The Leap of the Rabbit

Pediatric Obesity: Making the Leap from Knowing to Doing

We are in the midst of a great leap forward in pediatric obesity – from knowing to doing what we should in caring for the young persons with this chronic disease. ATPO 2024 at the University of Minnesota Center for Pediatric Obesity Medicine (CPOM) last week made this clear. We know much more about how to care for these children and youth today. But many practical hurdles make the leap to doing it quite challenging.

Regardless of those challenges, skilled providers, youth, and their families are indeed making that leap.

The Leap from Guidelines to Practice

Release of the Clinical Practice Guideline for Children and Adolescents with Obesity by the American Academy of Pediatrics last year was a huge leap forward. At the same time, it was daunting. For one thing, the proposal of such great change – from stonewalling to caring for these kids – was more than some people could handle. They imagined it would be apocalyptic.

In reality, though, Sarah Hample explained that the release of the guideline was merely the start of a process. It took 17 years to develop the guideline. So naturally, it will take time (hopefully not 17 years) to implement it.

Drivers and Hurdles for Delivering Care

With great clarity, then, Susanne Purnell told of the frustration that drove her to embrace the challenges of implementing obesity care in her primary care pediatric clinic:

“The driver behind my decision to take on obesity medicine grew from a frustration in seeing an unmet need for children in our community. I was absolutely convinced that care for these kids needs to start early and continue long term in the child’s medical home.

She described many hurdles, but the biggest of them relate to bias in social and professional norms. Because people presume that this is not a real disease, health plans are off the hook when they discourage care. Physicians avoid the subject, rationalizing their neglect of the problem with comments like “They know what they should do. I don’t have time.” Patients and families avoid the subject, uncomfortable with the idea that obesity is a disease. This intrinsic bias gets directed inward as blame or guilt for the parent and child.

The Challenge for Families and Young Persons

One of the best parts of this three-day program was the opportunity to learn from a panel of young persons and their parents. It is stunning to realize that parents have to protect their children from the bias that providers might have against them and their children. One mother, Stacy, described it quite well:

“The experiences that I have had are far worse than my daughter has had and I am so grateful it has improved. People have thrown things out of cars at me, yelled at me. They would rather we die than be fat. I knew that my kids would have issues with weight because all of my family did. So I have felt a very strong urge to protect my kids from a well-meaning physician who just doesn’t get it.

“I know you’ve been taught that fat people are gross, but just stop it. Check that opinion at the door.”

It is exhausting to seek care and find malice – even if it is only implicit.

An Exciting Future

But without a doubt, we are in the midst of exhilarating progress. Aaron Kelly, Co-Director of the CPOM, closed the meeting with some thoughts about what lies ahead. He says consensus is growing stronger and stronger that obesity is a disease and not a social construct, so the stigma will fade. First line treatment will include physiological therapy, costs will drop, insurance coverage will improve, and primary care providers will become more skilled with delivering it. He closed with these encouraging words:

“We’ve really entered a new era in our field. The pipeline of new therapies is strong and growing. We have critical unanswered questions, but you can be sure, they’re going to get answered.”

Click here for Kelly’s presentation on the outlook for pediatric obesity medicine. For further perspective, click here.

The Leap of the Rabbit, painting by Amadeo de Souza-Cardoso / WikiArt

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February 26, 2024

One Response to “Pediatric Obesity: Making the Leap from Knowing to Doing”

  1. February 29, 2024 at 9:36 am, Valerie O'Hara said:

    thank you Ted for highlighting this amazing course – which provides comprehensive science and empathy to help inform pediatric obesity care by experts in the field!