense of touch in the mouth — as opposed to other parts of the body — and how this relates to our food choices and intakes.

The team’s mission was to help the frustrated parents of fussy eaters and to figure out how to raise kids who like healthful foods — but of course, anything learned in this field will inevitably also benefit the evil geniuses who invent junk food.

Your responses and feedback are welcome!

Source: “Why kids shouldn’t eat added sugar before they turn 2,” TheConversation.com, 01/07/22
Source: “The Food Fix Is In,” OrlandoSentinel.com, 07/13/03
Source: “Deakin research to determine if fussy kids are touch sensitive,” MirageNews.com, 01/16/20
Image by James Willcox/CC BY-SA 2.0

Where Serenity Is Found

Is there a basic drive for serenity? There must be, because so many people look for it in drugs, including food, which if not technically a drug, sure knows how to act like one. Fortunately, serenity can be found in a lot of other places.

Several theoreticians in the behavioral field have compiled lists of basic drives, some of which could easily be interpreted as identical to a drive for serenity. If there are only three drives, one of them is for achievement, and what is achievement really, but the serenity that comes from knowing that one has done one’s best, and succeeded?

What is serenity but the absence of stress? Serenity is the opposite of stress, which is the feeling that people who overdrink, overdrug, overeat, or do anything else past the threshold of addiction, are trying to escape. If there are only four basic drives — fight, flight, feeding, and sex — the satisfaction of any one of them brings the peace of mind that comes from knowing that the enemy has been routed or defeated; the enemy has been escaped from; the stomach has been fed; the body has been satisfied. Serenity all the way around.

This blog has devoted so much attention to the efforts and successes of Reeling in Serenity because it is an excellent example of the efficacy of displacement activity. When a person has been brought low by addiction, in many cases displacement is about finding a thing to occupy the person’s mind, energies, time, and spirit in more healthful and satisfactory ways.

Fly fishing is a particular example, and the people who are into it testify that it matches up with recovery in a number of ways. (The magic here is that in other recovering addicts’ stories, something else, like music, cooking, engine repair, or a newly discovered devotion to family, can step in to satisfy whatever drive the drug was erroneously taken to serve.

How exactly does this help?

As it turns out, fly fishing is therapeutic in multiple ways that a recovering addict can benefit from. For instance, 12-step programs all say “Take it one day at a time.” That is all well and good, but what, exactly, is a person supposed to do on those days — other than abstain from their substance of choice?

For a fly fisher, there is plenty to do. Teach the newbies how to cast a line or tie flies or pick out the most useful clothing and gear. Work with an organization to keep the water clean. Help to bring in donations so free lessons and group retreats can continue to be offered. In their special field of interest, a person with a passion can change a sizable chunk of the world.

One anonymous woman in recovery wrote that because fly fishing required mental focus, it became a healthy escape. Rather than worry about things she could not control, she worked on developing fishing strategies, and realized how compatible that was with her 12-step program.

Various members of Reeling in Serenity and similar organizations testify to the peace of feeling like a part of nature, of feeling grounded. They speak of healing, community, the breaking of isolation barriers, escape from the mundane routine, safety, a reset of mind and soul, a recharging of energy, and a new sense of perspective.

They speak of better sleep, decreased anxiety, and improved physical well-being; of connection, and building other people up instead of tearing them down; of feeling the river wash away, bit by bit, the residual shame and guilt left over from their times of active addiction. According to the people who know, it works equally well for the newly sober and for those who have been on the path for many years.

Your responses and feedback are welcome!

Image by Roxnstix/CC BY-ND 2.0

The Profound Healing of Serenity

Here is a brief and partial explanation of why fly fishing helps people get better:

When we are close to moving water it creates an abundance of negative ions that we can absorb into our systems by proximity. These natural stimulating environments automatically up your serotonin levels, you absorb more oxygen into the blood and our bodies can better filter toxins.

In a previous post, we learned the story of Reeling in Serenity founder Becca Sue Klein, and now let’s go a little further back to when she was Becca K. Powell, writing for DunMagazine.com. Spending time with moving water had already earned her “a reprieve from the hustle and bustle of a hectic city life and the strength to get through two cancer diagnoses.”

In that era of life, she was serving as a senior staff member for the nonprofit Chattahoochee Riverkeeper, learning the truth of the slogan #WaterIsLife, and also working with the global organization called Waterkeeper Alliance, and fly fishing. Learning this new skill was empowering and served as “free therapy,” and she wrote:

Wading out into the water with my fly rod in hand has shown me strength, peace, freedom, a way to give back, and a beautiful new family.

A related memoir

Moshe Kasher shares a truth about his youthful Comedy Store performances. Upset by bombing onstage, he would spend his half-hour trip home texting one girl after another, trying for a late date. As the veteran of several teenage rehab stints, Kasher understood that he was acting out the emotional state called “Somebody please fix me — get me out of this…” If he was almost home and nobody had answered yet, he would stop and buy a fancy doughnut. And there it is, displacement. You can’t have one thing, so you settle for another.

Nobody starts out wanting to be a junkie. Addiction is a condition that someone settles for when they don’t have what they really want. The concept of displacement can work either way; it can also be a power for good. A person can find something else in life that is better than addiction, and repurpose their drive to experience one kind of pleasure into a drive to experience another kind of pleasure.

Poetic justice

This is what makes the Reeling in Serenity experience so cherished by the participants. They are people who found something better than whatever they used to be hooked on. Anglers, more often than not, are just in it for sport, not to feed themselves, so they catch and release. They unhook the fish and let it go, similar to how their Higher Power unhooks them and frees them from addiction.

Your responses and feedback are welcome!

Source: “How Water’s Negative Ions Increase Your Positive Vibes,” TherapyHealthStudio.com, 02/25/19
Source: “One Life One River,” DunMagazine.com 07/20/18
Source: “Moshe Kasher — Episode 938,” GregFitzsimmons.com, 01/04/22
Image by Korda Team/CC BY 2.0

More About Reeling in Serenity

Why are the premises of and the results obtained by Reeling in Serenity so phenomenal? As we have seen, the organization’s mission is to support individuals who are in recovery from addiction, through the peace, healing, and community that are to be found through fly fishing in the rivers of the nation and the world. Yesterday we went over the backstory of Founder and Executive Director Becca Sue Klein. Let’s hear from some of the others responsible for this wonderful nonprofit group.

Board member Jason Causey, who has accumulated more than 10 years of sobriety, says,

When you’re out there in nature listening to the water run by and someone is teaching you how to cast a fly line and you hook that first fish, I mean there’s just nothing like it. You’ve forgotten about every bad thing that has happened to you that day or that week.

Program Director Jennifer Gilbert detailed for the group’s website how, when she entered rehab in 2017, fly fishing helped her connect to her higher power. It is her hope that every newcomer in recovery will find the same peace and joy. Outreach Director Sylvia Huron also asserts that recovery and fly fishing go hand in hand. She says she has learned that the dedication required to become a better angler and the commitment needed for leaving addiction behind are mutually intertwined, as are the support and companionship found in the group.

Communications Director Georgia Skuza confides that “the addiction gene runs deep in my family” and affirms that fly fishing has been a vital part of her life and her healing journey. William Henry, Education Program Coordinator, describes how important it is to be actively engaged with nature and writes,

That connection, that mindful presence has been essential to maintaining my sobriety since 2007. It drives me to be grateful and take care of myself, and the environment. Volunteering for Reeling in Serenity allows me to combine all my passions and give back to my sober community, without whom I would not have the life I do today.

Social Media Advisor Erik Clymore had spent his first five recovery years “bouncing around from hobby to hobby trying to find my passion in life” until he discovered fly fishing, after which “everything clicked and I dove straight in.” Since then, recovery and angling have been his dual passions. He says, “Both recovery and fly fishing provide me with a loving community, appreciation for the little things, and a profound sense of purpose.”

Marketing and PR Advisor Kim Ranalla was already into the angling lifestyle because multiple serious injuries had led her to river fishing as a way of healing. She had, coincidentally, also been affected by the ravages of addiction in loved ones, and found that Reeling in Serenity provided “a pathway for me to process my own complicated grief by helping others along their healing journey.” As a volunteer, she wrote,

The organization is significant to me after losing loved ones in my life to addiction. Addiction has touched the lives of nearly everyone, in one way or another, making it a cause that I want to be behind.

Not impressed with what the market offered, she started a thriving business called Miss Mayfly, which produces a line of fishing gear products for women of all shapes and sizes. She says,

Fly fishing is an ideal conduit for physical, mental and spiritual healing. It requires a focus that helps distract from physical pain and emotional stressors, helping us to experience a deeper level of peace and calmness.

Your responses and feedback are welcome!

Source: “How fly fishing in PA will help people recovering from substance abuse,” GoErie.com, 02/07/23
Source: “Meet Our Team,” ReelingInSerenity.org, undated
Source: “Women Who Make a Difference,” MissMayfly.com, 09/08/22
Image by US Embassy London/CC BY-ND 2.0

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

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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:

Presentations

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