Children Watching

Benign Neglect for Childhood Obesity?

Leave fat kids alone. That’s the proposal from Aubrey Gordon in the New York Times, and she makes a compelling case. A war on childhood obesity mutated into a war on fat kids for four decades and accomplished almost nothing good. In fact, it left many kids, such as Gordon, burning up with feelings of shame. Granted, leaving kids in peace is a good alternative to a strategy of shame and blame for them and their parents. But is benign neglect for childhood obesity good enough?

The Case for a Truce

Certainly, Gordon makes a good case for declaring a truce. She describes how her pediatrician humiliated her when she was in fourth grade:

“I will remember the pediatrician’s words forever: It’s probably from eating all that pizza and ice cream. It tastes good, doesn’t it? But it makes your body big and fat.

“I felt my face sear with shame.

“There was more: Just imagine that your body is made out of clay. If you can just stay the same weight, as you grow, you’ll stretch out. And once you grow up, you’ll be thin and beautiful. Won’t that be great?

“I learned so much in that one moment: You’re not beautiful. You’re indulging too much. Your body is wrong. You must have done it. I’d failed a test I didn’t even know I’d taken, and the sense of failure and self-loathing it inspired planted the seeds of a depression I would live with for many years.”

Compared to that approach, benign neglect would definitely be a huge improvement.

Training Would Help

A new study by Karen Campoverde Reyes et al tells us that pediatricians are most often not equipped to provide competent obesity care. Overall, only six percent of primary care pediatricians felt successful in providing obesity care. Their knowledge of obesity was rudimentary. Most respondents – 96 percent of them – simply attributed obesity to overconsumption of food. Genetic factors finished in sixth place on the list.

That’s a pretty big miss, because obesity is a highly heritable disease. Genes account for about 70 percent of an individual’s susceptibility to obesity. And then, of course, the environment plays an important role to trigger it in susceptible individuals.

This research found that training makes a difference for confidence and competence. But only half of the pediatricians in this survey felt they were adequately trained merely to provide nutrition counseling. For more complex topics the numbers were much lower. For example, only 20 percent felt confident about providing pre or post bariatric surgery care.

Is Benign Neglect Good Enough for Childhood Obesity?

Given the current state of affairs, many pediatricians are not equipped to help kids with with obesity. So indeed, they could make things better if they stop dispensing the kind of blame and shame that Gordon describes getting from her pediatrician.

But no, that is not good enough. Every pediatrician should know that obesity is a highly heritable disease. For kids who have the genetic cards stacked against them, simple advice to eat less and move more is inadequate. Fatima Cody Stanford, senior author on the Reyes study, explains:

“Physicians, particularly pediatricians, should be trying to care for patients with obesity in a respectful fashion. So it is important for us to know that obesity is a complex, multi-factorial disease. With this knowledge, we don’t blame the patient for the disease that they have. Instead, we work to find solutions to ensure that they have the happiest and healthiest life possible.”

Click here for the Reyes study and here for the Gordon commentary.

Children Watching, photograph © Bernard Laguerre / flickr

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November 14, 2020

3 Responses to “Benign Neglect for Childhood Obesity?”

  1. November 14, 2020 at 7:26 pm, Bongo said:

    “Most respondents – 96 percent of them – simply attributed obesity to overconsumption of food”
    Erm, no: that claim is not in the Reyes study.

  2. November 15, 2020 at 4:28 am, Ted said:

    Quoting from the paper:

    “The major contributors to obesity according to the survey respondents are the overconsumption of food (96%).”

  3. November 16, 2020 at 11:04 am, Mary-jo said:

    When obesity was burgeoning in the pediatric population in the 80s, my experience at Emory was that pediatricians were extremely attentive and curious about what we could do to help their patients, who, of course, came in for other reasons — for ex., allergies and immunological diseases, gastrointestinal disorders, glucose ‘intolerance’ which we know now was T2D. It was an exciting time as people like Jules Hirsch, Rudy Leibel, George Bray, Albert Stunkard, Jim Hill were explaining the multifactorial aspects of obesity and even though, it wasn’t classified yet as a disease in its own right, the pediatricians I worked with really wanted to treat it, help their patients with it. Then came a period when it just seemed overwhelming to treat, certainly as obesity became epidemic in the population. Appropriate courses must be included in med school curriculums so that pediatricians know how to approach their patients with it. This seems to be happening now, so I’m hopeful.