World Obesity Day: Perspectives and Evidence

Today – World Obesity Day – is all about changing perspectives. The World Obesity Federation deserves credit for a well-chosen theme, because in the face of much new evidence about obesity, old perspectives are crashing into newer ones driven by evidence and science. Research has brought us new options for treating obesity more safely and effectively. Yet some people feel uncomfortable with these options. Strong reactions to new evidence-based guidance for obesity care in children and youth make this discomfort unmistakeable.

So we are grateful to Live Smart Texas for its World Obesity Day Summit with a keynote presentation by Sarah Barlow on the origin and substance of this new guidance.

From Expert Opinions to Evidence-Based Guidance

Barlow is uniquely suited to inform us all about the origins of the new pediatric obesity guideline. The simple reason is that she led the development of the the only guidance we had from the American Academy of Pediatrics (AAP) until now. It dates back to 2007.

The one most critical thing to remember is that the 2007 guidance was based on expert opinion. At that time, the evidence base for obesity treatment in children and youth was too thin to support a genuine evidence-based guideline. But now that has all changed, as Barlow explained:

“The 2007 recommendations were from a really different process because the state of the science was different at that time. The result was expert consensus recommendations.

“In contrast, the current clinical practice guideline development was a much more comprehensive process, and it took five years.”

This started with a massive, systematic evidence review summarized in technical reports. All of the evidence was carefully graded according to standard protocols. It yielded 13 evidence-based recommendations, which the AAP labels as Key Action Statements. These are the most factual statements you can find anywhere about the treatment of pediatric obesity right now.

Grappling with Facts, Feelings, and the Reality of Clinical Care Today

But this evidence-based guidance is only a start. In the real world, it runs headlong into strong feelings and biases that people hold. Some are fearful that treating obesity conflicts with their values for protecting children from the risk of eating disorders. Others are simply uncomfortable with new treatments for obesity – no matter what the science says.

This guidance also runs into real-world limitations of health systems for delivering evidence-based pediatric obesity care. Providers are not all fully equipped to deliver this care. Health systems and insurance are not ready to make it equitably accessible.

So we see that on World Obesity Day, perspectives are changing, but change is uncomfortable for many people. For others it can’t come quickly enough. This is a conversation that will continue.

Click here for Barlow’s slides and here for all the content from the Live Smart Texas World Obesity Day Summit. For the AAP Clinical Practice Guideline, click here.

World Obesity Day Theme, illustration by the World Obesity Federation

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March 4, 2023