Friedrich Nietzsche

ObesityWeek: Can We Escape Nihilism in Childhood Obesity?

ObesityWeek 2019 LogoWith the opening of ObesityWeek today, we’ll see smart clinicians and scientists taking on tough questions right from the start. We have the privilege to moderate a panel discussion in the opening session. It’s a privilege because three researchers and clinicians will bring their best thinking and science to the dilemma of nihilism in childhood obesity care. In an age of outrage, some people fear doing anything. Nothing can pass muster with diverse, polarized stakeholders. So nothing gets done.

Taking on this challenge are Michelle Cardel, Ania Jastreboff, and Hiba Jebeile. In the TOS opening session today, they will discuss the intense reaction to obesity treatment for youth and children. They’ll provide perspective on current options. But perhaps most importantly, they’ll address speculation that any treatment of childhood obesity sets up a risk for eating disorders


The outrage is easy to find. When WW licensed the Kurbo program for children and youth, some advocates were up in arms. Much of the agitation came from advocates for Health at Every Size®, along with some folks from the eating disorders community. Since the HAES folks question the status of obesity as a serious disease, this is not entirely surprising.

However, we also saw quite a number of people come forward to tell their stories of being compelled by a harsh parent to engage in weight loss efforts at an early age. There’s no doubt. That kind of ritualized stigma hurts. For many people, it leaves a psychological scar that lasts into adulthood.

When the American Academy of Pediatrics issued its position favoring bariatric surgery for teens with severe obesity, medical professionals responded positively. The data is pretty clear that it can be very beneficial. But Twitter clearly doesn’t like it. The response from the public ranges from “why is this necessary?” to  “that’s child abuse!”


Nevertheless, it’s a matter of fact. Treating obesity in children and youth can improve health without creating a risk of eating disorders. The key is to provide evidence-based care. Not to leave parents without alternatives to naive self-help. DIY weight loss for kids can be quite stigmatizing.

Likewise the recommendation of bariatric surgery for severe adolescent obesity comes from extensive experience and research. For youth who need it, it can be a godsend.

Unmet Needs

Five million kids in the U.S. have severe obesity and few options for dealing with it. Skilled providers are too few. And in the absence of good options, parents sometimes turn to approaches that can indeed be harmful.

It’s not good enough to tell parents to cut that out. To address this problem, we need to offer alternatives. So we need healthcare systems that have adequate scale for treating five million kids with severe obesity. Right now, we have fewer than 40 centers ready to care for kids with severe obesity. Nihilism is getting us nowhere.

Click here for more on today’s session with Cardel, Jastreboff, and Jebeile and plan to participate this evening. For current guidelines on childhood obesity treatment from the Endocrine Society, click here. Finally, you can find the Obesity Medicine Association’s Pediatric Obesity Algorithm here.

Friedrich Nietzsche, painting by Edvard Munch / WikiArt

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November 4, 2019

3 Responses to “ObesityWeek: Can We Escape Nihilism in Childhood Obesity?”

  1. November 04, 2019 at 9:19 am, John DiTraglia said:

    Primum non nocere =nihilism (x for surgery)

  2. November 04, 2019 at 4:44 pm, Michael said:

    Isn’t the shift to focus on childhood obesity simply just due to nihilism about adult obesity?

    • November 04, 2019 at 4:46 pm, Ted said:

      Actually, I don’t think so, Michael. While there’s plenty of nihilism out there on all fronts, I see some good progress for adults. Access to care is improving. We have more providers than ever before who understand obesity. But the progress for youth and children is not evident.