The Imperative for Progress in Pediatric Obesity Care

It is, quite simply, inspiring to spend an entire day with with a team of people dedicated to doing nothing but advancing the care of young persons living with obesity. We had this privilege yesterday at the University of Minnesota Center for Pediatric Obesity Medicine (CPOM). These are people dedicating themselves to bringing progress to pediatric obesity care. They’re doing it through caring for kids profoundly affected by this disease every day. Then they are also conducting and publishing groundbreaking research to add to the knowledge of how to provide the best possible care. And finally they are advocating for their patients to have equitable access to good clinical care.

New research out this week in JAMA Pediatrics reminds us just how inequitable the impact of pediatric obesity is.

Growing, Appaling Disparities

Ryunosuke Goto and colleagues analyzed trends in adolescent obesity from 1999 to 2018, using NHANES data. They took a careful look at the social and economic status of these youth living with obesity. In sum, what they found was that disparities in obesity have steadily risen in the last two decades.

Obesity prevalence grew faster for teens from low-income households, and for teens in households headed by someone with less education. So every four years the gap in obesity rates for low income households grew wider by 1.5 percentage points. For low education households, the gap grew by 1.1 percentage points every four years.

Disparate Access to Care

Access to pediatric obesity care is difficult for everyone. There are way too few centers that can deliver the level of care that CPOM does. But it is especially difficult for Black and Hispanic youth, as well as individuals who rely upon Medicaid for their health insurance.

The experience at CPOM illustrates this well. A year ago, if a young person relied upon Minnesota’s medical assistance program for health insurance and they needed anti-obesity medicines, they simply could not get them. The program flatly excluded them altogether. So patients and providers pressed the legislature to change things and now the exclusion is gone.

Unfortunately big problems remain. Because the folks administering the program have imposed stupid restrictions on pre-authorization for these meds. For example, if a patient doesn’t lose five percent of their body weight every six months, coverage ends. CPOM providers have found little understanding that achieving and maintaining a five percent reduction in weight can be quite helpful for a young person with obesity.

So physicians find themselves having to appeal – literally to a judge – for reversal of arbitrary coverage rules like this. But these appeals are case by case. It’s a war of attrition that denies coverage of medical care for kids with obesity.

Disparities Baked into the System

So it’s no surprise that disparities in obesity are widening. But thank goodness for the CPOM and similar centers around the country where professional are working hard to advance the standard of obesity care and equitable access to it.

Click here for the Goto research and here for further reporting on it. For further perspective on disparities in obesity care, click here. For the slides from our seminar as a visiting scholar at CPOM yesterday, click here.

Children at the Beach, painting by Maurice Prendergast / WikiArt

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June 23, 2022