Walls of the Saviour-Euthymius Monastery, painting by Nicholas Roerich / WikiArt

Scaling the Walls That Block Childhood Obesity Care

For decades now, childhood obesity care has been on the back burner because of a false dichotomy. All efforts have gone into prevention – a noble and elusive goal. But in the face of earnest efforts to prevent childhood obesity, the prevalence has relentlessly climbed. Meanwhile, the children affected – now roughly six million with severe obesity in the U.S. alone – have few options for effective medical care.

A new review paper in Obesity provides a complete outline of the barriers that block care for these children.

As Daunting as Fortress Walls

Gitanjali Srivastava and colleagues (including ConscienHealth’s Ted Kyle) describe a full inventory of these barriers. Pediatricians don’t receive training to offer much more than cursory (and ineffective) advice. Most people understand the disease as a behavioral problem, though the truth is that it’s one of physiology. From this misunderstanding flow bias and stigma, which doubles the harm of obesity. And finally, health plans routinely deny coverage for effective childhood obesity care.

Financial officers at the health plans love it, because they see it as cost avoidance. Plans can get by with it, because misconceptions about obesity make it OK to say that medical care is unnecessary – it’s just a manifestation of bad behavior. Not our job to fix it.

As a result, clinics and providers have a tough time making pediatric obesity care financially sustainable.  Thus, fewer than 50 centers exist in the U.S. to offer effective care for  six million children with severe obesity.

A Social Ecological Model for Progress

The fortress walls that prevent childhood obesity care at an effective scale will not come down easily. Srivastava et al tell us that it will require creative education and advocacy efforts across five domains – clinical, education, insurance, policy, and research. It will be challenging, but they explain why change is essential:

The prevalence of overweight and obesity approaches 35 percent of children and adolescents in the United States. Children with obesity of any classification have metabolic disease and psychosocial challenges at early ages. Delaying potential treatment until adulthood dooms these children to progressive disability and premature death. This is the reality of 13.7 million US children currently affected by obesity.

Our conscience does not allow us to let these barriers stand. Both prevention and treatment for childhood obesity are essential for the health of our children.

Click here for the full review by Srivastava et al.

Walls of the Saviour-Euthymius Monastery, painting by Nicholas Roerich / WikiArt

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December 29, 2020