health

New guidance: Use drugs, surgery early for obesity in kids

39 Comments
By JONEL ALECCIA

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The guidelines aim to reset the inaccurate view of obesity as “a personal problem, maybe a failure of the person’s diligence,” 

Not exactly like asthma as they say, because it is a health problem with strong relationship with culture and society values, but definitely not something to be effectively dealt just by considering it a patient failure.

The new guidelines may seem extreme but this is only because the option of a conservative approach is much worse for the children. The main causes of the obesity problem will not be solved with this, but many children will at least have a bigger chance for a long and healthy life while much more difficult measures (like a complete reworking on the culture and diet in the US) can be achieved.

In a way this is not a "US doctors like to give diet drugs and surgeries to kids" situation. it is a "US kids are so affected by obesity than drugs and surgeries to prevent it are less dangerous" one.

-4 ( +3 / -7 )

virusrexToday  08:22 am JST 

Not exactly like asthma as they say, because it is a health problem with strong relationship with culture and society values, but definitely not something to be effectively dealt just by considering it a patient failure.

It is like asthma as they say. The person who said so

“This is not different than you have asthma and now we have an inhaler for you,” Hassink said.

That is Doctor Hassink.

Are you saying the doctor is wrong?

1 ( +5 / -4 )

It is like asthma as they say. The person who said so

If you make no argument against the differences written in the comment you are actually accepting it is not exactly as asthma, you just disagree while being unable to disprove logically the very important difference mentioned.

Are you saying the doctor is wrong?

No, that is a completely invalid misinterpretation, I am saying there is a very important difference that is not present in the analogy, that is worth considering.

-4 ( +2 / -6 )

I don't want to parent-shame - although I do think there is a right way to parent and a wrong way - but will quickly prescribing pills and surgery to obese kids do anything to curb the problem in the future?

That depends on what problem you are referring, if it is about the culture and diet habits that cause this on the first place? then no. If it is about the health problems that will affect these children in the future then this measure will be more effective than what is included in the current guidelines that expose them to higher risks for their health.

 I would argue that they should be used as a last resort.

Which the are, the difference made now is between waiting to use these as a last resort or using them early, according to the authors of the guidelines an eariy use is better.

How about just eating less?

As useful a solution as saying "how about drinking less" to solve alcholism, or "smoking less" to solve tobacco related health problems.

-7 ( +1 / -8 )

virusrexToday  08:43 am JST

If you make no argument against the differences written in the comment you are actually accepting it is not exactly as asthma, you just disagree while being unable to disprove logically the very important difference mentioned.

No. You misread my comment, as you misread the article. And so your analogy is wrong. Here is the quote from the article again:

“This is not different than you have asthma and now we have an inhaler for you,” Hassink said."

No, that is a completely invalid misinterpretation, I am saying there is a very important difference that is not present in the analogy, that is worth considering.

What interpretation? It was a question. Do you understand the difference?

And who are you to say an analogy is worth considering? It obviously was not worth considering by the doctors in the article. Maybe you need to make a better analogy, or one that is logical, and people will consider it.

4 ( +6 / -2 )

No. You misread my comment

You provide zero arguments, there is nothing to misread about that.

And so your analogy is wrong

What analogy? I did not made any. You are very confused and would benefit from actually reading the article and the comments you are trying to criticize.

What interpretation?

The one you make about an important difference between the problem and the one used in the analogy meaning (only to you) that a contradiction is there, in actuality there is no such thing it is simply one thing that is not included in the analogy made but that is important to consider.

And who are you to say an analogy is worth considering?

I did not say the analogy is worth considering, you need to carefully read what you are trying to criticize.

-7 ( +1 / -8 )

it would be best to use the pills and surgeries as last resorts

Nothing in the article says they are the first option, it just say that the timing for using them as a last resort can be early to save lives.

All a quick medical or surgical intervention teaches them is that there's an easy fix for everything.

That comes again from the assumption that it is a quick and easy fix, when instead it is still a last resort, and that it does not replaces lifestyle changes just support them.

If pills and surgery is used only after lifestyle changes have failed or are ineffective, then we help the kids in trouble now, and perhaps introduce healthier habits to future generations.

They are used after the measures are not being effective but the important part is that according to the authors of the guidelines delaying the introduction of these last resort measures have a worse outcome which leads to lost lives, which is why they recommend to be used early (after better measures have failed).

To put a more extreme example is like saying that anemia can be solved by dietary and lifestyle changes or by blood transfusion, for some people transfusions are a necessity, even if this reduces the need for the lifestyle changes since it will "solve" the immediate problem, not doing transfusions but on the most extreme cases would help putting pressure on the patients to be successful with better solutions, but at a cost in lives.

-8 ( +0 / -8 )

I'd hate to see healthy habits such as playing sports, putting your game controller down, and eating well be replaced with pills and surgery.

Makes sense. But I would suspect that very few people who would take these pills, would be likely to put the controller down and play sports to lose the weight, or they would have done it already. And if taking these pills helps them lose weight and be healthier, I'm a proponent.

I say that as someone who works out 6 mornings a week, for at least 1.5 hours, and have lived a life of fitness. So it's not like I'm not a strong, strong proponent of exercise.

-4 ( +1 / -5 )

After 3000 years of civilization and probably longer, not to mention even infinitely longer years of evolution, the answer to obesity is medical intervention? I say hell no!

When I was a kid, everyday after school I played outside if it wasn't raining. Everyday. We were so active there wasn't a single obese child in our neighborhood. NOT ONE.

The answer is not drug treatment and surgical intervention, it is getting children to play outside. In the dirt.

Ignore those who continually support medical intervention for the profit of the pharmaceutical industry. It is wrong; and it is inherently dangerous.

8 ( +9 / -1 )

Count on America to fight everything with drugs. Whats wrong with proper nutrition and exercise?

6 ( +7 / -1 )

All male children in my neighborhood could play baseball/softball, basketball, tennis, soccer, football and either street and/or ice hockey, not to mention kick the can! Nobody was obese back in the day. It is unbelievable to me to hear some pushing surgery first before sports intervention.

5 ( +6 / -1 )

Whats wrong with proper nutrition and exercise?

That most people don’t have the time, knowledge, and/or drive to follow these.

It’s kind of like preaching abstinence to teens.

-7 ( +0 / -7 )

The poor and the uneducated eat more junk food.

0 ( +1 / -1 )

Or, reduce the amount of consumed coke, Monster, Lipton Iced Tea, etc. to almost zero and replace with H2O. And most definitely reduce the servings at restaurants, have healthier menus at American kyushoku (no burgers, NO chips).

So much there could be done to fight obesity in kids (and the population) that doesn't require drugs.

Three things are needed for a healthy life, nutrition, exercise and rest. Americans seem to mess with nutrition, for the most part.

8 ( +8 / -0 )

So when are our resident medical experts going to further chime in to support the recommendations of such hubris? I can't wait! Let's give our children drugs and surgically repair them! Brilliant! The Spartans would be turning over in their graves at the weakness of a society that makes fat and obese children.

5 ( +7 / -2 )

So when are our resident medical experts going to further chime in to support the recommendations of such hubris?

The recommendation of the well recognized experts that formulate the guidelines is more than enough, specially because you have made no argument that refute their claims not offered any data that disprove their conclusions.

Prove first that in the specific case where these measures are being recommended they offer no advantage, then you can criticize them (offering of course options of at least the same efficacy) else you are still claiming things are happening for an invalid reason without proving it first.

-10 ( +0 / -10 )

The major role of the medical or health care system increasing seems to be to promote big pharma, rather than actually trying to improve people's health. A complete overhaul is long overdue.

4 ( +6 / -2 )

Kids who reach or exceed the 120th percentile

I thought percentiles could only go from 1 to 100. Can anyone explain?

0 ( +0 / -0 )

The major role of the medical or health care system increasing seems to be to promote big pharma, rather than actually trying to improve people's health. A complete overhaul is long overdue.

This article makes clear that non pharmacological/surgical measures are the first line of treatment, but that delaying the initiation of drug/surgery based options on children that do not respond to the first line of treatment should not be delayed or the risk for the children would be much higher. What do you suggest to do instead for children for whom diet and excercise is not working? these are last resort measures.

I thought percentiles could only go from 1 to 100. Can anyone explain?

The text do not explain too much this detail but the "120" refers to 120% of the value at the 95 percentile independently of what percentile that is.

For example a boy at 10yo is considered obese when it reaches the 95 percentil at a BMI of 21.5, and severily obese when they reach 120% of that value with a BMI of 26 (which would be close to the 98 percentile). This relationship changes according to age, so the 120% of the 95 percentile at age 3 is actually closer to the 99.9 percentil.

You can check the charts in the CDC and it will be easier to understand.

https://www.cdc.gov/growthcharts/extended-bmi.htm

-5 ( +1 / -6 )

the "120" refers to 120% of the value at the 95 percentile

Thanks, virusex. That makes more sense.

-1 ( +0 / -1 )

“Obesity is not a lifestyle problem. It is not a lifestyle disease,” he said. “It predominately emerges from biological factors.”

Nonsense. If that were the case, adolescent obesity would have been a problem for centuries, not just the last couple of decades. People will blame big pharma for this, but it's the big food companies that are truly to blame. They have captured the entire system and shifted the blame so they can continue to shovel their junk down the world's throat.

6 ( +6 / -0 )

Clinical Trial Data from 201 children:

https://www.nejm.org/doi/full/10.1056/NEJMoa2208601

11% "Serious Adverse Events"

Possible Side Effects:

https://www.fda.gov/news-events/press-announcements/fda-approves-new-drug-treatment-chronic-weight-management-first-2014#:~:text=The%20most%20common%20side%20effects,%2C%20flatulence%20(gas%20buildup)%2C

"The most common side effects of Wegovy include nausea, diarrhea, vomiting, constipation, abdominal (stomach) pain, headache, fatigue, dyspepsia (indigestion), dizziness, abdominal distension, eructation (belching), hypoglycemia (low blood sugar) in patients with type 2 diabetes, flatulence (gas buildup), gastroenteritis (an intestinal infection) and gastroesophageal reflux disease (a type of digestive disorder). 

The prescribing information for Wegovy contains a boxed warning to inform healthcare professionals and patients about the potential risk of thyroid C-cell tumors. Wegovy should not be used in patients with a personal or family history of medullary thyroid carcinoma or in patients with a rare condition called Multiple Endocrine Neoplasia syndrome type 2 (MEN 2). 

Wegovy should not be used in patients with a history of severe allergic reactions to semaglutide or any of the other components of Wegovy. Patients should stop Wegovy immediately and seek medical help if a severe allergic reaction is suspected. Wegovy also contains warnings for inflammation of the pancreas (pancreatitis), gallbladder problems (including gallstones), low blood sugar, acute kidney injury, diabetic retinopathy (damage to the eye's retina), increased heart rate and suicidal behavior or thinking. Patients should discuss with their healthcare professional if they have symptoms of pancreatitis or gallstones."

Draw your own conclusion...

3 ( +3 / -0 )

Medicine instead of eating better. How about cutting out the Macs, Pizza, and the super size me, free coke refills. Ofcourse it might also help if you didn't buy everything from the freezer too. Companies have gotta make a profit, and if its on the back of your health and at the expense of the health care system. So I Guess the Bottom of the food chain is, the health care system. There really is nowhere else to go afte

3 ( +5 / -2 )

The major role of the medical or health care system increasing seems to be to promote big pharma, rather than actually trying to improve people's health.

You think lowering body fat levels is not an improvement of personal health?

-1 ( +2 / -3 )

@Wobot Easier said than done. If the brain controls a persons wants, needs and desires, there goes your though of eating less!!

How about just eating less? This seems a bit extreme...

-1 ( +2 / -3 )

Not exactly like asthma as they say, because it is a health problem with strong relationship with culture and society values, but definitely not something to be effectively dealt just by considering it a patient failure.

Just like asthma.

As per the expert in the article:

This is not different than you have asthma

0 ( +2 / -2 )

Just like asthma.

What strong relationship with culture and society values does asthma have? if you fail to make an argument for it you are implicitly agreeing that this point is not included in the analogy, and no, the expert did not say this was the case for asthma, that claim is completely yours.

-2 ( +1 / -3 )

The major role of the medical or health care system increasing seems to be to promote big pharma, rather than actually trying to improve people's health.

You think lowering body fat levels is not an improvement of personal health?

What?! Of course it is an improvement of personal health. But the medical and health care systems generally do not offer what is best for people to achieve to health goals, but rather what is more profitable (e.g., drugs, surgery...).

0 ( +2 / -2 )

What?! Of course it is an improvement of personal health. But the medical and health care systems generally do not offer what is best for people to achieve to health goals, but rather what is more profitable (e.g., drugs, surgery...).

Making as if the exceptions were the rule is not valid, this article makes it very clear that dietary and lifestyle changes are the best measure, but that some people do not respond to it, the drugs and surgery are used not to replace the best treatments, they are used after those failed to help the people.

-2 ( +1 / -3 )

Making as if the exceptions were the rule is not valid, this article makes it very clear that dietary and lifestyle changes are the best measure, but that some people do not respond to it, the drugs and surgery are used not to replace the best treatments, they are used after those failed to help the people.

They don't respond to the "best treatments" (or advice) because those offering them are incompetent or dishonest. And from what we witnessed during the past 3 years makes it clear that this is more the rule than exception...

0 ( +2 / -2 )

They don't respond to the "best treatments" (or advice) because those offering them are incompetent or dishonest.

That is just your personal belief and completely contradict the content of this article, what evidence do you have to say the AAP is incompetent or dishonest? they have a much more valid appeal to authority (and the data that support it) than what you say you have witnessed.

-1 ( +1 / -2 )

Raw BeerJan. 12  10:42 pm JST

They don't respond to the "best treatments" (or advice) because those offering them are incompetent or dishonest. And from what we witnessed during the past 3 years makes it clear that this is more the rule than exception...

How true, and there is a trail of evidence proving it.

-2 ( +1 / -3 )

How true, and there is a trail of evidence proving it.

So your argument is that the American Academy of Pediatrics is acting against evidence you can see? then how come you can't present that evidence even against the argument that it does not exist?

Dr. Ihuoma Eneli says your claim is false and that the evidence says the previous approach is not working, what evidence (since you say there is a trial of it) can you present to refute this?

-1 ( +0 / -1 )

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