Who Will Care for Children with Obesity?

Some responses to USPSTF recommendations for screening and care for children with obesity leave us shaking our head. Five million children are living with severe obesity in the U.S. Intensive behavioral therapy works to improve their weight and health status.  Less intensive advice to lose weight is largely ineffective. And yet, policymakers balk: “It could divert resources from population health approaches to prevention.”

Theoretical Concern About Childhood Obesity

By and large, everyone is on board with the notion that childhood obesity is a problem. People are happy to sign on for National Childhood Obesity Awareness Month. Support is strong for screening kids, even at school, for high BMI or weight-related issues. In an JAMA editorial, Rachel Thorton and colleagues from Johns Hopkins say this is an important part of everyday care for children.

But acutally caring for these children? “Difficult questions need to be answered . . . Should the focus be on clinical care or on public policy interventions?”

A False Dichotomy

Three editorials accompany these guidelines in JAMA. All three of them acknowledge this horrid, false dichotomy. “The benefit of treatment for obesity is clear,” say Jason Block and Emily Oken. “The USPSTF recommendations should lead to universal coverage for comprehensive, intensive behavioral treatment for obesity in children and adolescents.”

Further, they say, “policy efforts are complementary to obesity treatment and crucial to addressing obesity at the population level.”

Thorton et al deplore this “false dichotomy between individual level, clinic-based obesity treatment interventions and population level, policy-based prevention interventions.” And yet, they go on to promote it in their conclusion:

The USPSTF recommendation should provide an impetus to redouble efforts to invest in practice, community, policy, and multilevel intervention research focused on achieving primary prevention and sustained improvements in health and health trajectories for children and adolescents and their families. Such a focus is critical for reversing the obesity epidemic.

We cannot for a minute tolerate a false choice between prevention and treatment of obesity. Five million children with severe obesity in the U.S. face a lifetime of chronic diseases that might be prevented with adequate care. Support for screening without providing medical care for these children is callous neglect. It’s unconscionable.

Click here for the USPSTF recommendations in JAMA. Here, here, and here you will find companion editorials.

Mother and Child, photograph © Elizabeth Haslam / flickr

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June 21, 2017