Misleading Reporting on Childhood Obesity Guidelines

Stanford Professor Richard Thompson Ford observed that “a large and growing share of the national economy is now devoted to ensuring that we are kept in a constant state of rage and frustration,” and this phenomenon is driving a wedge between groups that could actually change things for the better if they collaborated. If we could get past the inflammatory hot takes designed to get clicks and rile up our factions, we might discover that most of us are on the same side.

Since the publication of the American Academy of Pediatrics’ new guidelines for treating childhood obesity, there has been a wave of reporting and commentary on how they encourage medication and even bariatric surgery for kids as young as 13. In many cases, it is presented as though the AAP is prioritizing the interventions over lifestyle change. As usual, more reasonable voices have been drowned out as they attempt to clarify that this was actually the final of 13 “key action statements,” and rated a “C” for the strength of its evidence, while all other recommendations were rated “A” or “B.”

The most vocal population criticizing these new guidelines seems to be the diverse group of professionals involved in encouraging healthier lifestyles, including those from the fitness industry and allied health professions. Ironically, these are the same professionals that the AAP guidelines repeatedly encourage partnering with. In fact, pharmaceuticals and surgery are only recommended “as an adjunct to health behavior and lifestyle treatment,” while pediatricians are encouraged to “familiarize themselves with resources and actively collaborate with other specialists and community programs” which includes specific recognition of registered dietitians, behavioral health specialists, and exercise specialists. The guidelines go on to clarify that “pharmacotherapy applies to children with more severe degrees of obesity and/or comorbidities” and that it is most effective when accompanied by intensive lifestyle interventions.

The guidelines state that intensive health behavior and lifestyle treatment is “the most effective known behavioral treatment of childhood obesity.” This presents tremendous opportunities for partnerships between fitness industry professionals and the pediatric care community, and yet the guidelines have been widely pilloried by the very community to which it offered an olive branch. The mere acknowledgment that medications may play a part in comprehensive treatment plans was enough to enrage countless commentators. Do these people feel the same way about Nicorette for smokers? What about the various pharmaceuticals approved for recovering alcoholics or opioid addicts? Clearly, there is room for both lifestyle measures and pharmaceuticals in our arsenal of potential treatments.

For those that argue that childhood struggles with weight are primarily the responsibility of parents, these guidelines spend significant time reinforcing parental roles. “The foundation of all comprehensive obesity treatment is helping the child and the family change lifestyle, behavioral, and environmental factors” to create a situation that supports better health outcomes. They list numerous parental responsibilities at every level of decision-making and care: role modeling, monitoring, limit setting, reducing barriers, managing conflict, and modifying the home environment. These roles are based on clear evidence that more involved parents are associated with higher treatment effectiveness. In fact, the evidence further suggests that parental involvement in improving their child’s weight can also have health benefits for the parents themselves.

The combined voices of the medical and fitness industries could be a strong coalition indeed in advocating for the policy changes necessary to improve the many social determinants of health (SDoH) that contribute to the obesity epidemic. This is precisely what the guidelines call for, including partnering with other organizations for advocacy both within and beyond the healthcare sector. This could include everything from improving access to healthy food to reinvigorating physical education in public schools. Every citizen that is concerned about the well-being of children should be supporting initiatives like this, and yet the people best equipped to make a difference are taking the opportunity to publicly deride potential partners on social media. 

So far, the AAP’s guidelines have been a rallying cry for division. Instead, they should be a call to action for collaboration across industries. From pediatricians to fitness professionals to teachers, the health and well-being of children are crucial to our country’s future in countless ways. Instead of dunking on each other on social media, this is an opportunity to unite in both action and advocacy.