Health care’s 3 epic childhood obesity failures

I don’t know about you, but I’m tired of spouting the same old worsening childhood obesity statistics, applying the same dilute and sometimes broken strategy, not getting anywhere, judging myself as a doctor, then shifting the blame to my patient and their parents, then feeling powerless and defeated.

Lather. Rinse. Repeat.

It’s a cycle we’re stuck in, and it’s not serving anyone, especially our patients.

I’m not going to go over the impact that’s happened and reflect on the efforts that are improving health in communities. I will say, as a pediatrician who left my practice to start my non-profit, Teach a Kid to Fish, in 2008, with the vision of “creating community solutions for children’s health,” there are many challenges to making change happen on a community level; politics and lack of sustainable community funding and resources being two of the biggest obstacles. I know this is true in every community.

I’m also not bashing visionary physicians who have done amazing things for children’s health. We have had many wins and successes and have driven a major impact on improving children’s health in our practices, health systems, and communities. Efforts are, at best, piecemeal and transient and dependent on the visionary physician champion’s ability to navigate community politics and rely on our free labor.

Most physicians work within the constraints of health care’s fee-for-service models and have many legitimate obstacles like time, lack of reimbursement, lack of training, and patients who have so many other struggles with mental health, emotional health, and social determinants of health that take priority.

Physicians are not here to fix and solve the epidemic of childhood obesity. We do not cause or control all things.

The reality is we are not stuck. The reality is we can do better. The reality is we have to.

The reality is, until we blow the whistle, admit we’ve (health care) gotten a lot of this wrong, and accept failure as learning, we’re not getting anywhere.

First, it’s going to be important to reflect on what hasn’t worked over the last few decades and why we can’t seem to get anywhere, especially when the data shows the increasing prevalence of severe obesity in teens and rising health disparities during the COVID-19 pandemic.

Think of it as a massive maintenance of certification project, a decades-long PDSA cycle that those of us who have been committed to deserve to be grandfathered into ABP MOC for eternity, please.

Here are health care’s three epic childhood obesity failures (listed in order of importance):

1. Parents are not supported to help children and teens make healthy lifestyle changes within the environments they live, learn, and play. Parents are directed with simple bullet point recommendations about what to do and are expected to magically make it happen. We live in an ultra-processed food system environment that has made us sick. Our culture’s answer has been restrictive weight-obsessed diet culture which has made us sicker and driven eating disorders.

Parents are expected to parent against the current of all the unhealthy and overwhelming forces, like dopamine zing sugary foods, screen time and its tendency to create process addictions, digital neuro-marketing tactics that create over-desire for processed foods, not to mention the harms of social media, cyberbullying and IG fake wellness perfection (yes, the Kardashians are ramping up their thin is in efforts as we speak) which embeds negative body image in our teens at every turn.

Parents need and deserve more support to help their children and teens with creating healthy habits and self-confidence. I coach parents and teens. Without the support they need, parents, even with good intentions, get into fear-based fix and solve mode, perpetuate restrictive diet culture in the home, and trigger eating disorders.

Fewer bullet points and compliance. Be more compassionate, stay the course, work through obstacles, and connect for the win.

2. Despite its lack of effectiveness and potential harms, health care has taken on diet culture’s calories in/calories out (the Energy Imbalance Model of Obesity) fixed and limited beliefs, and we can’t seem to let it go. Just look at the data that’s out now about the increasing prevalence of obesity, even severe obesity in children and teens during the pandemic. So, what do we do? We double down on what hasn’t worked and keep prescribing total calorie restrictions. More weight loss medications for teens are being approved by the FDA, and more teens are being funneled to the bariatric pathway. I’m not against prescribing weight loss medications or adolescent bariatric surgery. Both can be very helpful tools, especially to reverse comorbidities. Strategies to measure and improve outcomes in the initial stages of treatment are needed.

Public health’s Eat Less Move More messaging is a drop in the cesspool of the ultra-processed food industry’s environmental cues and its highly successful Food Addiction Business Model’s digital neuro-marketing tactics targeting children and teens.

It doesn’t have to be this way!

America has an epidemic of insulin resistance and metabolic effects such as pre-diabetes, Type 2 diabetes, non-alcoholic fatty liver disease, hypertension, high cholesterol, early heart disease, metabolic syndrome, and PCOS, just to name a few. Reversing insulin resistance requires a metabolic health approach where all calories are not seen as equal, and obesity is hormonal, complex, and not just simply caloric.

3. Our approach, specifically fixation on weight and BMI, has created stigma, weight blame, and shame for children and teens. Believe me on this one. I’m a TikTok doc, and BMI’s misuse has caused so much harm. There is story after story, laid out in viral TikTok videos, sharing patient experiences of doctors using BMI to weight-blame and shame, even children and adolescents. See my daughter’s and my KevinMD article: “Medical gaslighting due to weight stigma, and bias is harmful: A viral TikTok study.”

Our obsession with weight and BMI and not focusing on health has stigmatized our patients and created shame triggers for them whenever the topic is brought up or when going to weight management programs. Studies show high attrition rates for pediatric weight management programs.

Teens and their parents are reluctant to reach out for help because the topic is laden with stigma and shame. We offer compliance, telling patients what to do, and then provide a dose of blame when nothing works and feel defeated and disappointed in our patients and round it all out by chalking it up to parental apathy.

It doesn’t have to be this way.

It’s possible to create a community with a compassionate connection through listening, giving the power to choose and de-stigmatize by taking weight out of it.

After working on the childhood obesity epidemic for nearly twenty years, I’m ready to help teens, parents, and doctors create a completely radical self-love superpower approach to reaching health and life goals.

Let’s turn our three epic fails into an epic trifecta of wins for our patients.

Karla Lester is a pediatrician, certified life and weight coach, and diplomate, American Board of Obesity Medicine. She is founder, IME Community, and can be reached on Twitter @DrKarlaA, TikTok, Instagram @ime_community, Facebook, and YouTube.

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