16 Comments

I compliment Dave for his excellent analysis, an approach that most medical students need to emulate. The AAP sadly has become an advocacy entity. As a long-time member, I have never been polled by the AAP for perspective. The AAP should change gears and recommend new studies that are rigorous and can be used by objective public policy leaders for the future. Pediatricians need to take obesity much more seriously as a severe lifetime health risk, just as important as drug abuse and adolescent pregnancy.

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My 2 brothers and I have worked with overweight since 1980. We see many long-term successes. We keep it simple, consistently data based and provide long-term, specific support.

It seems our work with our clients is made much more difficult each year due to the increasing prevalence of overweight supported by the industries that sit on the shoulders of its existence (follow the money). Coupled with disavowal from the increasing costs of healthcare as related to this epidemic, and an expanding Head-in-the-Sand cultural attitude, our underestimated kids don't have a chance. IF adults could be truly educated and supported to confront the costs and adopt basic "rules of the road", (I promise no comfort on this) as we have seen so often in our practices, as a country we could turn this tragic epidemic around. Messaging, parenting, straight up education and systems of support could make a WORLD of difference....Missed opportunity; a message to mask could have been coupled with; "keep the cookies and chips out of the house." Why not?

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The failure to focus on obesity during the COVID pandemic was an egregious sin of commission that requires deeper analysis. Prevention is almost always more cost-effective than treatment after the fact. If I am not wrong, Fauci never mentioned treatment of obesity during the early phase of the pandemic. In fact, he seemed okay with the shutting down of gyms and lockdowns which predictably led to an overall increase in BMI in the American population and increased vulnerability to serious complications from the virus.

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And shutting down schools - kids didn't go out to playgrounds, barely got exercise. I bet pediatricians have files and files full of BMI charts with a sharp upwards movement during those years.

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PS: Are we as a country still subsidizing corn, soy, and wheat? Think about what that does when the cheapest/subsidized foods are all carb-heavy, nutrient light. What if we subsidized broccoli, carrots, beets, and kale instead?

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I can't believe I'm even reading this, and I have a kid that would be under this advisement. We simply got the kid to commit to a low(er)-carb diet and have already seen progress. Yes, it's hard to stay on, but I can't fathom even thinking about drugs unless as the author said, there are serious comorbidities.

Why not start with talking to the teachers who keep saying "Extracurriculars don't come before schoolwork"? My kid is willingly on an after school sports team, but keeps missing practices because she has a teacher whose grading is harsh and who chastises her for asking for extensions by even a couple of hours. (Things due at 5pm on Friday. How about 10pm? is that a big deal?)

I'm really at my wits end that you can get a 504 plan for something like anxiety that would allow the kid to have flexible due dates, but not for obesity. All I want is for her to go to practice.

And then there's the junk food the district is now giving her for free (California free lunch), but the district is at least acknowledging the problem and working with parents for a solution. But the core issue is that carbs are cheap and they literally don't have the budget to give free but healthier lunches . Parents will have to fundraise to make up the gap.

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Thank you for your clarity and taking the time to READ the literature. Changing behavior and nutrition works in most cases. My spouse and I had to wait until we left "the Work World". Then we were able to shed 30 lbs each and keep it off. I hope there is support for people to make wise decisions for a long time. It pays off. It truly does. Dana

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The findings that subjects’ (ie children’s) had weight gain after ending treatment with Liraglutitide and Semaflutide is disheartening. I think follow up post treatment for the other drugs is imperative to the treatment and guidelines for children. Not having a lasting effect post treatment ending, sets these children up with a dilemma. The life long dilemma of the risks of obesity vs the risks of the medication used to treat their obesity. To me this is very different than an adult (though many adults suffered with childhood obesity already). Pessimistically I feel that children with BMI’s of this magnitude are fated to deal with this burden their whole lives. Yes some will overcome but with the present wave of childhood obesity and the likelihood that it will increase is foreboding for future generations.

Obviously medications alone are not the answer to childhood obesity. Behavior and nutritional therapies will be crucial for what is an epidemic. More importantly is the need to prevent the onset of obesity at the earliest possible time in a child’s life. Unfortunately prevention is not where our Healthcare System excels.

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Working with inner-city clients for many years, I am sure these recommendations would affect poverty stricken children in incredibly greater numbers than others. Doctors frequently recommend bariatric surgery for obese adults in these areas, often with long term complications and temporary results. One woman I knew ate a couple of large pieces of cake at a birthday party following the surgery and nearly expired, despite warnings about diet. If people are used to a lifetime of bad food choices, the surgery will not fix this, and if there was fairly intensive, long term, food education and provision of good food (and subsidies to afford it), and this was effective, they wouldn't need the surgery. Also, if kids aren't allowed outisde because of random violence and predatory criminals in the neighborhood, fat or not, they'll have no exercise and will suffer from all kinds of physical problems, as doctors are seeing. Maybe guarded playgrounds where kids could go safely? I don't know what the solution is, but drugs and surgery are not rational responses to this issue.

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This is also the population who can least afford healthy foods, relies on cheap carbohydrates for meals, and rely on schools for reduced lunches where the schools can't afford healthy foods either.

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The intervention would have to be very early, in schools. Otherwise the expense of effecting what starts as behavioral change would be astronomical. When accused of supervising clients for excessive amounts of time, I used to respond, "if you were told that everything you believed about ________ (anything) since childhood was false, how long would it take you to abandon your belief?"

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The AAP is the most dangerous "professional" association in the country. Their response on COVID has been beyond the pall. Their comments on gender issues are right there with the COVID advice. And this is just more of the same.

If I were a pediatrician, I would be forming a new professional society just so that I would not have to hide under my bed in shame from these pronouncements. The lack of pushback from this entire specialty is mind numbing. I pity our poor children.

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Or they could just stop eating sugar, carbs. (Fruit too — if you’re super fat, fruit is NOT your friend!)

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Jan 15, 2023·edited Jan 15, 2023

Think of all the money, political power, and energy currently dedicated to pushing worthless-if-not-dangerous covid boosters. Now imagine what might happen if all that was instead directed at promoting simple lifestyle changes such as limiting eating to an 8-hour window daily (intermittent fasting), reducing carbs, limiting processed/packaged foods, and taking a short walk a few times a week if not daily (exercise and sunlight). Instead, ZERO resources are directed at promoting that message, while the AAP pushes drugs and surgery for overweight adolescents. How did insanity become so rampant in our public health infrastructure?

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We have such a great therapy for childhood obesity already. GYAOaP qd. That's the brand name. I believe the generic name is Get Your Ass Outside and Play.

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I'd love to have you take a look at this EBM post and consider crossposting or inviting the author to respond on Sensible Medicine.

https://open.substack.com/pub/weightandhealthcare/p/serious-issues-with-the-american?r=1ko3lc&utm_campaign=post&utm_medium=web

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