HJNO Jul/Aug 2023

HEALTHCARE JOURNAL OF NEW ORLEANS I  JUL / AUG 2023 35 But many adolescents, especially those at levels of severe obesity who are experienc- ing significant comorbidities, are in health peril — we’ve seen kids who develop dia- betes at age 13, have a heart attack at the age of 18, are immobile from the damage the excess weight has put on their joints, skeleton, muscles, organs. These may seem like extreme examples, but this is becoming more and more common. And even among the less extreme cases, the medication and surgery produce much larger weight loss and health improvements that are sustained over time. But again, these medications and surgeries are not monotherapies and are accompanied by behavioral counseling. It’s not an “either/or” or a “pick one” — this is a toolbox of options where IHBLT remains critical for all patients with obesity. Regarding the implementation of the practice guidelines, does the AAP have a plan to capture how many pediatricians and pediatric healthcare providers are following the new guidelines and implementing them into their practice? There are several groups across the country looking at this right now —more to come! Implementation science has shown it takes an average of 17 years before 14% of research findings are translated into prac- tice, but with the extensive implementation resources and provider training offerings made available by the AAP, and the urgent need to deliver care to the 14 million chil- dren already affected by obesity, we all hope this time to scale is far quicker. Our school systems provide one- to two-thirds of the meals for most children in America. Mandating them to only provide healthy, nutritional, unprocessed, whole meals seems like a simple, easy governmental fix that will save taxpayers a lot of money in the long-term. What are your thoughts on this as an effective solution? Yes, school nutrition programs do have regulations to follow regarding what foods they provide and serve in the cafeteria. There have been tremendous improve- ments to the national school breakfast and lunch programs and the snacks/beverages available in vending machines or otherwise sold at schools. However, these changes have not, to my knowledge, been shown to have a measurable impact on reducing child obesity. An observation that has been shown several times in cohorts across the country is that excess weight tends to occur during the summer months and other out- of-school times. A leading hypothesis called the “structured days” hypothesis is that the routine of school provides healthy, nutri- tious foods in appropriate portion size plus a regular wake/sleep schedule and oppor- tunities for physical activity, whereas chil- dren’s behaviors, accessible food, and envi- ronments are less healthy when they are not in school. So, while we should continue investing time and resources into improving the school environment, there is quite a lot to be done at home and in our communi- ties year-round. Is there an effort by the AAP to have discussions with food distributors like Walmart or fast-food options like McDonalds or Burger King? It feels like these three companies, because of their footprint and market share, could almost single-handedly make Americans healthier by only providing healthy options – make it part of a nationwide feel better campaign. Do you think that is a pipe dream? The food industry has self-regulated over the years and made some healthy changes to menus, and the federal government has also required changes such as posting nutrition labels of foods and calorie counts on menus. Some state governments and municipalities have reduced sugary bev- erage portion size and removed toys from children’s meals. There is much more to be done in this space, and these changes should continue to be a point of advocacy and partnership with the food industry. But it is only one of many contributors to the complex disease of obesity. Do you have any final thoughts on childhood obesity? It is an exciting time to see effective treat- ment options become available for families. I’m proud to dedicate my career to contrib- uting to the scientific evidence for obesity treatment and working with the healthcare sector, families, government officials, and other stakeholders to ensure every family has access to safe, evidence-based, sustain- able treatment for childhood obesity. Thank you for your time. n “Weight is an important marker of health and underlies several other serious and often life-threatening or life-shortening diseases. Weight and health go hand in hand.”