Fear, Myths, and Obesity in Youth

Laughing DemonThere’s nothing to spark surprise in the response to news that the American Academy of Pediatrics yesterday issued its first ever guidelines for obesity care in children and youth. The thought of actually providing care for obesity in youth is unsettling and thus is stirring up all kinds of fear and myths. In some cases, the loathing is not too deep below the surface.

Consider this comment from a registered nurse on LinkedIn:

“I totally disagree that parents and obese children should not be held responsible for their lifestyle choices. What they eat and the activity they expend is the REASON for obesity! Instead, the recommendations are to put them on drugs which will produce new diseases due to the inevitable adverse effects of pharmaceutical drugs. They also recommend major surgery: cutting out a portion of the stomach!

“Has our society become so inept that we can’t change to a healthy lifestyle?”

In short, the idea that we might offer medical care to young persons with obesity elicits fear that we’re all going to hell in a handbasket.

Fear of Obesity Meds

In that handbasket of fear, a consistent theme is the fear of obesity meds – even from some typically rational healthcare professionals. One registered dietitian wrote to say she fears that this will produce another fen-phen story. To say this surfaces a lot is a dramatic understatement.

We wonder why a bad experience with off-label use of an obesity med gets more traction than, for example, the Baycol story. This was a statin for treating high cholesterol, withdrawn in 2001 because it killed at least 51 people. Yet statins continue to be among the most prescribed medicines ever – quite rationally so. They are safe and effective.

But because of the fear and myths attached to obesity – especially in youth – obesity meds get very different treatment in the popular imagination.

Shaking Off the Myths

The dominant myth attached to obesity in youth is that if a child has serious obesity, it must be caused by terrible habits of eating and sedentary behavior. Parents are thus presumed guilty. Our friend Kim Murray explains how profoundly false this can be:

“When I was 3, I was underweight. A skinny little rail of a child. That was common for many of the kids on my Dad’s side of the family. We were all active children and ate fresh food from family farms and gardens.

“I, like my brother and most of my cousins, was overweight by the time we were teens. Most of my cousins were farm kids, working hard on the family farms. I was a city kid who spent summers at various farms or at the family cabin on the lake. Very active – chores, playing outdoor games, riding bikes, and I must have been half fish because I spent every hour I could swimming.

“We couldn’t afford soda and junk food. We ate food made from scratch. Well-balanced meals. And I continued to gain weight until I was heavy enough that people started making fun of me. That ended my active lifestyle, and I retreated to the world of books. None of the people in the books could see me and shame me.”

Cut It Out!

Let’s stop with the presumption that obesity, in youth or adults, has a single cause. A person’s genes set the table for obesity, but many different factors can serve it up. Just as there is no single cause, there is no single answer for preventing or treating it.

The good news is that medical care for obesity in youth, tailored to individual needs, can benefit a child’s health and well-being profoundly. So it’s time to let go of the myths and fears. Like any precious child, these young persons need our love and care, not blame and shame.

Click here to dig into the new guidelines for obesity care in youth, here and here for further perspective.

Laughing Demon, painting by Katsushika Hokusai / WikiArt

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January 10, 2023

5 Responses to “Fear, Myths, and Obesity in Youth”

  1. January 10, 2023 at 9:00 am, Allen Browne said:

    Kids and parents are easy targets for shame and blame – bias and stigma. But obesity is a disease – not a choice or poor decision. And now we have tools to improve the health of the people afflicted by the disease. And now the AAP says “treat”. We are making progress.


  2. January 10, 2023 at 1:02 pm, M. said:

    They changed the name from “weight management” to “intensive health behavior and lifestyle treatment” but still, the only measure of effectiveness is BMI. Where is the health part? And for children under 6 BMI is even more flawed, than with the adults.

  3. January 10, 2023 at 2:33 pm, Mary Hager said:

    We so often think in Binary modes: but unfortunately we do need to consider all the parameters that go into finding a workable solution. And, food choices will always be instrumental.

    When I was in elementary school we had only one frankly obese kid. His mother, as a sign of love (or her personal food preferences…and perhaps his) sent him to school with a thermos of KoolAde and cookies. I got a sandwich and a piece of fruit, along with the carton of whole milk distributed to all the students (there was no cafeteria).

    Parental decisions and food habits do impact and set the stage for forming food preferences and habits, even into adult hood.

  4. January 10, 2023 at 3:15 pm, Laura Boyer said:

    Healthcare professionals must be educated and updated on current evidence or the bias will persist. I remember when nicotine use was considered a choice and not “deserving of treatment “. The big change occurred in coverage for mental health and addiction disorders but we lagged behind in adoption of the thought that these are illnesses “deserving of treatment “and not lifestyle choices. It will take time

  5. January 10, 2023 at 5:56 pm, David Brown said:

    To be sure, some children are metabolically primed to become obese. To compensate for that sort of genetic disadvantage, it certainly makes sense to utilize surgery and pharmacology to improve health outcomes. However, prior to such drastic measures, it also makes sense to attempt to correct nutrient intake if doing so can alleviate the problem.

    Regarding nutrient intake, the field of medicine would do well to take note of the connection between endocannabinoid system dysfunction and obesity. Excerpt from a 2021 paper: “In this review, we try to explain the role of the endocannabinoid system (ECS) and the impact of genetic factors on endocannabinoid system modulation in the pathogenesis of obesity, which is a global and civilizational problem affecting the entire world population regardless of age. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7911032/#__ffn_sectitle