Treating Kids With Obesity Drugs and Bariatric Surgery

Last week, The American Academy on Pediatrics released its treatment guidelines for overweight and obese children. Rather than attacking the dietary guidelines, which prescribe a perfect diet for getting fat, addressing the absence of physical activity in schools, or the lack of sleep kids get nowadays, they came to the insane conclusion that doctors should consider prescribing weight loss drugs or bariatric surgery as part of a treatment plan.

I guess I shouldn’t be surprised, since conventional medicine has gone along with the idea that kids of the same age should be considered for puberty blockers or sex change surgery if they want it. 

The idea of starting kids on drug therapy or putting them through surgery for a condition that can be resolved through diet and exercise, to me, seems barbaric. Especially since the US Dietary Guidelines, school lunch programs, food subsidies, the absence of physical education in schools, and a lack of adequate sleep are what contribute to obesity in almost all cases. 

Overcomplicating Childhood Obesity

According to the most recent CDC data, 14.4 million children and adolescents are currently overweight or obese in America today. Based on epidemiological models, by 2050, 57% of today’s children will be obese adults.

We’re well on our way to living the life depicted in Wall-E:

As advanced and educated of a nation as we are, we way overcomplicate most of the problems we face as a nation. Maybe it’s so more money can be made from such problems. Or, perhaps it’s because we have to accept all possible, even ridiculous, and unsubstantiated ideas in the name of inclusivity.

That’s certainly the case when it comes to obesity and the AAP’s new practice guidelines.

This is evidenced by the first paragraph in the introduction to their practice guidelines:

The current and long-term health of 14.4 million children and adolescents is affected by obesity, making it one of the most common pediatric chronic diseases. Long stigmatized as a reversible consequence of personal choices, obesity has complex genetic, physiologic, socioeconomic, and environmental contributors. As the environment has become increasingly obesogenic, access to evidence-based treatment has become even more crucial.

Clinical Practice Guideline for the Evaluation and Treatment of Children and Adolescents With Obesity

It would be easy to miss the significance of these three sentences. We should not do that. They shape the worldview of the association instructing doctors on how to treat children. 

They’re saying:

  • We shouldn’t see obesity as reversible through one’s personal choices – people need others to intervene for them
  • Obesity is complex … well beyond the effects of diet and lifestyle choices (in a very small percentage of cases this is true)
  • Because the environment contributes so much to obesity, it’s crucial to provide obesity treatment. According to the guidelines, that treatment doesn’t begin in a gym with a physical education teacher or personal trainer, but instead with a medical doctor.

Confucius famously said,

Life is really simple, but we insist on making it complicated.

Confucius

The more complicated you make a problem, the less likely it is that you’ll solve it. Then again, the more you can convince people of the complexity, the more likely it is that you’ll be able to sell them new and expensive solutions. If you can get them to believe that only one professional has access to those new and expensive solutions, you’ll be able to charge a premium and eliminate competition from others. 

If people believe that obesity requires the same level of medical care as cancer or a broken neck, they’ll become dependent upon the medical system to take care of them. 

While the American medical system is a great place to go for trauma, it’s one of the last places you want to go for achieving or maintaining health. The United States ranks last among all industrialized nations in terms of keeping people healthy, even though we spend more than any other nation on “caring” for people.

The ultimate measure of whether a country’s health care system is functioning at a high level is reflected in whether people on average are able to lead long, healthy and productive lives. In this regard, the U.S. is a dismal failure for many people.

Michael Carome, M.D.

Drugs, Surgery, and Children

The AAP’s guidelines include recommendations for use of the following drugs:

  • Metformin: A commonly-used drug for managing type II diabetes. Side effects include “bloating, nausea, flatulence, and diarrhea” and lactic acidosis. Metformin controls blood sugar and insulin. So does not eating high-carb foods. Of course, there’s no mention of natural options like berberine, either, which has been shown in some studies to be equally effective and much safer.
  • Orlistat: A drug that blocks the absorption of dietary fat, including essential fatty acids essential for brain health and other metabolic functions. What could go wrong with that?
  • Glucagon-like peptide-1 receptor agonists: These drugs act on the nervous system to slow the transit time of food and reduce hunger. Animal research shows they could contribute to pancreatitis, thyroid cancer, and pancreatic cancer, which probably wouldn’t be a concern for someone who starts using them in their 70’s or 80’s, but what about kids in their teens with decades for those cancers to develop?1Filippatos TD, Panagiotopoulou TV, Elisaf MS. Adverse Effects of GLP-1 Receptor Agonists. Rev Diabet Stud. 2014 Fall-Winter;11(3-4):202-30. doi: 10.1900/RDS.2014.11.202. Epub 2015 Feb 10. PMID: 26177483; PMCID: PMC5397288. They are also known to cause acute kidney injury, nausea, injection site reactions, headaches, and nasopharyngitis.
  • Melanocortin 4 receptor (MC4R) agonists: This drug is prescribed for people with a genetic anomaly with the MC4 receptor, which affects body weight and energy metabolism. The list of potential side effects is so long that I won’t list them in this post, but you can find them here.2Kievit P, Halem H, Marks DL, Dong JZ, Glavas MM, Sinnayah P, Pranger L, Cowley MA, Grove KL, Culler MD. Chronic treatment with a melanocortin-4 receptor agonist causes weight loss, reduces insulin resistance, and improves cardiovascular function in diet-induced obese rhesus macaques. Diabetes. 2013 Feb;62(2):490-7. doi: 10.2337/db12-0598. Epub 2012 Oct 9. PMID: 23048186; PMCID: PMC3554387.
  • Phentermine: Phentermine is a chemical similar to amphetamine. It’s a nervous system stimulant that reduces appetite. Of course, it carries risks of numerous side effects like chest pain, irregular heartbeat, weakness, trembling, and difficulty breathing.
  • Topiramate: Often used in combination with phentermine, this drug curbs appetite. It includes many side effects already mentioned and adds new ones such as blurred vision, confusion, drowsiness, menstrual changes in females, speech or language problems, and painful urination.

Again, there is no mention of nutritional supplements or specific dietary protocols in the document whatsoever. Just as in adults, putting an obese child on a strict ketogenic diet, or even an ad libitum high-protein diet would likely result in weight loss results as good, if not better than the medications above, without the side effects.

Let’s not forget about the possibility of gastric bypass surgery, which includes risks such as blood clots, difficulty breathing, malnutrition, ulcers, and bowel obstructions. I would hope that any parent who’d consider having their child go through such surgery has first overhauled their refrigerators and cupboards with healthy food for the whole family, made exercise a part of the family’s lifestyle, and made it routine that everyone gets to bed early enough to get adequate sleep, which will likely make the bodies and minds of the whole family healthier.

Eat, sleep, move

Getting back to simplicity, three factors affect weight regulation more than any others. Three! They are:

  1. Food choices: Total calories and the balance or imbalance of carbs, fat, and protein. High-protein diets consistently improve people’s body composition (kids included), and yet, there wasn’t one mention in the entire document about increasing dietary protein.
  2. Physical activity level: Sedentary kids who use and build less muscle are more prone to weight gain and its associated health problems. To not include specific guidance to get overweight or obese kids into a strength and conditioning program seems absurd.
  3. Sleep quantity and quality: Inadequate sleep wreaks havoc on one’s metabolism and children may be at greater risk due to their need for 9-11 hours of sleep, depending on their age.

Whatever negatively impacts these three factors should be the top priority of healthcare practitioners and public health policymakers.

Think about it. What affects food choices?

  • Our poorly constructed dietary guidelines
  • Propaganda pushing people away from protein and nutrient-rich animal foods
  • Junk food packaging that targets kids like breakfast cereals, sweets, and frozen foods
  • Fast food advertising and the bribes included in Happy Meals
  • Greater financial support for processed food ingredients like corn and wheat which makes carb-rich foods way cheaper than animal-based foods

Or, consider the lack of activity or sleep debt. There’s a long list of contributors to those factors too.

My point is that our culture—the government, mainstream media, schools, and the medical system have done little to change the influences that have led us to the point that being at a healthy weight is the exception, not the rule. I don’t expect they ever will. There’s too much money to be made by making our population sick and overweight and then treating them for those diseases.

Kids need 9-11 hours of sleep. Every night.

They need to move and exercise their developing bodies, not just to burn calories, but to develop their nervous and muscular systems.

And they need nutritious, protein and micronutrient-rich food, not processed junk. 

All kids need this, not just those that are overweight or obese. In fact, the heavier kids might have an advantage as they and their families can see something is wrong with their current diet and lifestyle.

I was a fat kid, too, and even though I didn’t appreciate getting teased, the teasing made me more aware of the fact that I needed to make better choices. The kids that lack sleep, don’t exercise, and eat low-quality food, but aren’t overweight are at a distinct disadvantage as they appear to be healthy, but we don’t know the effects those choices will have on their brains and bodies.

Parents can start by setting an example as there’s a clear association between overweight parents and overweight kids.

Eat. Sleep. Move. 

And don’t do drugs, especially if your doctor thinks it’s the easy solution to lose weight.

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