Health experts push back on surgery to combat childhood obesity

Fox News contributors Dr. Marc Siegel and Dr. Nicole Saphier offered several medical solutions and mitigation strategies to reduce childhood obesity after the American Academy of Pediatrics (AAP) included surgery and medication for kids in their updated guidelines.

The AAP released new guidelines for the first time in 15 years recommending drastic medical solutions, with interventions that “could involve any approach, including screening, counseling, medically managed weight loss, pharmaceutical treatment, or surgery.”

The guidelines state in part that obesity should be evaluated and treated early, with medications for kids as young as 12 and surgery for children as young as 13.

While some critics of the AAP document focus on the recommendation of pharmaceutical medication and surgery, health experts noted that the guidelines mention the need for “nutrition, physical activity, and health behavior change.”

Siegel told Fox News Digital that the guidelines respond to an “emergency” exacerbated partly by school shutdowns and increased sedentary activities from the COVID-19 pandemic. He noted that while child obesity has increased from 5 percent in 1978 to roughly 20 percent in 2019, that number “exploded” over the last two-and-a-half years.

Saphier noted that it is more than the impact of the pandemic, pointing to cultural factors.

“There’s been a pervasive culture when it comes to talking about people being overweight. All of a sudden, physicians are being told they can’t use the terms obese and overweight; mind you, these are medical terms,” she told Fox News Digital.

Saphier said that pop culture is almost “celebrating” being overweight and obese, referencing pop star Lizzo, a proponent of the body positivity movement and frequently glamorized in magazines.

“Being bigger is unhealthy, and there are consequences to being bigger,” she added.

Saphier also said that cancel culture resulting from these magazines has led organizations like the AAP to take drastic action to combat childhood obesity, as healthcare providers are afraid to speak up for fear of being accused of “fat shaming.”

“That is not what we stand for in taking the Hippocratic oath,” she said. “That does no harm. We need to be able to stand up and call out these bad behaviors and say being overweight, being obese, that is not the message we want to share with our youth.”

Siegel said that while he appreciated the inclusion of lifestyle changes in the guidelines, he said he was bothered by the inclusion of “knee-jerk reactions” from health experts.  

“We don’t know the long-term implications of doing this to children,” he said.

Tirzepatide and Ozempic are two medications previously only given to those with type 2 diabetes and work by increasing the body’s production of insulin and decreasing the amount of glucagon.

Siegel said the drugs have been wildly successful in reducing people’s weight and mimicking bariatric surgery without needing a physical operation. Despite his adult patients’ success with the medications, he said there are no long-term studies to determine how the drugs affect children’s gut hormones and would not recommend those under 18 to take them.  

“These are brilliant drugs, and they decrease hunger, and they overcome insulin resistance, and they improve glucose metabolism in a really good way—but it’s too soon to be using them in kids,” he said.

Siegel said surgery, like medication for children, is “extremely problematic” and should only be in the most extreme cases. He added that while the guidelines did state that such measures should only be used for “severe” obesity in kids, the wording and structure of the guidelines were not clear-cut enough.

Siegel and Saphier also said child obesity could lead to life-threatening and severe consequences, including depression, hypertension, high cholesterol, and diabetes.

“You’re born with a set number of insulin receptors so if you increase your body surface area and you develop more insulin resistance, both of which occur from obesity, you dramatically increase your risk of type 2 diabetes—which increases the risk of cancer and heart disease,” Siegel said.

Saphier agreed with Siegel and said that surgery and medication could be great options for people who have continuously failed to lead a healthy lifestyle but should be the last line of defense after all other options have been exhausted. She noted that medications and surgery come with their own unique risks.

“Americans, in general, are always looking for the quick fix,” Saphier said. “We want a pill, a quick diet, anything that could give us a positive outcome with minimal effort, and unfortunately, that’s created our society”

Both health experts said they wanted to sound the alarm on the epidemic of obesity in America and that solutions need to focus primarily on families.

They urged families suffering from obesity to work with pediatricians, primary care physicians, and doctors to help cultivate their health plans, such as family walks, increasing the consumption of vegetables, biking, and quitting poor habits like smoking.

Saphier urged healthcare providers to do away with concerns about hurting someone’s feelings and instead explain to patients why it is essential to losing weight and put forth metrics to push solids plans into action. She added that there is a way for those in healthcare to champion body positivity while also spreading the message that being overweight or obese is unhealthy.

The two health experts acknowledged healthcare disparities in groups the government needs to pinpoint with programs meant to help poor Americans, but wind up hurting Black, Hispanic and non-White households more frequently found in lower tax brackets. One example he referenced was how food stamp programs like the Supplemental Nutrition Assistance Program (SNAP) include many products that are too high in carbohydrates, sugars, saturated fats, and sodium.

Saphier expressed disagreement with the current cycle, wherein government programs push unhealthy sustenance with tax dollars. Then taxpayers are expected to reap the consequences by paying for the medical care of those with ensuing chronic medical conditions resulting from obesity.

“While I don’t necessarily love increased regulation, when it comes to spending tax dollars, I think it is essential that this money is not going to unhealthy treats that will have long-term consequences,” she said.

She floated the idea of a tax incentive for those purchasing healthy foods and a higher tax on unhealthy foods that could go to a pool to pay for future chronic illnesses associated with obesity, which costs $173 billion a year.

Regarding solutions, both Siegel and Saphier said that these programs need to include meal plans, healthy options, and recipes targeting the child and the entire family.

The two health experts said that regular check-ups with an internal medicine provider, a pediatrician, and a nutritionist are essential.

Saphier and Siegel also noted that children spend most of their days at school, another realm that needs targeting.

“What you tend to see is there will be a healthy option and an unhealthy option. Well, I’m a mother of three children, and let me tell you, they want the unhealthy option. Heck, I want the unhealthy option. But, at the end of the day we need to kind of force them into making healthy choices,” Saphier said.

Siegel and Saphier added that nutrition and physical education should be mandatory aspects of school. Saphier said that students should only be offered nutritional foods without options.

Saphier also directed attention back towards the parents, whom she claimed needed to be responsible for the health decisions of young children.

“It sounds harsh, but I do think parents should be held accountable for their children becoming morbidly obese,” she said. “I think it is a form of child abuse, and we cannot tolerate it. It’s not OK and whatever that looks like.”