Guidelines Backlash, the Biggies — Access and Cost, Part 1

As previously mentioned, intensive health behavior lifestyle treatment (IHBLT) is on record as the best evidence-based treatment to prevent or reverse childhood obesity. Claire McCarthy, M.D., wrote,

This involves face-to-face, family-based, multidisciplinary counseling on nutrition and physical activity, preferably based in your community and connected to community resources. To make a difference, it should involve at least 26 hours over at least three to 12 months. These programs, unfortunately, are not easily available to most families.

There is, obviously, the expense. The staff of an adequately equipped pediatric obesity facility needs to include “pediatricians, endocrinologists, hepatologists, surgeons, social workers, psychologists, fitness experts and nutritionists.”

Such opulent medical centers exist mostly in large cities, and they are sought out by so many hundreds or thousands of patients that the wait time for an appointment can be quite long. The keeping of appointments may involve parents missing work, as well as expenses for travel, parking, eating, and maybe even staying overnight. For many families, this is not an enterprise that can be undertaken lightly.

Deep pockets required

Dr. Jessica Madden specializes in pediatrics, neonatology, and lactation, and has a strong interest in childhood obesity. Christopher Curley wrote of her,

She noted that interventions such as IHBLT require a significant time commitment… One major barrier to implementing IHBLT is the cost. Who is expected to pay for the cost of these programs? Are they (or will they be) covered by insurance, grants, or are families expected to cover the cost?

Aside from figuring out the logistics, and meeting the cost of transportation and the like, there is the issue of motivation. Attending 26 therapy hours over three to 12 months is a project that requires real persistence. So why not choose medication instead? It is no wonder that handing out pills simply seems more efficient and pragmatic. Dr. Nazrat Mirza, a co-author of the new AAP guidelines, told journalist Sara Monetta:

Just like asthma, just like hypertension… In hypertension you would tell somebody to cut salt, but then the blood pressure is still high, so you’re still going to give them medication.

Your responses and feedback are welcome!

Source: “New pediatric guidelines on obesity in children and teens,” Harvard.edu, 01/24/23
Source: “Criticism Emerges Over New AAP Guidelines for Childhood Obesity,” Healthline.com, 01/20/23
Source: “New US childhood obesity guidelines criticised by families,” BBC.com, 01/29/23
Image by Pictures of Money/CC BY 2.0

AAP Guidelines and Backlash, Part 9

When people praise the new AAP guidelines they often say, “Effective treatment, in the form of drugs or surgery, is available. So, why not opt for one of those methods?” Of similar mind is pediatric surgeon Ann O’Connor of the San Antonio Children’s Hospital, who is quoted as saying, “One of the things we know for sure is that as children with obesity get older, they get bigger and bigger and sicker and sicker, and their medical problems get worse.”

Among other possible outcomes of waiting, there is lifelong chronic illness. Endocrinologist Grace Kim (Seattle Children’s Hospital) warns that while it may take a decade for an adult to progress from prediabetes to diabetes, this can happen to a child in as short a time as two years.

Journalist Christopher Curley has pointed out that an increasing number of professionals now have a fundamentally different view of obesity, tending more to regard it as “a chronic, refractory, relapsing disease,” meaning that a wait-and-see approach cannot be satisfactory.

Uncomfortable truths

Dr. Jennifer Woo Baidal of Columbia University reminds us that bias is one of the prominent factors that prevent progress, especially when bias refuses to recognize that obesity is a very complex problem. This is true of professionals and laypersons alike. Dr. Baidal told the press:

Many people think children can just lose weight on their own, but it’s hard to make changes if there is limited access to affordable, healthy food and exercise. I think the guidance calls this out and gives support and instruction for providers on how to handle those factors.

Writer Catherine Pearson quoted Prof. Rebecca Puhl, deputy director of the Rudd Center for Food Policy and Health at the University of Connecticut, who said, “Physicians are not immune to societal weight bias that is prevalent in our culture… Weight bias is rarely, if ever, addressed in medical school training.”

Jason Wachob of MindBodyGreen.com writes that he is not against surgery or medication, but suggests that before considering either of those routes, the medical team should be totally convinced that the less intrusive possibilities for lifestyle modification have been exhausted. He mentions a thing that some find strange, that the AAP’s new recommendations were released before the same institution’s statement on obesity prevention, and adds:

While we need to act urgently to treat the mounting childhood obesity epidemic in this country, I think the order of these two publications is telling. The medical system is taking drastic measures to “treat” the signs of an issue before fully considering its root cause.

Wachob quotes family medicine physician Bindiya Gandhi, M.D., who reiterates that before considering bariatric surgery on pediatric patients, many other interventions can and should be utilized. According to this worldview, particular attention should be paid to eliminating sugar and hyper-processed foods, and to encouraging a meaningful amount of physical activity.

Also quoted is family physician Madiha Saeed, M.D., who confirms what has been known or suspected all along: “I was taught no nutrition and almost no lifestyle strategies to aid my patient care.” Dr. Saeed believes that more resources should be devoted to weight management education, and characterizes the new recommendations as “horrifying.”

Your responses and feedback are welcome!

Source: “Criticism Emerges Over New AAP Guidelines for Childhood Obesity,” Healthline.com, 01/20/23
Source: “What Parents and Caregivers Need to Know,” NYP.org, undated
Source: “New Guidelines Underscore How Complicated Childhood Obesity Is for Patients and Providers,” NYTimes.com, 01/20/23
Source: “The New AAP Childhood Obesity Guidelines Are Setting Kids Up To Fail,” MindBodyGreen.com, 01/17/23
Image by Jernej Furman/CC BY 2.0

AAP Guidelines and Backlash, Part 8

The previous post discussed the major changes that are meant to be implemented in the treatment of childhood obesity, and which the American Academy of Pediatrics will encourage, going forward. Yet, there is more to the story, and an apparent enthusiasm in some quarters for further policy adjustments. Concerning the standard by which obesity is measured, the individual’s Body Mass Index, problems have been evident for quite some time.

Very close to the date when the AAP released its controversial new guidelines to prevent and cure childhood obesity, the Centers for Disease Control released updated growth charts. Reporting for media giant CNN, journalists Jamie Gumbrecht and Jacqueline Howard explained that those charts are…

[…] standardized tools used by health care providers to track growth from infancy through adolescence. But as obesity and severe obesity became more prevalent in the past 40 years… the charts hadn’t kept up. The newly extended percentiles incorporate more recent data and provide a way to monitor and visualize very high body mass index values.

Apparently, the extended growth charts will be used by providers who treat severely obese children, but meanwhile, the previous child and adolescent charts will not change. Has anyone interviewed a mathematician about whether the basic formulae are solid? As journalist Catherine Pearson has pointed out, reliance on the Body Mass Index standard is increasingly problematic as a measure of metabolic health, relying as it does on arbitrary number scores alone.

Not getting the message?

Are some healthcare providers misinterpreting the new guidelines, willfully or unwittingly? Are some members of the public spreading misleading or ignorant commentaries just to be contrary? Who knows? Users of social sites like Facebook and Twitter have noticed some of their fellow communicators complaining that the AAP guidance ignores the vast harm done by junk food. Another wrinkle that health professionals have noticed is the layperson’s tendency to blur the line between extra poundage and morbid obesity, which complicates the debate even more.

Time is not on our side

Regarding the previously endorsed “watchful waiting” philosophy, more and more experts point out that we do not have all the time in the world, because once obesity has taken hold of a person, the window for potential reversal is a narrow one. A typical warning comes from obesity specialist Matt Haemer of Children’s Hospital, Colorado. He mentions that despite good-faith efforts to make positive lifestyle changes, 80 to 90 percent of child obesity cases persist into adulthood.

(To be continued…)

Your responses and feedback are welcome!

Source: “Updated obesity treatment guidelines for children and teens include medications, surgery for some young people,” CNN.com, 01/11/23
Source: “New Guidelines Underscore How Complicated Childhood Obesity Is for Patients and Providers,” NYTimes.com, 01/20/23
Source: “Aggressive treatment guidelines for childhood obesity getting backlash,” WashingtonPost.com, 01/20/23
Image by Bilal Lashari/CC BY 2.0

AAP Guidelines and Backlash, Part 7

As the previous post mentioned, although many parents and health practitioners prefer working with the diet plus exercise method of controlling childhood obesity, official policies will now support that model to a much lesser extent.

As Gina Kolata reported for The New York Times, some major research projects have been less than encouraging. Back in the 1990s, the National Institutes of Health sponsored two very sizable and careful studies. Could weight gain in children be prevented at school, through the expansion of physical education programs? How about cafeteria meals designed to be more nutritious?

What if students were taught more intensively about good eating and lots of exercise? What if parents were also brought into the picture? Kolata writes,

One study, an eight-year, $20 million project sponsored by the National Heart, Lung and Blood Institute, followed 1,704 third graders in 41 elementary schools in the Southwest… Some schools got intensive intervention, while others were left alone.

In the intervention schools, students changed their eating habits to include slightly less fat, but not much else happened. The investigators had to regretfully declare that body weights had not noticeably shrunk. However, there still is no universal agreement on the failure of diet and exercise. Kolata’s article also included some paragraphs that cast a shadow over the controversial new AAP proposals:

It takes years for doctors to start using new guidelines, noted Dr. Louis Aronne, an obesity medicine specialist at Weill Cornell Medicine in New York. “The ones for adult obesity have never really been adhered to,” he noted. “Adults with obesity are already advised to get surgery or drug treatment, but just 2 percent ever do.”

For The Washington Post, Ariana Eunjung Cha listed the three most important new guideline concepts that the public is meant to grasp:

1. Obesity is a chronic medical condition, not primarily a consequence of lifestyle choices.
2. Medications are a tool that can be used in children 12 and older in a safe manner. Bariatric surgery can also be considered for severe obesity in children 13 and older.
3. More must be done to ensure access to treatments for all children who need them.

Many health professionals and laypersons would prefer to stick with emphasizing healthy eating and increased exercise, ideas which although now relegated to an inferior position, are not entirely abandoned. The new guidelines still include them in the preferred method of first resort, known as Intensive Health Behavior Lifestyle Treatment, or IHBLT.

As summarized by Claire McCarthy, M.D.:

This involves face-to-face, family-based, multidisciplinary counseling on nutrition and physical activity, preferably based in your community and connected to community resources. To make a difference, it should involve at least 26 hours over at least three to 12 months.

This will be discussed further.

(To be continued…)

Your responses and feedback are welcome!

Source: “Why Experts Are Urging Swifter Treatment for Children With Obesity,” NYTimes.com, 01/27/23
Source: “What you need to know about the new childhood obesity guidelines,” WashingtonPost.com, 01/20/23
Source: “New pediatric guidelines on obesity in children and teens,” Harvard.edu, 01/24/23
Image by U.S. Dept of Agriculture/Public Domain

AAP Guidelines and Backlash, Part 6

Childhood Obesity News has discussed many of the infamous co-morbidities associated with child obesity. The truly alarming news is that they currently occur at much younger ages.

To counter that trend, every once in a while there is a major development. The National Institutes of Health designated obesity as a chronic illness in 1998. In 2013, the American Medical Association deemed obesity a disease. In 2007, the American Academy of Pediatrics issued a set of prevention and treatment guidelines, which were only updated last month.

For journalists, it is easy to summarize the updates, as Nina Shapiro has done:

The emphasis on the new guidelines is earlier intervention for children with obesity, with recommendations for children ages 6 to 12 years (and even younger in some situations) to receive behavior and lifestyle treatment. Children over age 12 years can be considered for pharmacotherapy in addition to behavioral therapy. And children ages 13 years and over whose BMI is 120% above the 95th percentile may be candidates for bariatric surgery.

The recent mini-revolution has attracted attention and criticism. The information in that medium-sized paragraph has lit fires all over the place. It is now feared that clinicians may tend to become too aggressive in the use of pharmaceuticals and surgery. Having researched the reactions of professionals from nutritionists to pediatricians, Shapiro wrote:

They emphasize that the focus should first and foremost be on increased education on the risks of high-sugar, highly processed foods. They state that increased physical activity, stress management and better education should obviate the need for medications or surgery. Unfortunately, we are not seeing improvements in these arenas; in fact, children are more sedentary and are eating less healthfully than in years past.

In some quarters, the perceived abandonment of the diet plus exercise paradigm is seen as not just giving up too easily, but actually courting failure. There is anxiety among parents who fear that the new suggestions will make people think the diet plus exercise approach should be forgotten.

For example, BBC News journalist Sara Monetta interviewed a mother who was distressed to learn that her 14-year-old daughter’s school planned to end Physical Education classes, during which young people get actual exercise, and replace them with a standard classroom health course. In contrast, young Jaelynn had taken part in a YMCA summer camp that included plenty of outdoor activity, and lost 12 pounds in three months. This also improved the chronic kidney disease from which she had suffered since childhood.

But people are being discouraged from this kind of optimistic thinking. The studies have been conducted, and the news has not been good.

(To be continued…)

Your responses and feedback are welcome!

Source: “New Guidelines On Childhood Obesity Are Met With Some Resistance,” Forbes.com, 01/17/23
Source: “New US childhood obesity guidelines criticised by families,” BBC.com, 01/29/23
Image by Mohd Fazlin Mohd Effendy Ooi/CC BY 2.0

AAP Guidelines and Backlash, Part 5

New York Times journalist Catherine Pearson wrote,

The American Academy of Pediatrics released new guidance last week about how to evaluate and treat children who are overweight or obese, issuing a 73-page document that argues obesity should no longer be stigmatized as simply the result of personal choices…

… Which kind of oversimplifies matters. Up to this moment in time, theoreticians and researchers have suggested over 100 possible causes of obesity, ranging from genetics to gut microbes to air pollution to electronic screens. Harvard’s Dr. Claire McCarthy set out some pertinent statistics:

Hovering around 5% in 1963 to 1965, rates of obesity had more than tripled to 19% by 2017 to 2019. Early data suggest childhood obesity rates continued climbing during the pandemic. If these trends continue, 57% of children currently ages 2 to 19 will have obesity as adults in 2050.

She makes the point that obesity is typically stigmatized as a personal choice issue, or if not precisely “choice,” at least a matter of individual responsibility, which is a hard sell when a baby pops out of the womb weighing 16 pounds. But as time goes on and evidence piles up, it may not be just bad eating habits, low-quality food, or lack of exercise. The factors that contribute to childhood obesity include genetic, physiologic, socio-economic, and environmental, among many other possibly more peripheral factors.

And each one is complicated. For instance,

Prenatal factors, such as maternal weight gain or gestational diabetes, increase risk before a child is even born. We are just beginning to understand genetic factors, many of which can be further affected by the child’s environment. There are ways that systemic racism and deeply embedded socioeconomic factors play a role.

At any rate, the AAP invested a lot of verbal energy in preparing the nation for its bombshell recommendations — drugs and bariatric surgery for teens and even children. The reaction to these two concepts has been clamorous. In the case of acceptable drugs, one is said to have helped adolescents reduce their Body Mass Index number by around 15%.

Another is said to age the face at the top of a newly-slimmed body, reminiscent of a quip attributed to Zsa Zsa Gabor: “After a certain age, a woman has to choose between her face and her fanny.” More will be said about these and other suggested pharmaceuticals. Among many other loud voices are those which insist that the pharmaceutical research to date is nowhere close to adequate.

Also, it seems that many professionals and members of the public have misunderstood the AAP’s intention, which is to recommend drugs and surgery as extreme measures to be taken only after serious lifestyle intervention has been tried. The organization has also acknowledged that some prejudice and stigmatization, unfortunately, come from doctors and other medical professionals. There is a belief that using gentler language will help, for instance not saying “obese child” but instead, “child with obesity.”

Maybe; maybe not. Pearson quotes adolescent medicine specialist Dr. Jason Nagata:

He has worked on studies showing that disordered eating behaviors like fasting or vomiting are common in children with obesity. Even if parents and doctors are careful to use person-first language and focus discussions on health, not weight, a child may only hear “you’re telling me I’m too fat, I need to lose weight,” he cautioned.

Your responses and feedback are welcome!

Source: “New Guidelines Underscore How Complicated Childhood Obesity Is for Patients and Providers,” NYTimes.com, 01/20/23
Source: “New pediatric guidelines on obesity in children and teens.” harvard.edu, 01/24/23
Image by Howard Lake/CC BY-SA 2.0

AAP Guidelines and Backlash, Part 4

In the past few weeks the new anti-obesity guidelines issued by the American Academy of Pediatrics, revised for the first time in 15 years, have caused quite a flurry. Previous posts have discussed some of the angles, but the worst is yet to come.

Background: Contrary to long-held hopes, young people rarely “outgrow” childhood obesity, but rather just bring it along into their adolescence, where it coexists with such typical problems as skin eruptions, sexual anxiety, and academic challenges. Then, they simply carry the excess weight into adulthood, along with a whole array of new physical, social and emotional issues.

One doctor’s view

Dr. Sarah Armstrong is the AAP’s obesity section chairperson, as well as a Duke University professor of pediatrics. We have already referenced some of the information that journalist Caroline Kee obtained by interviewing her, and there is more to say. Dr. Armstrong recommends a “whole child” approach and believes that parents and healthcare professionals should no longer wait for the situation to worsen because the overwhelming odds are that both obesity and co-morbidities will increase over time. With longevity, every problem becomes more difficult to treat.

Starting at age six, the at-risk child should receive at least a year of intensive treatment, including face-to-face counseling and lifestyle modification training. If no progress is made, patients in their teens, or approaching their teens — or even younger — might reasonably be prescribed one of six weight-loss medications that have been deemed safe. Even then, pharmaceuticals should not be expected to take the place of lifestyle modifications. Whichever drug is chosen should be used simultaneously with the cultivation of good everyday, real-life habits.

Reinforcement

Also quoted is pediatrician Dr. Sarah Hampl, another co-author of the revised guidelines:

The evidence suggests that you should treat children as early as obesity is identified and with the highest available intensity of treatment that is appropriate, given their age and the severity of their obesity. Different risk factors influence a child’s weight, (including) things we can’t control, such as genetics.

But that is not all. After intensive case evaluation, weight-loss surgery is now seen as acceptable for individuals as young as 13. It took a 73-page report to introduce these new recommendations, which have been met with reactions ranging from disbelief to outrage. The AAP tried to soften the concepts and show them as reasonable and in many cases necessary.

New York Times journalist Catherine Pearson wrote that the organization…

[…] argues obesity should no longer be stigmatized as simply the result of personal choices, but understood as a complex disease with short- and long-term health implications… [T]here is no evidence to support delaying treatment for children with obesity in the hope that they will outgrow it.

This is very caring, but do others, including experts and parents, have more to say about all these ideas? You bet they do!

(To be continued…)

Your responses and feedback are welcome!

Source: “New AAP childhood obesity guidance includes medication, surgery: What parents should know,” Today.com, 01/11/23
Source: “New Guidelines Underscore How Complicated Childhood Obesity Is for Patients and Providers,” NYTimes.com, 01/20/23
Image by Toho Scope/CC BY-SA 2.0

AAP Guidelines and Backlash, Part 3

The previous post left off with Dr. Nicole McLean speaking of how pediatricians and other healthcare providers need to avoid stigmatizing language when talking with parents and children. Along with language, racial disparity is an enormous area of concern.

The first, having to do with the tone and precise phrasing of weight-related discussions, is very much under the control of individual practitioners. The second is of course partly controllable by health care providers, but the influence they can exert is quite small when stacked up against an imposing historical background and a societal mindset that often seems to be intractable.

We also mentioned how talk therapy has not been particularly effective, which is not totally due to the choice of language. Yet at present, a formula that includes a lot of talk seems to be the best thing on offer. For The New York Times, Catherine Pearson reported on what has been described as “the most effective behavioral treatment for children with obesity who are six and older,” which is enrollment into an intensive program concentrating on health behavior and lifestyle treatment.

Such programs are found in community hospitals, specialized obesity treatment clinics, and medical centers connected with universities. The specialists involved include, naturally, nutritionists, along with social workers and exercise physiologists. The ideal course of treatment must include at least 26 hours of in-person counseling with the whole family.

The fly in this ointment is that such programs are scarce, and even if they are available, few families have the resources to devote that much time, or to organize the travel arrangements. There was even a question about whether to include this item in the AAP recommendations at all, since it was felt that the majority of families would not be able to find an appropriate program or manage the logistics of attendance.

On the other hand, it is the organization’s responsibility to recommend whatever seems to be the best course of action. Dr. Sarah Hampl of Children’s Mercy Hospital is quoted as saying, “We have to lead with the evidence, because that is what we were charged to do.”

Journalist Caroline Kee interviewed and quoted Dr. Sarah Armstrong of the American Academy of Pediatrics:

“Childhood obesity has been continuing to increase almost in all age groups, races/ethnicities and sexes for the past 30 years.” Existing racial and ethnic disparities in obesity prevalence have also widened over time, and the pandemic was like a “magnifying lens” on these trends, she adds. “We saw greater year-to-year increases in the prevalence of obesity for all children during the pandemic years than we had in the previous 20 years combined.

Your responses and feedback are welcome!

Source: “Children with obesity should get proactive treatment,” 6abc.com, 01/10/23
Source: “New Guidelines Underscore How Complicated Childhood Obesity Is for Patients and Providers,” NYTimes.com, 01/20/23
Source: “New AAP childhood obesity guidance includes medication, surgery: What parents should know.” Today.com, 01/11/23
Image by Quinn Dombrowski/CC BY-SA 2.0

AAP Guidelines and Backlash, Part 2

This post is continued from the previous one. American Academy of Pediatrics Guidelines co-author Dr. Sarah Hampl, a pediatrician and weight management specialist, said, “Our kids need the medical support, understanding and resources we can provide within a treatment plan that involves the whole family.”

And that in itself is a problem. In the area of behavior “modeling,” previously known as setting a good example, not much progress seems to have been made in the past decades. Even in families where a good example is set, a very harmful condition known as Oppositional Defiant Disorder tends to crop up. In other words, anything that parents demonstrate or suggest is impossibly lame, and not to be adopted under any circumstances, just because some kids enjoy saying “No” more than anything.

An article written by Dr. Nicole McLean says,

Overweight means having BMI 85% greater than others their age and gender, while obese children are at or above 95%. BMI is an imperfect tool…

By this logic, in theory, the criterion of normalcy can continue to spiral upward toward infinity. If a child weighs 300 pounds, that’s okay as long as 15% of the other children are even heavier. Aside from the obvious problems like not being able to find cool clothes or fit into a classroom desk, obese children are at higher risk for all kinds of physical and psychological ailments like sleep apnea, heart disease, type 2 diabetes, hypertension, high cholesterol, fatty liver disease, arthritis, depression, and social malfunction.

Meanwhile, the AAP casts a rosy, optimistic glow over its recommendations:

All services for children and teens should also be carried out in a way that is mindful of patients’ culture and language preference, the guidelines say. By working with families to identify personal beliefs, risk factors, and challenges, pediatricians can provide a personalized plan for treatment.

Dr. McLean also wrote,

The new AAP guidelines call on pediatricians and other health care providers to avoid stigmatizing language when discussing weight with patients. The organization is also calling for policy changes that could help reduce racial disparities in childhood obesity, including improving access to healthy foods and treatments for groups at greatest risk.

In the actual world, where parents face increasingly difficult challenges to just keep their children housed and fed, how often does this ideal service scenario line up with reality? Some doubters speak of the expense and scarce availability of the type and duration of treatment that is recommended.

Some say that even under the best circumstances, talk therapy, especially in a family setting, is not spectacularly successful. The next post will go into more detail about the specifics. And no matter what, young people are setting out on a rough road, in challenging relationships with bodies that experience the increasing risk of serious medical conditions with every day that passes.

(To be continued…)

Your responses and feedback are welcome!

Source: “Children with obesity should get proactive treatment,” 6abc.com, 01/10/23
Image by GollyGforce/CC BY 2.0

AAP Guidelines and Backlash, Part 1

This year began with news that many felt was shocking and even scandalous. After a 15-year pause, the American Academy of Pediatrics issued a new set of childhood obesity guidelines. “Watchful waiting,” or giving children time to outgrow obesity, is not doing the trick. As Kaitlyn Radde reported for National Public Radio, “The group is now advising pediatricians to ‘offer treatment options early and at the highest available intensity’.” To some, those words have an ominous ring.

The new guidelines were authored by, among others, the vice chair of the AAP’s Clinical Practice Guideline Subcommittee on Obesity, Dr. Sandra Hassink. For children age six and older, but in extreme cases for those as young as two, the journalist wrote:

The most effective interventions require upwards of 26 hours over three to 12 months of intense, in-person behavior and lifestyle treatment from health care providers. Such treatment includes coaching on nutrition, physical activity and changes in behavior, such as role modeling by parents.

The preference is for those conversations to be couched in the “motivational interviewing” technique. This is where the clinician asks open-ended questions to try and understand the different family members’ perspectives. It is not difficult to imagine this leading to privacy issues, religious issues, distrust of governmental authority, and other undesirable reactions, but presumably, avoiding this is part of the training that professionals receive. On the other hand, one school of thought tends to believe that many patients and families will improve spontaneously, because the mere knowledge that someone cares and takes an interest, is beneficial.

A heavy schedule

All of this is, as the saying goes, “a lot,” especially for families with limited means. Even though the majority of Americans want to believe that COVID-19 and its numerous variants are in the rear-view mirror, those nasty critters are very much with us. People are still sick, and people are still unemployed, and some are both. If they have the time for these interventions, they don’t have the money — and vice-versa.

Those whose lives were least changed by the pandemic are the extremely disadvantaged, who did not use to have cars or childcare options or an extra dime to spare, and they still don’t. Seemingly ordinary amenities like well-child checkups are luxuries far beyond their means. But the recommendations for obesity abatement do not end with expensive and time-consuming appointments. Radde describes the next steps:

After this intensive therapy, weight loss drugs should be considered for adolescents as young as 12, the AAP says, while teens 13 and older with severe obesity should be evaluated for weight loss surgery.

But then, for young teens, the situation becomes even more problematic, because getting the recommended weekly injection of a drug called Wegovy is dicey, “due to recent shortages and insurance companies declining to cover it.”

Currently in the United States, more than 14 million children, or one in five humans in that age group, are officially obese. With regard to the objections that some critics have voiced, the organization also says that…

[C]hildhood obesity is a disease with genetic, social and environmental factors — not something caused by individual choices — and that it shouldn’t be stigmatized by health care providers.

(To be continued…)

Your responses and feedback are welcome!

Source: “Childhood obesity requires early, aggressive treatment, new guidelines say,” NPR.org, 01/09/23
Source: “Children with obesity should get proactive treatment,” 6abc.com, 01/10/23
Image by franchise opportunities/CC BY-SA 2.0