This Monday, the first guidance on childhood obesity in 15 years was released by the American Academy of Pediatrics2 (AAP), and it’s receiving a lot of attention. The academy is suggesting for the first time that medication can be offered to kids as young as 12, and that weight loss surgery can be offered to those as young as 13. This is a revision of the existing guidance to use a “watchful waiting" approach that delays more intensive treatment until children are older. This is nothing new. “As a physician, I was taught no nutrition and almost no lifestyle strategies to aid my patient care,” integrative family physician Madiha Saeed, M.D. tells mindbodygreen in reaction to this news. “Putting more resources into weight management education, encouraging healthy behaviors, changing food policies, and providing healthier options in food deserts [is essential]. This latest recommendation is horrifying.” “There are many interventions that can be done before bariatric surgery in [the pediatric] population, including adhering to appropriate lifestyle changes from changing up diet, adding more exercise, supporting sleep and mental health,” echoes board-certified family medicine physician Bindiya Gandhi, M.D. Before turning to meds and going under the knife, we need to consider to the underlying drivers of this metabolic health crisis. It doesn’t take a rocket scientist to determine that pharmaceuticals and surgeries will dwarf the costs of changing school curriculums to reflect our dire need to get our kids and our future generations thriving. Yes, I’m probably oversimplifying the complexity of what would be required for an overhaul of our education system, but it’s clear to me it needs one. This is also bigger than our education system, and goes back to what we as a nation place a financial value on. What if we subsidized vegetables, fruits, and nutrient-dense animal products, instead of just corn and soy? It also extends to habits at home. Research shows that one’s home environment embracing and implementing good nutrition5 is paramount. “Obesity in children is not simply a child problem. It involves the entire family system, and therefore effective treatment requires a systems-level approach,” Nicole Beurkens, Ph.D., C.N.S., a clinical psychologist, nutritionist, and special education teacher with almost 20 years of experience supporting children, young adults, and families, tells mindbodygreen. “Supports in the areas of nutrition, exercise, sleep, stress management, family relationships, and more are all components of effectively treating obesity in children. Patients and families should be provided with information and access to all of these things, with ongoing support for implementation, before prescription medications or weight loss surgeries are utilized,” Beurkens adds. Childhood obesity is complex and multifactorial (genetics, lifestyle, school environment, food security, family dynamics, socioeconomics, psychological factors, and trauma all play a role) and there are no easy answers here. But we must consider the potential ramifications of measures as drastic (and irreversible) as surgery. “While those interventions may provide benefit for some children, there are known physical and mental health risks involved with those approaches over both the short and long term of a child’s life,” says Beurkens. Furthermore, “Children are still growing physically, mentally, and emotionally, so when they are provided with the right resources in a positive light, it could be life-changing,” adds Saeed. “These new guidelines will not change the trajectory of obesity, but further fuel the problem.”
