Reader feedback and reactions

The new guidelines for the clinical management of fat children recently released by the government and AMA has resulted in overwhelmingly negative responses from parents and the public — but silence from medical and health professionals and media.

The reactions have been incredibly strong and moving, and everyone talked about how they felt the need to have their voices heard, so I'm sharing a few representative comments here.

The parents and consumers who have responded to these guidelines shared stories that were amazingly similar, emotional and protective of children. Most remembered life as a fat child and being subjected to doctors who put them on diets and intense interventions that resulted in a lifetime of dieting and misery, and don’t want that for another generation. One wrote: “I do not want to live in a world where children will have no choice but to become bulimic in order not to have their stomachs forcibly removed from them if they don’t lose weight.” Another expressed outrage with today’s warped priorities and said that there is too much investment in children looking identically perfect, rather than appreciating the diversity in bodies and talents. One mentioned that reading is a sedentary activity and not all children are meant to be athletes or models. She remembered spending entire Saturdays reading as a child while excelling in academia.

One wrote (and gave her permission for it to be reprinted here):

I am an avid reader of your blog and often find myself in a rage about what you reveal on a daily basis. As a fat person since the age of five, I feel the stigma everyday of what has become a worldwide war on fat. I went on my first diet at the age of seven and was seeing a dietician weekly by the age of nine. I tried Weight Watchers for the first time at 11. If gastric bypass had been widely available when I was a teenager, I'm sure I would have done that, too. I'm 33 now and have given up dieting. It was killing me.

I'm writing because nothing you've written has affected me quite as much as your recent expose of the new AMA guidelines. I am the mother of a three-year-old boy [and] I am terrified about his future under these guidelines.

I am also enclosing pictures of my son, for whom I am ready to go to war. He is now considered “overweight” according to these guidelines. This is the picture of this senseless “childhood obesity epidemic.”

My parents — who are also fat — did everything “right" (no juice or soda, plenty of physical activity, limited TV, family meals) but I was still fat. Doctors at that point (in the 1970s and 80s) encouraged my parents to take me to a dietician and Weight Watchers and all the other “interventions", but it was of no use in reducing my weight. I spent more than 20 years of my life dieting, with the result being only increased weight, drastically decreased metabolism, and a lifetime of issues surrounding food.

I don't want this for my child.

She also shared a photo of herself when she was seven and first began dieting. It was of a delightful, healthy little girl, much like her little boy today. Countless women have looked back at scrapbooks from when they were young and can now see the perfectly healthy girls they were. But back then they’d been told they were unacceptably fat and had been led to believe it was because they were eating too much or the wrong food and had "issues" with food — when they ate no differently than any other child. Tragically, those little girls grow up and rarely escape from the belief that their fat is their own fault, rather than simply the way Mother Nature meant for them to be.

Most readers found the paternalism and classism of this war on fat to be shameless, with one saying: “If you listen to or read obesity warriors’ discussions they are absolutely obsessed with what poor people are “doing wrong.” They pick apart these incredibly detailed upper-class fantasies about how poor people live vs. how they “should” live and think of ways to “educate them” or - failing “education” - coerce them. She called it for what it was, saying don’t “tell me it’s just about “being healthy” and not about fat being hated in our society. You tell me that this plan which advocates medication and SURGERY for kids who don’t ... fit into an arbitrary BMI category is just about making sure kids are healthy....Tell me ... that this has nothing to do with the fat=bad equation that people have just made up to make themselves feel better because people don’t like [fat people].

As this blogger at The Rotund, wrote:

This is ridiculous. And “we must take care of the children” doesn’t justify this. The government is not our nursemaid - they don’t belong in our bedrooms, in our uteruses, in our kids’ lunchboxes determining whether or not they get to eat a carrot stick or a celery stick today. You think it’s shameful that your neighbors’ kids are fat? I don’t care! ... But you don’t get to go over there and tell them how to raise their kids because a) you don’t know HOW they are raising their kids and b) being a fat kid is not the same as being an abused kid.

One expressed not only upset at the waste of healthcare expenses on these evaluations and tests, but how they will torment children who happen to be genetically larger: “Fasting glucose tests...are blood tests, preceded by no food and minimal water for 12 hours. Be hungry, thirsty, and stuck with a needle? Let’s see how fast we can make chubby children hate going to the doctor. Children within the government’s definition of normal are also to be subjected to evaluation of their eating and exercise habits? No children, no families, are to be spared the indoctrination that fat is evil? Aren’t the five year olds who are dieting today bad enough? Shall we see if we can add more?”

And all expressed disbelief that such guidelines would be issued from medical professionals and public health officials when they are based on no science and no evidence. As I mentioned in that original post, the AMA Expert Committee said it had been working behind closed doors since before 2005 to create these guidelines along with government agencies, stakeholders and RWJF. A report on some of those meetings was posted online here. It summarized their intentions and, using wording nearly identical to those used by RWJF in its April announcement, admitted they had no evidence for anything they were doing:

· The magnitude of the obesity epidemic is too great to wait for evidence-based guidelines before increasing efforts focused on prevention and intervention.

· There should be an increased focus on what has worked in the past for other public health threats such as tobacco.

· Much more research is needed to determine what clinical and community based interventions are helpful in decreasing childhood obesity.

· The Robert Wood Johnson Foundation, the NICHQ, the CDC, the MCHB of HRSA, and the AMA provide the basis for a national network of organizations that can accelerate the necessary research and interventions related to the prevention, diagnosis and treatment of childhood obesity, so that best practices are determined and disseminated at a rate surpassing the normal diffusion of knowledge and practice into the health care community.

Readers are right. This isn’t about the practice of medicine, this is “public health” — a very different agenda. Public health has grown far beyond things such as safe community drinking water and helping to control the spread of communicable diseases, into a more socialist role that overcedes those of individuals. In fact, according to V. James Guillory, the AMA Expert Committee member who filed that report above for the American College of Preventive Medicine, and colleagues writing in a recent American Journal of Public Health: “The mandate to ensure and protect the health of the public is an inherently moral one....and it implies the possession of an element of power to carry out that mandate.”

A 1988 Institute of Medicine report defined public health as what a society does collectively to ensure conditions for people to be healthy and its report “focused specifically on ways to strengthen governmental public health infrastructure.” The Committee on Assuring the Health of the Public in the 21st Century, which had created that 1988 report, reconvened in 2002 to create a more inclusive action plan to institute the government’s Healthy People 2010. This second report, The Future of the Public’s Health, focused on greatly expanding and strengthening the power of “the governmental public health infrastructure and several potential partners in the public health system, namely, the community, the health care delivery system, employers and business, the media, and academia.

In case you’re wondering who chaired this Committee on Assuring the Health of the Public in the 21st Century, it was Jo Ivey Boufford, M.D. and Christine K. Cassel, M.D. Briefly:

Dr. Boufford was a Robert Wood Johnson Health Policy Fellow at the Institute of Medicine from 1979-1980 and was made an advisor to the Assistant Secretary of Health at the Dept. of Health and Humans Services during the Clinton Administration and then became Acting Assistant Secretary for Health. While at the HHS, she served as the U.S. representative on the Executive Board of the World Health Organization. She then became Dean of the Robert F. Wagner Graduate School of Public Service at New York University until November 2002, and sits on the National Advisory Council for the Agency for Healthcare Research and Quality. She was elected to the Institute of Medicine in 1992 and sits on its Executive Council.

Dr. Cassel was Founding Director of the Robert Wood Johnson Clinical Scholars Program, and Founding Director of the Center for Health Policy Research. She is President and CEO of the American Board of Internal Medicine and ABIM Foundation, was previously Dean of the School of Medicine and Vice President for Medical Affairs at Oregon Health & Science University in Portland, Oregon. She was a member of the Advisory Committee to the Director at the National Institutes of Health and is on the Institute of Medicine (IOM) Governing Council and has served on previous IOM committees responsible for influential reports. Dr. Cassel served on the President’s Advisory Commission on Consumer Protection and Quality in the Health Care Industry from 1997 to 1998.

This may help more consumers realize why all we hear is news to make us feel afraid and in need of greater protection; about how horrible things are and that something must be done; that our food, eating and lifestyle habits, and health are in deplorable shape; and that our children are in danger — while all of the facts paint a very different picture.

While most do, not everyone completely gets yet that there is not this massive epidemic of gargantuan children as seen on TV. Children today are actually eating better than in past decades and not nearly as bad as special interests are making their diets out to be. Most families do have dinner together. Children are healthier today than ever. Those extreme cases of 100-pound 5-year olds that the media loves to use to market a crisis on behalf of obesity interests are not typical. There have always been such extreme cases, but they are overwhelming not due to their parents feeding them incorrectly. The preponderance of clinical research has, and continues to demonstrate, that fat and thin children do not eat any differently or have any differences in their activity levels to explain the difference in their sizes.

There is no health crisis for which children need more interventions or more authorities telling them that they need to eat or behave more “healthfully"— things which are more often based on poor science (like believing children should have little or no fat, sugars, or meat products; or that if children don’t eat perfectly and get the full complement of fruits and vegetables they are doomed because people are told that kids don’t grow up and we always eat like we did as kids; or that children aren’t playing and active today because they’re all plopped in front of a screen gobbling chips and pop — as seen on TV).

There are unbelievable interests all jumping on the childhood obesity bandwagon or the campaign for “healthy” eating and lifestyles, and to profit off of fears about health and food, and the “problems” of today’s children. While some scramble to package their initiatives to make them seem different and helpful and only “out of concern for health,” they’re not. No matter how well-intentioned, they are not helping or healthful to kids in this current climate and kids don’t need more of the same.

Our kids today are being drowned by healthism, and fears about their bodies and food. They can’t just be kids.