America’s unhealthy weight obsession now affecting kids
“If diets worked, Oprah and I would be thin.” — author Aubrey Gordon
Our culture is obsessed with being thin, much to our detriment. Adults spend more than $66 billion per year on weight loss programs that are generally ineffective. Now we have focused this national obsession on our children, with the controversial recently released American Academy of Pediatrics (AAP) guidelines on treating childhood obesity.
These guidelines suggest measuring Body Mass Index annually and define obesity as a BMI of greater than the 95th percentile for each age. The experts recommend referring children as young as 2 for intensive health behavior and lifestyle treatment. They also recommend weight loss drugs for obese children as young as 12 and consideration for bariatric surgery for severely obese kids starting at age 13.
Twenty percent of our kids are considered obese. There are many factors responsible for this, most importantly, the change in our food supply over the past 50 years from natural foods to highly processed foods with much added sugar, high fructose corn syrup, salt and fat. The food industry has mastered making food taste better with these additives to sell more product without regard to the public health consequences. Oversized bottles of sweetened beverages are one of the worst offenders; kids consume extra calories daily by drinking sodas and juices instead of water.
American kids have become increasingly sedentary over the same 50 years. Instead of playing outside, children now spend most of their free time in front of a computer or phone screen, TV or video game. The net effect is obvious; as kids consume more calories and burn fewer calories, they have gained more and more weight.
Thus, our culture and the food industry have created a problem and now the medical establishment is recommending drugs and surgery to treat it, instead of addressing the original problem. More direct prevention strategies, such as encouraging healthy eating, sports participation and physical education at all ages makes more sense.
What are some problems with these AAP guidelines?
First, BMI is a flawed measure. It does not account for the fact that bone and muscle weigh more than fat. Thus, muscular individuals can be inappropriately labeled as obese. The categorization of ideal weight is quite arbitrary and does not account for genetics or ethnicity. Further, there is no evidence that being mildly overweight is harmful to health.
Such focus on weight starting at early ages will surely lead to more children with eating disorders. Fat shaming violates one of the sacred principles of medicine — first do no harm.
The recommendation to consider giving drugs to kids for weight loss is quite concerning. There are currently four drugs approved for obesity treatment in children 12 years and older. Wegovy (semaglutide) was approved in December. I could not find any data on the long-term safety of this drug in children. Wegovy has a black box warning of the potential to cause thyroid tumors.
It also can cause pancreatitis, acute renal failure, and gallbladder problems. The cost is $1,386 per month and it is usually not covered by insurance. Studies from Novo Nordisk, the manufacturer of the drug, showed that kids regained weight after the drug was stopped, suggesting it needs to be given for years. Do we really want to be giving weekly injections of this expensive drug to our kids?
More concerning is the recommendation to consider bariatric surgery on obese kids aged 13 and over. We certainly do not know the long-term metabolic effects of this on a growing child and most people regain weight after this surgery.
Addressing the causes of childhood obesity makes more sense than implementing these potentially harmful treatments. Our focus should be on making sure children have access to healthy foods and a safe place to play after school.