I read an article on Medpage the other day - “Docs have Role in Preventing Childhood Obesity” - about recent recommendations by the American Academy of Pediatrics (AAP), which I found both annoying and discouraging in equal amounts.

First the annoying part: a prominent, almost certainly staged picture of two overweight children with their mouths open, watching TV, a huge spread of take-out food on the coffee table before them.  Who allows their children to be photographed like that?  And, by the way, where are the parents?

Leaving aside the flawed premise underlying the article that obesity is caused by children over-eating and under-exercising (an assumption that ignores recent scientific enquiries into epigenetic effects of environmental obesogens, including changes to the gut microbiome), I have been upset for years that “concerned physicians” have never had the courage to address the issue of childhood obesity and health with parents, who, presumably, are in charge of their children’s behavior.

Ah, but that’s the problem, they’re not.

Presumably these children didn’t use their own money to buy the food pictured in the article.  It’s also unlikely that they purchased the TV (much less paid for cable, Netflix, etc.).  And since no adult is in this picture we are left to assume that they walked away and left the children to eat alone, with only an electronic device as company.  If the photographer had pictured the adults, what would they be doing?  What would they have been eating and drinking?  Why is the AAP not focusing on adult abdication of responsibility for feeding and educating children?  Why is the AAP not asking: 'where, dammit, are the grown-ups!?'

I think I know why.  The AAP (and all other physician organizations, for that matter) cater to doctors and their livelihood.  With a problem like childhood obesity, it's far easier for a doctor to discuss “helping the child make wise snack choices” than to say to the parents, who, after all, will likely leave a practice if a doctor annoys them: 'you need to be in charge.  If you don’t want your children to eat these things, don’t buy them.  Period.  Oh, and it will be essential for you to model different food choices yourself.' They might add that modeling limited “screen time” would also be useful for parents to do...

And such modeling or education should not be left to the schools, nutritionists, or even doctors.  Schools were never intended to be in loco parentis; a school’s job is to teach us to read, write, compute, analyze, think critically and to interact socially in positive ways.

Finally, the discouraging, sad and counterproductive part about the article is its misplaced emphasis on “fat” rather than health.  We actually have little evidence for obesity being reversible with “better eating”, but lots of evidence that health is impacted by nutrition.*  

* Prevalence of malnutrition at the time of admission among patients admitted to a Canadian tertiary-care paediatric hospital. Baxter, Al-Madhaki, Zlotkin. Paediatr Child Health. 2014 Oct;19(8):413-7.