For obese kids, the USPSTF recommends diet and exercise; the American Academy of Pediatrics recommends surgery and ozempic

The AAP is, yet again, a failed organization

Good morning all. This Monday, I take a day off. For the study of the week, Vinay Prasad contrasts the different recommendations on the treatment of childhood obesity. The USPSTF or United States Preventive Services Task Force is an independent volunteer panel of experts in disease prevention and evidence-based medicine. They are as close to neutral judges of medical evidence as it gets. JMM

The American Academic of Pediatrics (AAP) proudly told parents to avoid peanuts in kids at high risk of allergy. That turned out to be exactly the wrong advice — it increased allergies. This same group said 2 year old babies should wear cloth masks, except when they nap (together, in the same room), to slow the spread of COVID19. Families with young kids that didn’t mask were asked to step off airplanes, or turned away from day care. Masks were used in speech therapy sessions. These recommendations were mind-boggling, and they shredded trust in public health.

The AAP gets things wrong because they are too (extreme left wing) political, and not wise. They don’t understand the limits of evidence, and appear disinterested in calling for, designing or running randomized trials to improve their guidance. Instead, they are happy to offer strong opinions, when the best course of action is to collect data (see also screen time). Previously, I outlined their failures in a Sensible Medicine post.

The AAP (American Academy of Pediatrics) is broken, failed organization

Now, the AAP is being called out by the United States Preventive Services Task Force. Both groups are issuing guidance this year on what to do about pediatric obesity.

The USPSTF has issued draft guidance that emphasizes diet and exercise. The AAP champions surgery and medications. I have been critical of the AAP’s endorsement — a topic I discussed here. Now let’s compare the two documents.

Let’s take a look at the USPSTF.

Here is what the USPSTF says:

They call for more research. And here too with specific endpoints.

Yet, here is what the AAP said in January for kids as young as 8.

And for older kids over 12 (SHOULD OFFER).

Again, the AAP’s recommendation is unfounded. If you randomize 10,000 obese 12 year olds to Ozempic, what happens 5 years later, or 10 years later? I suspect — given the massive rates of real world discontinuation — there may be 0 sustained weight loss. It may even increase weight from rebound. Worse, we do not know know the effects on quality of life, complications, and we may never know the effects on survival.

To recommend a costly drug with an uncertain long term safety profile (taken forever) to 12 year old children — based on current evidence — is incredibly unwise. It feels as if the AAP is working for the pharmaceutical firms — not children. Moreover, what could the money needed for Ozempic (12,000 a year) be used for instead. Better food? An exercise coach?

The USPSTF reaches the only sensible conclusion. For now: more data is needed. That is my conclusion as well, and I favor large, pragmatic randomized trials in adults and kids with staggered starting times (adults first — to protect kids from harms we may not yet know). It is inappropriate in my mind to say pediatricians SHOULD prescribe these drugs for a 12 year old, and the USPSTF agrees.

Conclusion

In October 2022, while the AAP continued to recommend masking children as young as 2, the group met indoors and did not mask themselves (see pic). Their absurd policy was applied to children seeking care for speech delays, but they displayed (a very natural) hypocrisy at their own conference.

But that wasn’t their only error. They flip flopped on schools, got peanut allergies wrong, and are prescribing Ozempic recklessly in children with inadequate safety and efficacy data. There are other divisive issues on which they are rightly criticized. If the AAP continues in this direction, they will burn through any remaining credibility.

The AAP is failing their mission “to attain optimal physical, mental, and social  health and well-being for all infants, children, adolescents and young adults.” The AAP can course correct and return to fulfilling their mission, but they must ditch politics and focus on generating high-quality evidence for their recommendations. Each failure is ultimately hurting children and they must recognize this. 

I think this organization needs an investigation. I encourage Congress to do so.

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PS: it appears the AAP spends more time thinking about the least offensive words to talk about obesity rather than asking for randomized data for how to improve the health of overweight and obese kids. From their document.

I also find it incredible that “overweight” is offensive but “unhealthy weight” is ok. This is Orwellian.