Childhood Obesity: Are Drugs and Surgery the Answer?

Childhood Obesity: Are Drugs and Surgery the Answer?
Overweight boy consulting with doctor in office. (Shutterstock)
Martha Rosenberg
2/7/2023
Updated:
3/24/2023
0:00
In January, the American Academy of Pediatrics (AAP) issued its new clinical practice guideline for the evaluation and treatment of overweight and obese children and adolescents.

The health of an estimated 14.4 million U.S. children and adolescents is affected by obesity and the trend is escalating. In 1963, five percent of children and adolescents were obese—by 2018 that number had jumped to 19 percent.

“A predictive epidemiologic model estimates that if 2017 obesity trends hold, 57 percent of children aged two to 19 years will have obesity by the time they are 35 years of age, in 2050,” writes the AAP in the new guidelines.

Obesity “puts children and adolescents at risk for serious short- and long-term adverse health outcomes later in life, including cardiovascular disease, including HTN [Hypertension]; dyslipidemia [abnormally elevated cholesterol or fats in the blood]; insulin resistance; T2DM [Type 2 diabetes mellitus]; and nonalcoholic fatty liver disease,” writes the AAP.

Obese youth may also have elevated systolic blood pressure, low-density lipoprotein, lower insulin sensitivity, and “poor psychological and emotional health, increased stress, depressive symptoms, and low self-esteem.”

According to the new guidelines, interventions “could involve any approach, including screening, counseling, medically managed weight loss, pharmaceutical treatment, or surgery.” Consequently, some doctors, public health experts, and parents are now pushing the new guidelines that include weight loss medications such as diet pills and bariatric surgery for kids as young as 12 and 13 respectively.
These measures are in extreme contrast to the lifestyle changes typically advised for children.

Opposition to Guidelines

Dr. Robert Yoho, a retired surgeon, told The Epoch Times that “bariatric surgery showed an intermediate-term death rate of about one in 250 in adults [in older studies] making it one of the riskiest procedures known.”

The hard evidence for surgical care “ranges from speculative to nonexistent,” said Yoho. “The field is almost unstudied—we rely on tradition—we give surgeons near-complete therapeutic autonomy, and many of their net outcomes are in doubt.”

Dr. Bill Wilson, a family physician, and author of “Brain Drain,” told The Epoch Times, “The AAP guidelines are ill-conceived because they are clearly not science-based. If you don’t understand how to define and measure a condition [obesity], how can you possibly effectively treat it? The discussion should begin and end with solid science.”

According to Wilson, the long-term consumption of highly processed foods manufactured by Big Food, or the “Food Industrial Complex,” as he calls the industry, nudges people toward mental disorders even as it compels the body to store extra fat—regardless of how much the person eats.
Dr. Marc Siegel a professor at NYU Langone Medical Center told Fox News Digital that semaglutide, one of the recommended drugs (marketed as Ozempic, Wegovy, and Rybelsus), is so effective it actually mimics bariatric surgery but “It’s too soon to be using them in kids,” he said. Surgery is “extremely problematic” for children added Siegel and the AAP guidelines need to be clearer.
Other experts have raised the concern that medications and surgery bring risks. While patients and doctors both may like a quick fix, the new guidelines remain controversial when they do nothing to address the root causes of obesity, which often come down to high-calorie processed foods, stress, and a sedentary lifestyle. Though that common sense explanation would seem apparent to many, leading health authorities like the AAP have a more complicated explanation.

Is Obesity a Chronic Disease?

The National Institutes of Health declared obesity a “chronic disease” in 1998 and the AAP concurs. Risk factors for the “disease” of obesity include “adverse childhood experiences,” and “weight bias and stigma considerations,” it says. “[M]ultiple influences” cause obesity including “individual and familial risk factors” and “broader structural and contextual inequities,” adds the Academy.

The AAP guidelines downplay personal and parental responsibility for obesity as well as overeating. In some cases, the guidelines emphasize political elements over personal behaviors.

“Inequalities in poverty, unemployment, and homeownership attributable to structural racism have been linked to increased obesity rates,” note the guidelines, while also questioning the impact of ultra-processed foods often linked to chronic illness and obesity.

Bans on Drug Advertising Work

The U.S. is hardly the only industrialized country with growing obesity rates, including in children. However, other countries have taken a look at the causes before recommending surgery or diet drugs for children.
For example, the UK identified a clear connection between advertising junk food—high sugar, high fat, high-calorie foods—on public transport routes and obesity and enacted a ban on such advertising in 2019. In just three years the ban resulted in 94,867 fewer cases of obesity than expected according to researchers at the University of Sheffield and the London School of Hygiene & Tropical Medicine—a nearly five percent decrease.
How were declines in obesity ascertained? One investigation method was to compare the purchasing habits of nearly 1,000 Londoners following the advertising ban, with those of 1,000 people in the northeast of England where the ban was not in effect.
In addition, clear drops in the incidence of actual obesity-related diseases were also seen. “The same study found the policy has led to 2,857 fewer cases of diabetes, and 1,915 fewer cases of cardiovascular disease,” reported the BBC. As anyone who works in advertising will tell you, “advertising works.”

Is Obesity Acceptance Part of the Problem?

Medications and surgery present unique and new risks, and while people know their food choices and activity levels are critical, some just can’t find the will to make changes.
A society in which there is a “celebration” of obesity and “body positivity movements“ has had the effect of silencing doctors, Dr. Nicole Saphier, a radiologist and director of breast imaging at Memorial Sloan Kettering told Fox News Digital.

“All of a sudden, physicians are being told they can’t use the terms obese and overweight,” she said.

“Americans, in general, are always looking for the quick fix,” said Saphier. “We want a pill, a quick diet, anything that could give us a positive outcome with minimal effort.”

What About Prevention and Eating Well?

What about prevention? “This guideline does not cover the prevention of obesity, which will be addressed in a forthcoming AAP policy statement,” says the AAP.

The guidelines do note, however, that “the AAP’s Bright Futures recommendations, which are based on systematic reviews and expert panels, offer prevention guidelines.”

Consumption of highly processed foods containing hydrogenated oils and high-fructose corn syrup is a major driver of obesity but is given little mention in the guidelines in preference of the “underlying genetic, biological, environmental, and social determinants that pose risk for obesity,” which shift focus from eating and personal responsibility.

The guidelines do link poor diet—particularly fast food—to weight gain, but claim “The association between sedentary behavior and adiposity [obesity] has been shown to range from small to inconsistent.” It is similarly ambivalent about snack foods.

“A recent systematic review of body fat and consumption of ultra-processed foods (defined as snacks, fast foods, junk foods, and convenience foods) in children and adolescents found a positive association, but noted that longer-term studies examining the association of these foods and obesity are needed.”

High-fructose corn syrup does not appear in the guidelines, though the ubiquitous ingredient is routinely linked to deleterious physical and mental effects.
The availability of fattening fast food and aggressive marketing to children merits only a paragraph or two in the guidelines. Other medically recognized obesity drivers like excessive screen time, inadequate sleep, early antibiotic exposure, and endocrine disrupters are mentioned but only briefly.
And what about parents’ role in children’s weight and diets? “It sounds harsh, but I do think parents should be held accountable for their children becoming morbidly obese,” said Saphier who is the mother of three children.

More Drugs For Children?

For years, many medical and mental health professionals have charged that children are being overmedicated whether for attention-deficit/hyperactivity disorder, or emotional and mood problems that are increasing youth diagnoses. Culture and lifestyle are major culprits in these afflictions, but are not addressed with the kind of money and political willpower marshaled by drug makers.
“Of course, they’re going to treat obesity with pharmaceuticals,” tweeted political commentator Matt Walsh of the new guidelines.
Originally approved as a diabetes drug, semaglutide injections have a list price of more than $1,600 per month. Like other new, high-priced drugs, this cost provokes insurance denials and risks raising health care costs for everyone.
According to MedlinePlus, a health site published by the National Library of Medicine, semaglutide “may increase the risk that you will develop tumors of the thyroid gland, including medullary thyroid carcinoma.” It is also unsafe for people with multiple endocrine neoplasia syndrome type 2. More dangers associated with semaglutide were identified by Stat News in January.

Are the AAP Recommendations a Conflict of Interest?

The American Academy of Pediatrics, like many professional medical associations that influence medical practice, has drugmaker corporate sponsors. These include Johnson & Johnson (among the AAP’s “top 10 donors”) Abbott, Merck, and Novavax.

If obesity is defined more as a disease arising from systemic racism or inequality rather than an affliction resulting from poor-quality food and problematic lifestyles, it could become a boon to drugmakers and alleviates Big Food of its culpability.

Critics of the guidelines also note that in 2017, the AAP received funding from Pfizer and is certainly a leading voice for childhood vaccinations. A patron sponsor of AAP is Novo Nordisk which makes Wegovy, (semaglutide) a leading weight loss drug, now recommended in the guidelines.
The AAP did not immediately answer The Epoch Times’ questions of whether the new guidelines could represent conflicts of interest in light of their drug maker funders. In 2013, the Milwaukee Journal Sentinel and MedPage Today reporter John Fauber reported that the AAP endorsed guidelines that recommended particular acne drugs when 13 members on a 15-member panel were “paid consultants or speakers for companies that make the drugs.”

How Can Parents Prevent Obesity in Their Children?

Long-standing common-sense advice backed up by research urges families to emphasize healthy food and activity. Outdoor walks, biking, and eating more vegetables and whole foods, while avoiding processed foods are critical—especially because children spend so much time indoors at school.
The obesity advice given by the Harvard T.H. Chan School of Public Health is that parents who want to slim their children down or prevent obesity should:
  • Limit unhealthy foods served to children, including refined grains and sweets, processed meat, and sugary drinks.
  • Increase the children’s physical activity.
  • Limit children’s television time, screen time, and other “sit time.”
  • Try to improve their sleep and reduce their stress.
But policy changes could also address the obesity crisis says information on the Harvard site. They include:
  • Ending tax subsidies for TV advertisements for unhealthy foods targeted at children.
  • Taxing artificially sweetened beverages.
  • Teaching children and parents about unhealthy beverages, and the effects of physical activity and screen time.
  • Increasing physical activity in PE [physical education] classes through policy changes and teacher training.
The lesson from the 2019 London ban on ads for high-sugar, fat, and calorie foods is also worth learning from.

There may be many reasons for childhood obesity but the impact of cheap high-calorie foods that are designed to be irresistible, can’t be overlooked—especially when they are the most readily available and advertised foods.

Nor can we ignore the fact that some of the most valuable and profitable companies are investing heavily in technology, including artificial intelligence, to better grab our attention and keep us clicking, scrolling, watching, sitting—and getting fat.

Martha Rosenberg is a nationally recognized reporter and author whose work has been cited by the Mayo Clinic Proceedings, Public Library of Science Biology, and National Geographic. Rosenberg’s FDA expose, "Born with a Junk Food Deficiency," established her as a prominent investigative journalist. She has lectured widely at universities throughout the United States and resides in Chicago.
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