OCW2021: Can We Be Helpful on Childhood Obesity?

Focusing on childhood obesity for Obesity Care Week, we have a basic question are we ready to be helpful? Because truthfully, our record on this subject has been spotty. Way back in 1974, the Lancet told us “we need to be more vigilant in preventing obesity throughout childhood.”

But since then, the prevalence of childhood obesity has only risen. Along the way, advocates and policymakers have tried some things that may have made things worse for children.

Weight-Based Bullying Is Real

Almost all children experience weight-based bullying or teasing at school – either as targets themselves or as witnesses to their friends being targets. It does serious harm and it starts at a young age.

Dubious Awareness Campaigns

This is why childhood obesity “awareness” campaigns can do more harm than good. You can believe us when we say that children who are heavier than their peers already know it. If they don’t notice, their peers will tell them. But it’s pretty clear that thinking of oneself as fat doesn’t help. In fact, youth who see themselves as too heavy are more likely to have obesity as adults than youth who are blissfully unaware of their high weight status.

Nonetheless, policymakers decided in the early 2000s that screening kids for obesity in school would be a good idea. Arkansas started doing it statewide in 2003. The idea spread to other states. Was this helpful for childhood obesity? Probably not. A recent RCT in JAMA Pediatrics found no benefit and some indications of potential harm. Likewise, ad campaigns like Strong4Life tried to raise awareness about childhood obesity. But they probably were more successful in dispensing shame.

Where Is the Care?

While advocates and policymakers have been putting efforts into “awareness” of childhood obesity, less has been done about providing care for the growing numbers of children and youth severely affected by obesity. We can find fewer than 50 centers in the U.S. that provide serious, comprehensive care for children with severe obesity. That’s obviously inadequate for more than five million children living with this condition.

Ask anyone who runs one of these centers and they will tell you. We are not meeting the needs of all these young people and their families.

The care is lacking because the resources are not there. Health plans resist paying to provide the care these kids need. The options for treatment are improving, but they are still too few.

Glimmers

We do see reasons for hope. Not only are treatment options improving, but we detect more attention to real needs of children with obesity from the American Academy of Pediatrics. In 2017, the Academy issued a strong statement on weight stigma. We see more attention in JAMA Pediatrics to the need for respectful language and care. The Academy has even advanced support for metabolic and bariatric surgery in youth who need it.

Indeed, the landscape for childhood obesity care is changing. It needs to.

Click here for perspective on the impact of COVID-19 on children living with obesity. For a review of barriers to caring for youth with obesity, click here.

In the Children’s Chamber, painting by Kuzma Petrov-Vodkin / WikiArt

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March 4, 2021