The American Academy of Pediatrics just came out in favor of powerful prescription drugs (which must be taken lifelong to avoid weight regain & chronic disease) for adolescents--and potentially for pre-teens (ages 8-11)--with moderate to severe obesity. Bariatric surgery (permanently reengineering kids’ gastrointestinal systems) should also be considered for adolescents with severe obesity.
(The Academy also recommends "nutrition support, physical activity, and behavioral therapy"--but as with so many other areas of US chronic disease management, we can see where default treatments are headed: drugs & surgical procedures.)
Such radical treatment recommendations created the usual (and temporary and ineffectual) tsunami of news & social media shock and indignation.
The decades-long performative reaction to the increasingly bad news on dangerous levels of early obesity–and now 1 in 3 teens with prediabetes, across ethnicities & income levels–is itself sickening. I keep feeling waves of nausea, whenever I hear the short-term noise--yet knowing how little we are doing to prevent all of this.
Thought experiment: what if pediatricians also had the power to prescribe 13 years of systemic prevention through schools for all of our children: more physical activity & healthier nutrition habit development for all… Drugs & surgery would become a contingency plan instead of the default…
Instead, pediatricians spend the few minutes they have with each patient encouraging parents to have their kids be more active and to eat better--then, without schools' support and with screen-time etc. proliferating at home, long-term behavior rarely changes. Given our track record with widespread prescribing of ADHD meds for kids, we know what happens as soon as pharmaceuticals become an endorsed option.
We’ve seen it coming for decades–we knew better. But we think about it for a bit when each new-and-worse headline pops up. Then other clickbait and the many demands of our busy lives distract us.
Let’s be honest. The American Way of Health Care is to expect minimal behavior change. Since it is very hard for adults to sustain major improvements in their habits for many years in a row–drugs and procedures become inevitable.
Make no mistake: this is a deadly serious health AND financial disaster:
- For ourselves (with household budgets increasingly burdened by health care costs)
- For governments (increasingly dominated by health spending to treat chronic diseases that should have been prevented)
- And for the economy (sapped by lost productivity & GDP from--mainly should-have-been-prevented--chronic diseases).
Yet in contrast to so many other major issues we face as a country, including long-promised health care cost reform mirages--we can actually do something about this! Special interests are not fighting K-12 prevention--"everyone" wants kids to be healthy. And proven, evidence-based, high-ROI strategies are there for us to deploy.
It would be so much easier for each of us to be healthier, if medically-recommended lifestyle changes were built upon 13 years of healthy-habit foundation-laying K-12. Then, when we try to improve our health behavior as adults, we are just getting back on the bandwagon that we temporarily fell off of after high school–instead of fruitlessly trying to start on our own from scratch and then keep that up for the rest of our lives.
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