HJNO Jul/Aug 2023

28 JUL / AUG 2023 I  HEALTHCARE JOURNAL OF NEW ORLEANS   Thank you for taking the time to discuss pediatric obesity, Dr. Staiano. What got you interested in researching this topic? My passion for pediatric obesity began in my own community — growing up in Baton Rouge and attending LSU for college, I had the opportunity to be an intern at LSU’s Pen- nington Biomedical Research Center, which is a premier center for scientific research on obesity, nutrition, and related metabolic dis- eases. This was before pediatric obesity was widely recognized in the press and across the government as a leading public health crisis, but I quickly learned of the rising sta- tistics in prevalence and the worrying health outcomes our children and adolescents were experiencing with early diagnosis of heart disease, diabetes, etc. It also became clear that obesity is highly stigmatized and many individuals with obesity experience significant bias and discrimination, often contributing to poor quality of life, anxiety, and depression. I pursued a PhD in psychol- ogy and a Master of Public Policy at George- town University because I wanted to make a sustained impact on reducing obesity and increasing treatment options for children and families. Serving on the national com- mittee for these new AAP clinical practice guidelines has been one of the most mean- ingful experiences in my career, as they will make a real difference in making treatment options more accessible to our youth. Before we jump into our discussion, I’d like to echo the importance of prevention as the journal editor indicates. TheAAP has a number of existing policy statements that address prevention at a variety of levels, and they’re updating the obesity preven- tion guidance for release this year as they do routinely with all statements. As citizens, civic leaders, healthcare practitioners, and parents, it is critical to support ongoing prevention efforts to work alongside the food industry, urban planners, and elected officials to revamp our food and activity environment. But meanwhile, there are over 14 million children and adolescents in the U.S. who already have obesity, and they need access to evidence-based treatment options. This is what this specific AAP clinical practice guidelines addresses — when healthcare providers have a patient with overweight or obesity, these are the recommendations grounded in science for evaluation, medi- cal monitoring, and treatment to give those children the best path toward better health. Why do you think we are having an obesity problem today in America? We know it is not a pandemic, because it is not happening worldwide. What are we doing in America that is causing this mostly preventable disease in our youth? Obesity is increasing worldwide, includ- ing in developed nations and in low- and middle-income countries. The U.S. is at the top of the rankings. If you look at our surroundings, it’s obvious that our envi- ronments are obesogenic — meaning, our physical environments are structured in ways that promote gaining weight and not conducive to losing weight or maintain- ing a healthy weight. Think about the most readily available foods that surround us, the fast food and quick serve outlets, and the food deserts that lack grocery stores serv- ing fresh produce and lean protein. Consider the limited walking paths and the few safe and accessible physical activity outlets we have, or how dependent we are on personal vehicles for getting from point A to point B. Studies have shown that second and third generation immigrants living in the U.S. have higher likelihood of obesity compared to new immigrants — this is indicative of the environmental contributions to this disease. Right now, most children and adolescents with obesity do not have access to evidence- based treatment options to help them to lose weight or slow down their weight gain. This is what theAAP clinical practice guide- lines and other scientific and advocacy work is trying to fix. We also recognize that obesity has com- plex and multifactorial contributors — genetics contributes to at least half of the predisposition to obesity, but the environ- ment and behaviors also contribute to a sig- nificant portion of obesity. Unfortunately, obesity is highly stigmatized — people with cancer are called victims whereas people In the Mar/Apr issue, our letter from the Editor was critical of the American Academy of Pediatrics for its recent childhood obesity recommendations of medication and surgery intervention without discussing prevention. In the search to understand more about this alarming epidemic in our youth, Kenny Cole, MD, who usually pens this section, suggested we pull in Amanda E. Staiano, PhD, associate professor and director of Pediatric Obesity and Health Behavior at Pennington Biomedical Research Center. Staiano served on the recent AAP’s Clinical Practice Guidelines Committee on child obesity treatment.