@ New obesity guidelines for kids

[goldengirlz]

www.nbcnews.com/news/amp/rcna64651

The AAP is no longer recommending “watchful waiting” for childhood obesity. Kids 12 and up should be offered one of the new weight loss medications (you know, the expensive ones already seeing a shortage) and kids 13(!) and up should be considered for surgery.

When you consider the socioeconomic factors that play into childhood obesity, this seems like they’re missing the boat.

[AJL]

Abso-fucking-lutely not! 🤬

[Bad Dingo]

The guidance isn't just about medication and surgery (which may be indicated and shouldn't be denied to minors under appropriate care and guidance).

""Tangible change will require significant changes that are often outside a family’s control.

“We can recommend more servings of vegetables and more fun physical activity. However, if a person’s neighborhood has no grocery stores to shop at or sidewalks or parks to walk in, these recommendations are not realistic,” said Dr. Roy Kim, a pediatric endocrinologist at Cleveland Clinic Children’s in Ohio.

The new guidelines do not directly address obesity prevention — that will come in future guidance — but they do emphasize the importance of funneling funds into public health policies aimed at obesity prevention. This includes creating safe, walkable neighborhoods, arming schools with the tools they need to support healthy lifestyles during childhood, and making sure everyone has equal access to affordable healthy food, which is not yet a reality.

“We need to make walking places safe, easy and comfortable. We need to figure out ways to leverage existing opportunities for people to exercise and access healthy food that is cheap and convenient,” said Han."

[Bad Dingo]

www.aap.org/en/news-room/news-releases/aap/2022/american-academy-of-pediatrics-issues-its-first-comprehensive-guideline-on-evaluating-treating-children-and-adolescents-with-obesity/

[sonrisa]

So everyone who doesn't support hormone blockers or affirming surgery is going to get right on this and lobby to have states ban it, right? Need to protect the children.

[goldengirlz]

Jan 9, 2023 11:06:29 GMT -5 Bad Dingo said:

www.aap.org/en/news-room/news-releases/aap/2022/american-academy-of-pediatrics-issues-its-first-comprehensive-guideline-on-evaluating-treating-children-and-adolescents-with-obesity/

The AAP can play lip service to the social determinants of health (I’m well-versed in the jargon), but those are policy issues much bigger than one physician group. What’s in doctors’ control? Drugs and surgery.

[sent]

Jan 9, 2023 11:03:22 GMT -5 Bad Dingo said:

This includes creating safe, walkable neighborhoods, arming schools with the tools they need to support healthy lifestyles during childhood, and making sure everyone has equal access to affordable healthy food, which is not yet a reality.

“We need to make walking places safe, easy and comfortable. We need to figure out ways to leverage existing opportunities for people to exercise and access healthy food that is cheap and convenient,” said Han."

How do we do this? I specifically chose to live in walkable areas since I became an adult. In my current town, people hate having to spend either their own money or even the town's money to fix the sidewalks. The town next to me has a lot of sidewalks but they make no sense. Like they cut off on one side of the road only to continue on the other side but there is no safe way to cross the busy road. Most suburban sprawl I have witnessed go up in my lifetime was designed to not have sidewalks and now we're magically going to try and undo it?

[jeaniebueller]

Jan 9, 2023 11:20:34 GMT -5 goldengirlz said:

Jan 9, 2023 11:06:29 GMT -5 Bad Dingo said:

www.aap.org/en/news-room/news-releases/aap/2022/american-academy-of-pediatrics-issues-its-first-comprehensive-guideline-on-evaluating-treating-children-and-adolescents-with-obesity/

The AAP can play lip service to the social determinants of health (I’m well-versed in the jargon), but those are policy issues much bigger than one physician group. What’s in doctors’ control? Drugs and surgery.

I think the purpose is with that recommendation from AAP, that groups that can make policy recommendations and/or apply for grants for services can now point to the AAPs position to support funding those areas.

[goldengirlz]

Jan 9, 2023 11:45:12 GMT -5 jeaniebueller said:

Jan 9, 2023 11:20:34 GMT -5 goldengirlz said:

The AAP can play lip service to the social determinants of health (I’m well-versed in the jargon), but those are policy issues much bigger than one physician group. What’s in doctors’ control? Drugs and surgery.

I think the purpose is with that recommendation from AAP, that groups that can make policy recommendations and/or apply for grants for services can now point to the AAPs position to support funding those areas.

Yeah, but none of that is new. It’s just adding to the chorus. Does anyone really believe that in the year 2023, the AAP is the first medical group to propose that we need green space and walkable neighborhoods? How much of that has changed?

[pixy0stix]

Jan 9, 2023 11:45:12 GMT -5 jeaniebueller said:

Jan 9, 2023 11:20:34 GMT -5 goldengirlz said:

The AAP can play lip service to the social determinants of health (I’m well-versed in the jargon), but those are policy issues much bigger than one physician group. What’s in doctors’ control? Drugs and surgery.

I think the purpose is with that recommendation from AAP, that groups that can make policy recommendations and/or apply for grants for services can now point to the AAPs position to support funding those areas.

Agreed. Oftentimes if we tie issues directly to kid's health, we (general) get more interest in actually changing policies/codes/rules/regulations.

[pixy0stix]

Jan 9, 2023 11:47:49 GMT -5 goldengirlz said:

Jan 9, 2023 11:45:12 GMT -5 jeaniebueller said:

I think the purpose is with that recommendation from AAP, that groups that can make policy recommendations and/or apply for grants for services can now point to the AAPs position to support funding those areas.

Yeah, but none of that is new. It’s just adding to the chorus. Does anyone really believe that in the year 2023, the AAP is the first medical group to propose that we need green space and walkable neighborhoods? How much of that has changed?

Well, the infrastructure bill that was passed last year addresses a lot of it. Where there's money, there's projects.

[jeaniebueller]

Jan 9, 2023 11:47:49 GMT -5 goldengirlz said:

Jan 9, 2023 11:45:12 GMT -5 jeaniebueller said:

I think the purpose is with that recommendation from AAP, that groups that can make policy recommendations and/or apply for grants for services can now point to the AAPs position to support funding those areas.

Yeah, but none of that is new. It’s just adding to the chorus. Does anyone really believe that in the year 2023, the AAP is the first medical group to propose that we need green space and walkable neighborhoods? How much of that has changed?

  the AAP is very influential, so its a big deal to have them on record supporting these ideas, regardless of other groups. 

[goldengirlz]

Jan 9, 2023 11:49:36 GMT -5 pixy0stix said:

Jan 9, 2023 11:47:49 GMT -5 goldengirlz said:

Yeah, but none of that is new. It’s just adding to the chorus. Does anyone really believe that in the year 2023, the AAP is the first medical group to propose that we need green space and walkable neighborhoods? How much of that has changed?

Well, the infrastructure bill that was passed last year addresses a lot of it. Where there's money, there's projects.

Of course. I’m not saying it’s not important. I’m just saying that it’s not the most newsworthy takeaway. It’s the “dog bites man” part of the news, whereas the other stuff is the “man bites dog.” (I think people get that journalism reference.)

Also, the infrastructure bill already addressing these issues a year ago is more proof that if this is the first time the AAP is mentioning this, they are wayyyy behind.

[seeyalater52]

Jan 9, 2023 11:16:28 GMT -5 sonrisa said:

So everyone who doesn't support hormone blockers or affirming surgery is going to get right on this and lobby to have states ban it, right? Need to protect the children.

Oh look, someone said exactly what I was thinking.

No further comment.

[wanderingback]

I think people should read the whole article and the direct link from the AAP before commenting. It is definitely a very nuanced subject.

I wish it would’ve addressed obesity and chronic conditions more. It can definitely be challenging to treat kids and teens with hypertension and type 2 diabetes without a comprehensive approach, which I think can be very different than a child who doesn’t have another chronic condition.

Here is one important excerpt:
The guidelines emphasize a holistic approach to obesity treatment. This includes looking at the entire life of a child, considering not only physical habits such as diet and activity levels but also mental health, environment and the social inequities he or she faces.

“There are a huge number of drivers of obesity that come from the environment itself. The more adverse the environment around you, the harder it is to live a healthy lifestyle,” Hassink said.

Tangible change will require significant changes that are often outside a family’s control.

“We can recommend more servings of vegetables and more fun physical activity. However, if a person’s neighborhood has no grocery stores to shop at or sidewalks or parks to walk in, these recommendations are not realistic,” said Dr. Roy Kim, a pediatric endocrinologist at Cleveland Clinic Children’s in Ohio."

[Velar Fricative]

I have a hard time wrapping my head around obesity as disease when obesity may be symptoms of other chronic conditions. In other words, isn’t there a lot of debate surrounding whether diabetes causes obesity or obesity causes diabetes? I’ll look this up later unless people here can confirm.

I bring this up because I assume there are children (and certainly adults) who are classified as obese but their health markers show no issues. Little to no issues with their behaviors or environments. Are those the people for whom surgery or medication would be offered to if there are no other conditions, because the AAP believes obesity itself is a disease? Not that I expect the AAP to go straight to surgery or medication for every patient, but just a thought.

[goldengirlz]

wanderingback, if that was directed me, I DID read the position statement and the news coverage. To be clear, I didn’t mean to imply that I think pediatricians will rush every obese teenager to the operating room or that every obese middle schooler will have a prescription for Wegovy, which perhaps is what some people might have thought I was saying.

Obviously I recognize that those options will be reserved for the most extreme cases. But the AAP has issued numerous position papers over the year emphasizing the importance of addressing the social determinants of health — everything from school lunches to safe streets. So in terms of what’s changed, it’s the treatment guidelines.

That’s not to discount all the other stuff or say that these position statements do nothing. But that’s not why this is blowing up in the news right now.

[wanderingback]

Jan 9, 2023 12:54:36 GMT -5 goldengirlz said:

wanderingback, if that was directed me, I DID read the position statement and the news coverage. To be clear, I didn’t mean to imply that I think pediatricians will rush every obese teenager to the operating room or that every obese middle schooler will have a prescription for Wegovy, which perhaps is what some people might have thought I was saying.

Obviously I recognize that those options will be reserved for the most extreme cases. But the AAP has issued numerous position papers over the year emphasizing the importance of addressing the social determinants of health — everything from school lunches to safe streets. So in terms of what’s changed, it’s the treatment guidelines.

That’s not to discount all the other stuff or say that these position statements do nothing. But that’s not why this is blowing up in the news right now.

Nope wasn’t directed at anyone!! People
Often don’t read the articles lol.

[icedcoffee]

Kind of related: I live in a suburb on a busy street and lobbied to get a sidewalk on my street because it would allow more people to walk to school and the local park. We received so much push back including people who were upset that their kids would no longer be eligible for bussing (because they could walk the less than 1 mile to school). You would prefer your kid ride a bus than safely walk!?!?!

Anyway---I won and we did indeed get a sidewalk about 3 years ago and we use it daily to walk to school and the park.

My first reaction to this article is that I think it's really great that they're putting into print that their is more to it than food and exercise because for a very long time kids and adults got dismissed by doctors as "just eat less and move more" and while that can be true for some, for many it is much more. So kudos to that. But it's obviously a very complex issue because of social determinants of health.

[was5]

I hope the updated guidelines lead to more insurance coverage for medications for teens.

My 15 year old was referred to a pediatric endocrinologist by her pediatrician because her insulin levels were elevated. She is also considered obese (always in a high percentile for her weight but gained a lot during Covid when her school was remote for a year in middle school). He prescribed medication but it would have been $1200 per month. I have been overweight my entire life so I was happy to have an option for my daughter, until I realized how expensive it would be. Meeting with the endocrinologist was the first time I didn't feel moral judgement for being overweight myself or for my child being overweight. It was approached from a lens of predisposition due to genetics and I really appreciate that.

[calmcosmo]

How about a bar height storage piece?

We have a similar space and my husband built a bar and we used some remnant granite for the bar top. We use it to store pool stuff (towels, sunscreen toys, etc) since our sunroom/screen porch opens to our back yard. However, when we entertain it turns into a place to put food and drinks and to help with the flow when we entertain.

[AJL]

My problem with any of the semaglutide (Wecovy, Ozempic, etc) drugs being used for weight loss is that once those drugs have stopped, the patient usually gains all the weight back that they lost. It’s not calories in, calories out. The mechanism these drugs use is to delay gastric emptying (food stays in the stomach longer so you feel fuller longer), increase insulin production, and increase insulin sensitivity. It also suppress appetite all together which can lead to malnutrition if people are not being adequately fed, especially children just starting puberty.

But my biggest problem is we have no long term studies to indicate how this impacts growing bodies especially children. Secondly is that if weight loss is the goal then this is a lifelong medication. The weight will come right back because you can't teach yourself to suppress your appetite or teach your digestive system to slow down.

I have a lot of experience with this drugs as a diabetic. I would never consent to putting my child on them for weight loss. As for WLS, fuck that! Not for kids without a severe, last-ditch life saving reason.

One more thing about obesity being detrimental to mental health in young people --- why do you think that is? Could it be that we live in a deeply fat phobic, misogynistic, ant-Black society? So rather than change society, we’re going to keep telling fat kids that their fatness is the problem and they need to chemically and surgically alter their bodies.  And don’t anyone come after me to relate my argument to the anti-trans legislation that’s getting passed. It’s not the same.

[wawa]

Jan 9, 2023 11:25:43 GMT -5 sent said:

Jan 9, 2023 11:03:22 GMT -5 Bad Dingo said:

This includes creating safe, walkable neighborhoods, arming schools with the tools they need to support healthy lifestyles during childhood, and making sure everyone has equal access to affordable healthy food, which is not yet a reality.

“We need to make walking places safe, easy and comfortable. We need to figure out ways to leverage existing opportunities for people to exercise and access healthy food that is cheap and convenient,” said Han."

How do we do this? I specifically chose to live in walkable areas since I became an adult. In my current town, people hate having to spend either their own money or even the town's money to fix the sidewalks. The town next to me has a lot of sidewalks but they make no sense. Like they cut off on one side of the road only to continue on the other side but there is no safe way to cross the busy road. Most suburban sprawl I have witnessed go up in my lifetime was designed to not have sidewalks and now we're magically going to try and undo it?

I mean...no, not by magic. Whole companies and gov't departments worth of engineerings and planners are out there making projects happen to fix all the messed up infrastructure to allow for active transportation. A very typical project type is to take a holistic look at a suburban area, map out their missing links in their pedestrian network, and then figure out how much it'll cost to fix it all and make a prioritization plan for them to tackle it. And then they write grant applications so they can afford to actually do it. It is happening. Just not overnight. We had 50 years to build this bullshit, it's gonna take a minute to fix it all. All the new federal funding is helping.

Well funded Safe Routes to Schools programs can also help move the needle on this topic specific to kids. also in terms of new development lacking ped infrastructure, lobby your local electeds on including pedestrians infrastructure in their APFO or concurrency requirements or enact complete streets ordinances.

[Velar Fricative]

AJL, that really resonated. We basically are trying to improve the mental health of larger children and teens because the rest of society is so cruel to them. That’s an us problem being thrown on them to fix, however well-intentioned and supportive their healthcare providers are.

[wanderingback]

Jan 9, 2023 13:58:59 GMT -5 AJL said:

My problem with any of the semaglutide (Wecovy, Ozempic, etc) drugs being used for weight loss is that once those drugs have stopped, the patient usually gains all the weight back that they lost. It’s not calories in, calories out. The mechanism these drugs use is to delay gastric emptying (food stays in the stomach longer so you feel fuller longer), increase insulin production, and increase insulin sensitivity. It also suppress appetite all together which can lead to malnutrition if people are not being adequately fed, especially children just starting puberty.

But my biggest problem is we have no long term studies to indicate how this impacts growing bodies especially children. Secondly is that if weight loss is the goal then this is a lifelong medication. The weight will come right back because you can't teach yourself to suppress your appetite or teach your digestive system to slow down.

I have a lot of experience with this drugs as a diabetic. I would never consent to putting my child on them for weight loss. As for WLS, fuck that! Not for kids without a severe, last-ditch life saving reason.

One more thing about obesity being detrimental to mental health in young people --- why do you think that is? Could it be that we live in a deeply fat phobic, misogynistic, ant-Black society? So rather than change society, we’re going to keep telling fat kids that their fatness is the problem and they need to chemically and surgically alter their bodies.  And don’t anyone come after me to relate my argument to the anti-trans legislation that’s getting passed. It’s not the same.

Yes, my understanding is that people can expect to take the medications as lifelong, just like many other meds for chronic conditions.

I believe with Wegovy specifically there’s a trial looking to see if it improve cardiovascular outcomes in users. I think if it does, that’ll def be another reason people will be recommended to take it long term also.

ETA: I’m not saying I am or am not pro these medications, just was pointing out that yes indeed they are considered chronic/long term medications in case people weren’t aware.

[imimahoney]

My daughter is obese. She has been in the 90-99th% for weight since she was 3. Between ages 2-3 she gained 30 lbs and since then she has been overweight. No one knows why. She is turning 8 soon and weighs more than her 11 yr old brother who is in the 60th% for weight. She is in the 40th% for height so it's not just like she's big, she is just very heavy.

She eats well (for an 8 yr old) does several sporty activities and doesn't drink sugary drinks. It kills me because she and we do everything she is supposed to do and is still heavy. She knows she is heavy and hates it. She has a very large stomach and notices how her body is so different than her peers. We tell her she's beautiful, get her adorable outfits, pump up her self-esteem constantly but it only goes so far compared to what she sees and hears daily.

She's had blood work and it's all normal, obesity runs in my husband's family but not until puberty age.

I would love for some help from docs to actually figure out why she is so heavy rather than be told to just give her diet pills. How frustrating.

[pugz]

AJL yes I've been reading a lot about the injectable medications and the weight will absolutely come back when folks stop taking the meds. And I'm cool with lifelong meds for things like my mental health, but we have years of research on those. Something I was reading the other day mentioned how Phen Phen (I think it was that one) was on the market for 5 years before they discovered it had bad long term consequences and then the drug was pulled. Research in the early stages was positive and it was FDA approved.

It's all very overwhelming and I feel for parents that are trying to navigate all of this with their kids. It's so hard to make any kind of risk/benefit analysis because of our culture and the way fat folks are treated.

[Saudade]

Jan 9, 2023 17:48:15 GMT -5 pugz said:

AJL yes I've been reading a lot about the injectable medications and the weight will absolutely come back when folks stop taking the meds. And I'm cool with lifelong meds for things like my mental health, but we have years of research on those. Something I was reading the other day mentioned how Phen Phen (I think it was that one) was on the market for 5 years before they discovered it had bad long term consequences and then the drug was pulled. Research in the early stages was positive and it was FDA approved.

It's all very overwhelming and I feel for parents that are trying to navigate all of this with their kids. It's so hard to make any kind of risk/benefit analysis because of our culture and the way fat folks are treated.

Re bolded:

This isn't actually what happened. Fen-Phen was two different, already approved drugs that were mixed together to make Fen-Phen, bypassing the FDA approval process. Then the reports came in about the cardiac issues and it was subsequently pulled. 

[Saudade]

I have mixed feelings:

I hope it leads to better coverage wrt insurance, especially for IHS and Medicaid patients.

I worry it will be another metric that I'll be evaluated on, which is bullshit.

[wanderingback]

Jan 9, 2023 16:17:55 GMT -5 imimahoney said:

My daughter is obese. She has been in the 90-99th% for weight since she was 3. Between ages 2-3 she gained 30 lbs and since then she has been overweight. No one knows why. She is turning 8 soon and weighs more than her 11 yr old brother who is in the 60th% for weight. She is in the 40th% for height so it's not just like she's big, she is just very heavy.

She eats well (for an 8 yr old) does several sporty activities and doesn't drink sugary drinks. It kills me because she and we do everything she is supposed to do and is still heavy. She knows she is heavy and hates it. She has a very large stomach and notices how her body is so different than her peers. We tell her she's beautiful, get her adorable outfits, pump up her self-esteem constantly but it only goes so far compared to what she sees and hears daily.

She's had blood work and it's all normal, obesity runs in my husband's family but not until puberty age.

I would love for some help from docs to actually figure out why she is so heavy rather than be told to just give her diet pills. How frustrating.

Ugh I’m sorry her doctors told her to take diet pills. That does not sound appropriate in your daughter’s case at all. I would def think about switching doctors.