Understanding new, more aggressive childhood obesity guidelines
More than 14 million U.S. children and teens live with chronic obesity, according to the American Academy of Pediatrics.
In early January, the academy released new guidelines for treating childhood obesity, some of which have received pushback from some medical professionals.
The guidelines in question include the possible use of weight loss medications for teens 12 and older, and possible weight loss surgeries for teens 13 and older.
For clarification on the new guidelines, WYSO’s Jerry Kenney spoke with Dr. Carol Barlage from the Rocking Horse Community Health Center in Springfield.
Dr. Carol Barlage: I think there's probably a lot more context than what you may have read. I think it is a very complex issue. So, it could be the right way to go in several situations, other situations it's going to be a lot more difficult to decide whether we should continue with intensive lifestyle measures versus trying the medical treatments that are available or the surgical procedures. There's a lot of things that's influencing childhood obesity these days, a lot of social determinants of health, as well as genetics and home environment. And I think we used to look at it in terms of people's life choices, but it's not just about that anymore. Food insecurity plays a big role for the patients I see. And so, I do think in some situations it is going to be the right way to go.
Jerry Kenney: So, I know it's been about 15 years since the pediatric association has updated its guidelines, but if I understand you correctly, you're telling me the focus on healthy lifestyles is still a big part of their guidelines and recommendations?
Dr. Barlage: That's correct. I mean, the mainstay of treatment remains focusing on lifestyle interventions and a big part of that, and a big part of what we do as primary care providers, is something called motivational interviewing, which you may have heard of, but it's really trying to assess where people are in terms of their willingness to change and even ability to change. In our case, because we do a lot of focus now on looking at our patients ability to afford food, to have food in the house, and that is definitely been a situation for many of our patients where they don't have enough food in the home and the food that they are able to afford, or at least the food they think they can afford, is all of the things we don't want them to be eating.
A second thing is, we serve a lot of patients who've lost one or both parents and are either in foster care or in the care of relatives. We also have many patients who have had significant trauma, often starting at very young ages, and so they use food as a coping mechanism and every generation before them has done the same. Lack of education or literacy is another social determinant of health. We also have, most recently, and I think I heard something on your station about this, but most recently we've had a very large influx of immigrants from other countries and that also puts a whole new dynamic to this situation.
JK: So along with these new guidelines, what is it that organizations like Rocking Horse really need from state, local, federal governments or other stakeholders and the community at large?
Dr. Barlage: One thing that's really focused on in the new guidelines is that it's really the availability of that intensive lifestyle management treatment. Turns out (for) most people the magic number is 26 hours or more in terms of spending time with educated providers who can give them that education needed to change their life. And right now, for instance, Rocking Horse has never had a nutritionist. We don't have the budget to hire somebody who can do that. Many of our patients, although we have access to two large children's hospitals that do have programs dedicated to childhood obesity, they can't work out the transportation or there's so many other factors influencing their ability to get to those appointments. So, in terms of local funding, government funding, state funding, I think once this is recognized more as a real illness versus a stigma, we'll hopefully be able to get to the point where we can get that funding.
JK: What do you think we should be paying attention to that maybe we haven't even talked about yet?
Dr. Barlage: You know, I think we need to be a little more aggressive rather than passive, both as providers but as a society as well. Big business that markets all these unhealthy foods to the people who are most vulnerable —that's one aspect. There's lots more. And then as providers, you know, there's always been a focus on kind of watchful waiting. You know, they'll kind of grow out of it. And I think the new guidelines emphasize that, no, we should really start treatment as soon as it's recognized.