Fed Up with Rationalization in Childhood Obesity

Shadow (Children by a Window)Every discussion, every meeting that touches on childhood obesity brings a difficult mixture of encouragement and frustration. The encouragement comes from engagement with good people who have a genuine desire to do the right thing for our children. Everybody wants to see the next generation of children be healthier and have more opportunities than those of us who will be handing the world over to them. But the frustration comes from rationalization that ensues to divert people from actually providing care for the growing numbers of children whose lives are already being shaped by obesity – especially those who have been living with severe obesity from an early age.

We’ve Got to Prevent It!

This week in USA Today, Karen Weintraub published a truly outstanding exploration of diverse thinking about the very complex subject of obesity. But on one very critical dimension, she came up short. That is the experience of obesity in childhood.

The dominant voices in the public sphere on child obesity for a long time have simply avoided talking about the experiences and needs of children living with obesity from an early age. The rationale for this is that it’s simply too hard to treat. Christina Economos told Weintraub:

“If we can put our resources into prevention, it’s going to go much further in the longer-term than waiting to treat someone. The only way is starting early.”

This brings us an exclusive reliance on teaching kids to eat healthy and enjoy healthy lives to prevent obesity. Such programs are great, but they’ve yet to put a dent in high rates childhood obesity. In fact, thoughtful people are telling us that current nudge-and-educate strategies for obesity are unlikely to prevent persistent high rates of child and adult obesity.

No More Rationalization Please

So can we set aside the rationalization about how only one pathway for dealing with childhood obesity will work? Surely we do need to inspire good nutrition and active lives for our children. But we also need prevention strategies that will have an effect on obesity prevalence – programs backed by real data to show an effect.

And just as urgently, we need to provide care for the growing numbers of youth living with severe obesity. To reduce the harm to their health. Bill Dietz explained to Weintraub exactly why this is so important:

“The longer these problems exist and persist, the more damaging they’re going to be. The older you get and the more severe the obesity you have in childhood, the more likely it is to persist into adulthood.”

Instead of more rationalization about ineffective approaches for preventing childhood obesity, we need to put some energy and resources into caring for the children already affected and giving them a shot at better, healthier lives.

Click here for the latest report on trends in childhood obesity from JAMA Pediatrics and here for a report on treatment options beyond lifestyle.

Shadow (Children by a Window), painting by Maurice Prendergast / WikiArt

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July 31, 2022

6 Responses to “Fed Up with Rationalization in Childhood Obesity”

  1. July 31, 2022 at 7:43 am, John DiTraglia said:

    Amen.
    “But we also need prevention strategies that will have an effect on obesity prevalence – programs backed by real data to show an effect.”
    But they don’t exist yet. So we need to be honest about that.

    Reply

  2. July 31, 2022 at 9:32 am, Mary-jo said:

    Intentional, appropriate treatment for children with obesity, screening and targeted interventions for high-risk children IS zone of the BEST prevention strategies to help children with obesity, prevent them from complicating their disease further as they age into teen years and adulthood and help to prevent THEIR children from developing complicated obesity! As a young dietitian working in administrative dietetics because that was all available to me because I struggled with obesity from childhood, I heard Albert Stunkard speak about importance of treating children with obesity, matching approach to the child and family dynamics, but offering long-term monitoring no matter what approach was used, for years, if needed. That talk changed my life! That was in the 70’s! I really believed treatment for children with obesity was well on its way! Yet, we are *here* in 2022!

    Reply

  3. July 31, 2022 at 10:02 am, Allen Browne said:

    Yup!

    2 goals –
    1) prevention has to reduce the incidence of the disease
    2) Treatment has to improve the health and quality of life of the individual child

    We have the tools for treatment and the knowledge of how to use them. The problem is access to care. We have to get by the patients, the providers, the payors, the policy makers, and the public – all are barriers.

    Prevention is tougher. Logic has not worked. Now we need to apply a scientific understanding of energy regulation and figure out what makes it go awry. Certainly stress, sleep, ACE’s, circadian rhythm, and microbiome are involved. Undoubtedly obesogens are involved. These are big issues – poverty, racism, inequality, the environment, etc are the background that probably needs to be improved. It makes treatment look easy.

    But the kids are worth it!

    Allen

    Reply

  4. July 31, 2022 at 11:43 am, Aaron Kelly said:

    I agree, Ted. We need to extend our focus beyond obesity prevention. Prevention is important, but one in five children and teens in the U.S. are already living with obesity. They deserve better than being told to simply try harder to lose weight. Their parents deserve better than being told it is their fault. We don’t tell kids with depression to try harder to be happy. We don’t tell kids with anxiety to try harder to calm down. We don’t tell kids with ADHD to try harder to focus. Healthcare providers take the primary responsibility for managing these conditions by referring them to behavioral counseling AND offering them medications targeting neurotransmitters in the brain to “take the edge off” of their disease and give them a tool to take control of their health. The science tells us that obesity is no different. Not all children and adolescents with obesity necessarily need, or want to use, medications to manage their excess adiposity. But, all who are medically eligible should be offered the choice of anti-obesity medication by their healthcare provider as part of comprehensive and evidence-based obesity care. And, insurance should cover it. Our kids deserve better.

    Reply

  5. August 01, 2022 at 9:31 am, Connie said:

    “We have the tools for treatment and the knowledge of how to use them. The problem is access to care. We have to get by the patients, the providers, the payors, the policy makers, and the public – all are barriers.” I completely agree. I’d like to hear your thoughts on the policy piece. Any good resources for developing a policy agenda at the county or state level?

    Reply

  6. August 01, 2022 at 7:55 pm, David Brown said:

    Allen Browne wrote, “We have the tools for treatment and the knowledge of how to use them…Prevention is tougher. Logic has not worked. Now we need to apply a scientific understanding of energy regulation and figure out what makes it go awry.”

    Good observations. Actually, energy regulation is well understood. Excerpt: Endocannabinoids and their G-protein coupled receptors (GPCR) are a current research focus in the area of obesity due to the system’s role in food intake and glucose and lipid metabolism. Importantly, overweight and obese individuals often have higher circulating levels of the arachidonic acid-derived endocannabinoids anandamide (AEA) and 2-arachidonoyl glycerol (2-AG) and an altered pattern of receptor expression. Consequently, this leads to an increase in orexigenic stimuli, changes in fatty acid synthesis, insulin sensitivity, and glucose utilisation, with preferential energy storage in adipose tissue. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3677644/

    Reply

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