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The New AAP Childhood Obesity Guidelines Are Setting Kids Up To Fail

To be abundantly clear, I am not against surgery or medication, as both save lives every year. However–and this is a big however–when it comes to comorbidities significantly driven by nutrition and physical activity3, I am a firm believer that one should exhaust all lifestyle4 modifications before considering medication and surgery.

Have we really exhausted all other options?

It’s worth noting that these new recommendations on the treatment of childhood obesity were released beforethe academy’s statement on obesity prevention, which is forthcoming. 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.

This is nothing new. “As a physician, I was taught no nutrition and almost no lifestyle strategies to aid my patient care,” integrative family physician Madiha Saeed, M.D. tells mindbodygreen in reaction to this news. “Putting more resources into weight management education, encouraging healthy behaviors, changing food policies, and proving healthier options in food deserts [is essential]. This latest recommendation is horrifying.”

“There are many interventions that can be done before bariatric surgery in [the pediatric] population, including adhering to appropriate lifestyle changes from changing up diet, adding more exercise, supporting sleep and mental health,” echoes board-certified family medicine physician Bindiya Gandhi, M.D.

Before turning to meds and going under the knife, we need to consider to the underlying drivers of this metabolic health crisis.

Sugar: On average, sugar makes up 17% of what children consume each day. Half of that comes from drinks with added sugar. Perhaps we should consider reducing added sugars from our childrens’ school lunches and our households?Ultra-processed foods: Ultra-processed foods now comprise 66% of calories in children and teen diets. What do you think would happen if we educated children about nutrient-dense fruits, vegetables, whole grains, and protein sources–whole, real foods–in our schools, had gardens and classes on how to meal prep, and made healthier food choices accessible in the classroom? Lack of exercise: The average child spends less than an hour a day doing physical activities. What if everyday children got to go outside and exercise during the school day for a meaningful amount of time?
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Does all this sound like a radical change in our education system? Or is it more radical to go to medication and surgery? What do you think will cost more in the short term or long term?

It doesn’t take a rocket scientist to determine that pharmaceuticals and surgeries will dwarf the costs of changing school curriculums to reflect our dire need to get our kids and our future generations thriving. Yes, I’m probably oversimplifying the complexity of what would be required for an overhaul of our education system, but it’s clear to me it needs one.

This is also bigger than our education system, and goes back to what we as a nation place a financial value on. What if we subsidized vegetables, fruits, and nutrient-dense animal products, instead of just corn and soy?

It also extends to habits at home. Research shows that one’s home environment embracing and implementing good nutrition5 is paramount.

“Obesity in children is not simply a child problem. It involves the entire family system, and therefore effective treatment requires a systems-level approach,” Nicole Beurkens, Ph.D., C.N.S., a clinical psychologist, nutritionist, and special education teacher with almost 20 years of experience supporting children, young adults, and families, tells mindbodygreen.

“Supports in the areas of nutrition, exercise, sleep, stress management, family relationships, and more are all components of effectively treating obesity in children. Patients and families should be provided with information and access to all of these things, with ongoing support for implementation, before prescription medications or weight loss surgeries are utilized,” Beurkens adds.

We need to do better.

Childhood obesity is complex and multifactorial (genetics, lifestyle, school environment, food security, family dynamics, socioeconomics, psychological factors, and trauma all play a role) and there are no easy answers here.

But we must consider the potential ramifications of measures as drastic (and irreversible) as surgery. “While those interventions may provide benefit for some children, there are known physical and mental health risks involved with those approaches over both the short and long term of a child’s life,” says Beurkens.

Furthermore, “Children are still growing mentally and emotionally, so when they are provided with the right resources in a positive light, it could be life-changing,” adds Saeed. “These new guidelines will not change the trajectory of obesity, but further fuel the problem.”

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The takeaway.

After deciding that the “watchful waiting” approach to childhood obesity is not working, the AAP is now recommending medication and metabolic and bariatric surgery in children as young as 12-13. This is a complex issue with no silver bullet solution–but it makes one point very clear: something needs to change. Our institutions in terms of our government and large corporations are failing our children, and it’s beyond heartbreaking. It feels like we’re setting up our kids to fail here, and they areour future. We need to do better. We can do better.

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