This is the Weight and Healthcare newsletter! If you like what you are reading, please consider subscribing and/or sharing! The US Preventive Services Task Force has put out their draft recommendation for higher-weight children. It is open for public comment until January 16. I’ve been fully immersed in it since the moment that I knew about it yesterday (their evidence synthesis is 381 pages long!)
The growth charts were intended as a way to monitor children's growth and the 95th percentile of the growth charts was not called "obesity"; rather it was called "overweight" and not considered as a disease but supposed to be just an indicator for a further assessment, serving as a screening level. Then without any real justification, a group formed by Bill Dietz, then at CDC, decided to change the terminology without justification. So a screening level got transformed into a "disease." I and my colleague at CDC fought hard and long against this change. The decision went way up the chain and was eventually decided at a higher level, above CDC We lost. See Moynihan R. Expanding definitions of obesity may harm children. BMJ. 2006;332(7555):1412 This is available for free.
Thank you for sharing this link and for your endless research. I have quoted and re-cited your work in my work countless times. Others are correct in acknowledging that there is a massive gap in research and knowledge amongst health care workers, physicians often being the worst suspects. Minimal and slow progress is being made, I feel, with more people speaking out.
I am happy to remark on the recommendations, as a pediatric provider, but cannot do it as eloquently and thoroughly as you have. My thought process is always to counter the argument in a framework of eating disorders. Why is there not equal assessment and intervention of those bajillions (my very scientific number) of American children and teens with very disordered eating. I have never in my 20 years of parenting had a pediatrician assess my children for an eating disorder. Do eating disorders cost society millions of health care dollars? They do. Treating my daughter's anorexia has cost now greater than $300,000. She is mostly recovered, still with weekly help, due in part to people like you who persist in fighting for prevention of further damage, equal health care and societal change.
Agree with this 100% as a fellow pediatric clinician (although I work in nutrition support primarily). Just wanted to add to your comment that ED treatment is not accessible for so many people. So that raises the overall healthcare costs even further, considering that untreated eating disorders are very likely to contribute to a lifetime of health problems including depression, metabolic disorders, etc etc.
I find this particularly troubling given the ages involved. Were the expected weight changes due to growing and/or entering puberty taken into account? Plus, it is particularly scary how interventions such as these could impact brain and/or emotional development.
How discouraging to see such a report distributed without adequate research of quality studies (not financed, in part or in whole, by the diet industry), without adequate longer-term follow-up of diet subjects, and apparently without adequate study of the changes -- environmental, sociological, economic, psychological, and such -- that have taken place since the drafters' imagined Golden Age (aka HAPPY DAYS) when they believe no child was fat. This will join my file of your reports that goes along with me to my medical appointments with my physician who, after 3 years, still has no clue about me (eg, she's "heard" of DES but doesn't know much about it beyond possible infertility).
I was diagnosed with PCOS just before I turned 20 and ADHD finally just before I turned 50. Both of these conditions I believe have had significant roles in how I have gained weight over the years, starting when I hit puberty and especially in high school. Being put on a diet by a doctor at that age would not have helped, and likely would have screwed me up even more. I always gained the most at times of stress and what would have been more stressful than "letting down" a medical professional?
Can you clarify - does the part between the stars, below, mean that even though the children lost weight that there were small or no impact on actual measures of health??
“In the short term, weight management interventions led to lower weight in children and adolescents with [moderate] effects [for behavioral interventions] with no evidence of serious harm and *small to no impact on health, behavioral, or intermediate cardiometabolic outcomes*”
Correct - I read the report and they concluded that weight loss did not meaningfully impact future health markers. Also, as Regan pointed out, the lack of longitudinal follow up beyond 13 months means that we have no data on long term health outcomes of these weight loss interventions. And yet, the USPSTF still recommended weight loss 😒
The growth charts were intended as a way to monitor children's growth and the 95th percentile of the growth charts was not called "obesity"; rather it was called "overweight" and not considered as a disease but supposed to be just an indicator for a further assessment, serving as a screening level. Then without any real justification, a group formed by Bill Dietz, then at CDC, decided to change the terminology without justification. So a screening level got transformed into a "disease." I and my colleague at CDC fought hard and long against this change. The decision went way up the chain and was eventually decided at a higher level, above CDC We lost. See Moynihan R. Expanding definitions of obesity may harm children. BMJ. 2006;332(7555):1412 This is available for free.
Thank you so much for this context Katherine, and for your work pushing back against this. I'll include it in my follow-up piece.
Thank you for sharing this link and for your endless research. I have quoted and re-cited your work in my work countless times. Others are correct in acknowledging that there is a massive gap in research and knowledge amongst health care workers, physicians often being the worst suspects. Minimal and slow progress is being made, I feel, with more people speaking out.
I am happy to remark on the recommendations, as a pediatric provider, but cannot do it as eloquently and thoroughly as you have. My thought process is always to counter the argument in a framework of eating disorders. Why is there not equal assessment and intervention of those bajillions (my very scientific number) of American children and teens with very disordered eating. I have never in my 20 years of parenting had a pediatrician assess my children for an eating disorder. Do eating disorders cost society millions of health care dollars? They do. Treating my daughter's anorexia has cost now greater than $300,000. She is mostly recovered, still with weekly help, due in part to people like you who persist in fighting for prevention of further damage, equal health care and societal change.
Agree with this 100% as a fellow pediatric clinician (although I work in nutrition support primarily). Just wanted to add to your comment that ED treatment is not accessible for so many people. So that raises the overall healthcare costs even further, considering that untreated eating disorders are very likely to contribute to a lifetime of health problems including depression, metabolic disorders, etc etc.
I find this particularly troubling given the ages involved. Were the expected weight changes due to growing and/or entering puberty taken into account? Plus, it is particularly scary how interventions such as these could impact brain and/or emotional development.
Thanks for an informative well-presented post.
How discouraging to see such a report distributed without adequate research of quality studies (not financed, in part or in whole, by the diet industry), without adequate longer-term follow-up of diet subjects, and apparently without adequate study of the changes -- environmental, sociological, economic, psychological, and such -- that have taken place since the drafters' imagined Golden Age (aka HAPPY DAYS) when they believe no child was fat. This will join my file of your reports that goes along with me to my medical appointments with my physician who, after 3 years, still has no clue about me (eg, she's "heard" of DES but doesn't know much about it beyond possible infertility).
I was diagnosed with PCOS just before I turned 20 and ADHD finally just before I turned 50. Both of these conditions I believe have had significant roles in how I have gained weight over the years, starting when I hit puberty and especially in high school. Being put on a diet by a doctor at that age would not have helped, and likely would have screwed me up even more. I always gained the most at times of stress and what would have been more stressful than "letting down" a medical professional?
Thank you for sharing this information.
Can you clarify - does the part between the stars, below, mean that even though the children lost weight that there were small or no impact on actual measures of health??
“In the short term, weight management interventions led to lower weight in children and adolescents with [moderate] effects [for behavioral interventions] with no evidence of serious harm and *small to no impact on health, behavioral, or intermediate cardiometabolic outcomes*”
Correct - I read the report and they concluded that weight loss did not meaningfully impact future health markers. Also, as Regan pointed out, the lack of longitudinal follow up beyond 13 months means that we have no data on long term health outcomes of these weight loss interventions. And yet, the USPSTF still recommended weight loss 😒